D-Dimer: A Primer Biomarker in COVID-19

Aim and Objective: To explore risk factors associated with mortality in COVID-19 patients and assess the use of D-dimer as a first line biomarker for disease severity and clinical outcome.

Materials and Methods: We retrospectively analysed the pathological and radiological characteristics of 2087 consecutive cases of COVID-19 in PSH, Vadodara, Gujarat, from March 2021 to July 2022. Graphically, MS-Excel with median values were used. Correlations of D-dimer upon admission with disease severity and in-hospital mortality were analysed accordingly. Data were collected in MS-Excel with median values.

Results: 2087 patients having positive RT-PCR and confirm diagnosis of Covid-19 were included upon hospital admission. Whereas, 65.78% (n= 1373) were male and 34.21% (n= 714) were female. Mean age was 52± 4 year. D-dimer level > 250 ng/mL at the time of hospital admission was the only fluctuating value accompanying with increased mortality [(95% CI), P = 0.025]. D-dimer elevation (≥250 ng/mL) was seen in 81.31% patients. Pericardial effusion and Deep vein thrombosis were ruled out in probability of thrombosis based on 2-D echo, X-ray chest and USG. This recommend that hyper-coagulopathy of the fibrin plays a significant role in the occurrence of thromboembolic complications with COVID-19 patients. D-dimer levels was crucially escalated with increasing severity of COVID-19 as determined by clinical improvement (within 5 days of hospital stay) and chest CT staging (CO-RADS score out of 25, P = 0.000). 319 patient were died during above said period and overall in-hospital mortality rate was 15.28%. Additionally, 6.08 % (n=127) patient were on BIPEP and all are died with 100% death ratio. Median D-dimer level in non-survivors (15.29%) was significantly higher than in survivors (84.71%, n = 1768, RR 24.69%). Median elevated D-dimer level was 600.5 ng/ml. Furthermore, the disease activity were higher in the overhead D-dimer level group demonstrated to have anticipating value in differentiating disease severity along with high ESR level and hs-CRP and the fibrinogen level was also upraised indicated seriousness of disease.

Conclusion: We concluded that D-dimer level was routinely uplifted in patients with COVID-19 disease. D-dimer levels match up with severity of the disease and are a significant definitive prognostic first line marker for in-hospital mortality for COVID-19 disease. Furthermore, a significant association between the high D-dimer level and severity of COVID-19 disease was noted among comorbid patients. Additionally, raced D-dimer level demonstrated with high ESR level and hs-CRP and the fibrinogen level indicated seriousness of disease in comorbid patients.