D-Dimer as a Predictive Biomarker of Severity and Mortality in COVID-19 Patients

Background: Since December 2019, Coronavirus has been spreading widely becoming a fatal global pandemic. We need to understand the pathophysiological mechanisms of the disease in order to determine early and effective predictive biomarkers for severity and mortality, therefore finding better treatment approaches. Object: We aim to investigate the predictive value of d-dimer in COVID-19 in order to determine the severity, mortality and the risk of developing thrombotic events. Methods: We enrolled patients with confirmed COVID-19 who referred to the COVID department at Tishreen University Hospital (Latakia, Syria) from May 2020 to March 2021. We retrospectively documented demographic characteristics, clinical data, laboratory parameters and chest computed tomography staging. We followed up the patients' clinical progress during hospitalization, as well as their need for supportive oxygen (invasive and non-invasive mechanical ventilation) and the occurrence of thrombotic complications during hospitalization. Finally, we listed the cases of recovery and death. Results: We included 284 patients (68.3% males and 31.7% females). The mean age was 65 years, ranging from 27 to 92. D-dimer was only obtained for 193 patients, which included 28 mild to moderate, 115 severe and 50 critically ill patients. D-dimer was elevated (≥ 500 ng/mL) in 110 patients. On admission, D-dimer level was associated with an increased clinical severity. It was higher in critically ill compared to moderate cases ([3397.5±3296.7]ng/mL vs [1066.1± 1963.2] ng/ml, P = 0.0001) as well as for radiographic severity ([626.5±1047.1] ng/mL vs [2262.6± 2751.2] ng/ml, P= 0.007), respectively. All of those who did not survive had increased D-dimer level upon admission. When compared between patients who survived and who died during hospitalization, a significantly higher D-dimer level was detected in non-survivors versus survivors ([3099.9±2808.2] ng/mL vs [1308.9± 2249.3] ng/ml, P= 0.0001). ...........