D-Dimer associated with severity, a pooled analysis

Quality of evidence: C+

Authors: Lippi et al.

Journal: Thrombosis and Haemostasis

Objectives: Assess the association between increased D-dimers and the severity of COVID-19

Strength of evidence: C+ (metanalysis, only 5 studies, low homogeneity)

Methods/publication type:

Meta-analysis
Litterature from 2019 to March 4, 2020
Medline/PubMed interface, Scopus and Web of Science
Search for "laboratory” “COVID-19” “coronavirus 2019” “2019-nCoV” or “SARS-CoV-2
5 studies included

Highlights :

In 3 studies (Huang et al., 41 patients, Tuang et al., 183 patients and Wang et al., 138 patients) : D-dimers levels were respectively about 5, 3.5 and 2.5 times higher in people with serious illness versus less severe cases (median: 2.4 vs 0.5 mg/L, p = 0.004; 2.12 vs 0.61 mg/L, p <0.001 ; 4.14 vs 1.66 mg / L, p <0.001)
In Zhou et al (191 patients): D-dimers about 9 times higher in people who died vs survivors (median: 5.2 vs 0.6 mg/L, p <0.001)
Standardized mean difference between severe and less severe cases, in these 4 studies = 2.97 [2.47 - 3.46]
In Ghan et al (1,099 patients): the risk of increased D-dimers (>0.5 mg/L) is more frequent in patients with a serious illness versus less severe cases (59.6%195 vs 43.2%, p = .002)
D-Dimer levels associated with severity
Antithrombotic therapy might be useful for limiting severity, trials warranted