D-dimer and Covid-19 Disease Progression: An Evidence Based Research on Time-to-event Outcomes and Diagnostic Test Accuracy

ABSTRACT

Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19. We aimed to quantify the associations of Ddimer with disease progression in patients with COVID-19. This systematic review and meta-analysis was registered with PRO SPERO, CRD42020186661. We included 113 studies in our systematic review, of which 100 records (n = 38,31 0) with D-dimer data) were considered for meta-analysis. Across 68 unadjusted (n = 26,960) and 39 adjusted studies (n = 15,653) reporting initial D-dimer, a significant association was found in patients with higher D-dimer for the risk of overall disease progression (unadjusted odds ratio (uOR) 3.15;adjusted odds ratio (aOR) 1.64). The time-to-event outcomes were pooled across 19 unadjusted (n = 9743) and 21 adjusted studies (n = 13,287);a strong association was found in patients with higher D-dimers for the risk of overall disease progression (unadjusted hazard ratio (uHR) 1.41;adjusted hazard ratio ( aHR) 1.1 0). The prognostic use of higher D-dimer was found to be promising for predicting overall disease progression (studies 68, area under curve 0.75) in COVID-19. Our study showed that higher D-dimer levels provide prognostic information useful for clinicians to early assess COVID-19 patients at risk for disease progression and mortality outcomes. This study, recommends rapid assessment of Ddimer for predicting adverse outcomes in COVID-19.