Increased D-dimer is associated with disease progression and increased mortality in Turkish COVID-19 patients

Yıl 2023, , 175 - 181, 31.05.2023

Zeynep Mercancı Can Ilgın Sehnaz Olgun Yıldızelı Derya Kocakaya Baran Balcan Buket Erturk Sengel Sait Karakurt Emel Eryuksel

https://doi.org/10.5472/marumj.1302440

Öz

Objective: Coagulopathy is thought to play an important role in the development of severe COVID-19. High D-dimer levels have been
reported in Chinese cohort studies. However, ethnicity has significant implications for thrombotic risk. Our aim in this study is to
determine the effect of D-dimer measurements on disease prognosis and mortality in Turkish patients with COVID-19.
Patients and Methods: The study was designed retrospectively. Patients over the age of 18 who were admitted to our hospital were
included in the study.
Results: The study included 226 patients. According to the World Health Organization staging, 75(33.2%) patients, according to the
staging of Siddiqi et al., 67 (29.7%) patients progressed. In the ROC analysis performed to predict mortality, AUC value for D-dimer
was found to be 82.25% (95%CI 74.8%-89.71%). When the cut-off value for D-dimer was accepted as ≥3.25mg/L, specificity was
94.15%, correctly classified rate 88.5%, positive likelihood ratio as (LR):5.69, negative LR:0.71.
Conclusion: As a result, similar to the Chinese cohorts, elevated D-dimer measurements increase disease progression and mortality
in Turkish patients with COVID-19. D-dimer levels of 3.25 mg/L and above, strongly determine the risk of increased mortality in the
Turkish Caucasian ethnic group.

Anahtar Kelimeler

COVID-19, D-dimer, Mortality, Ethnicity

Kaynakça

• [1] World Health Organization, Director-General’s remarks at the media briefing, April 14th 2020 Available at: https:// www.who.int/director-general/speeches/detail/who-directorgeneral- s-remarks-at-the-media-briefing-on-2019-ncov-on- 11-february-2020. Accessed 11.02.2020
• [2] Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost 2020; 18: 1559-61. doi: 10.1111/jth.14849.
• [3] Magro C, Mulvey JJ, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res 2020; 220: 1-13. doi: 10.1016/j.trsl.2020.04.007.
• [4] Fox SE, Akmatbekov A, Harbert JL, Li G, Quincy Brown J, Vander Heide RS. Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med 2020; 8: 681-6. doi: 10.1016/s2213-2600(20)30243-5.
• [5] Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Engl J Med 2020; 383: 120-8. doi: 10.1056/ NEJMoa2015432.
• [6] Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054- 62. doi: 10.1016/s0140-6736(20)30566-3.
• [7] Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18: 1094-9. doi: 10.1111/jth.14817.
• [8] Liao S, Woulfe T, Hyder S, Merriman E, Simpson D, Chunilal S. Incidence of venous thromboembolism in different ethnic groups: a regional direct comparison study. J Thromb Haemost 2014; 12: 214-9. doi: 10.1111/jth.12464.
• [9] Fogarty H, Townsend L, Ni Cheallaigh C, et al. COVID19 coagulopathy in Caucasian patients. Br J Haematol 2020; 189: 1044-9. doi: 10.1111/bjh.16749.
• [10] Republic of Turkey, Ministry of Health Available at: https:// covid19.saglik.gov.tr/TR-66301/covid-19 – rehberi.html. Accessed on 12.02.2020
• [11] Schünemann HJ, Khabsa J, Solo K, et al. Ventilation Techniques and risk for transmission of coronavirus disease, including COVID-19: A living systematic review of multiple streams of evidence. Ann Intern Med 2020; 173: 204-16. doi: 10.7326/m20-2306.
• [12] Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 2017; 43: 304-77. doi: 10.1007/s00134.017.4683-6.
• [13] Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant 2020; 39: 405-7. doi: 10.1016/j.healun.2020.03.012.
• [14] Marshall JC, Murthy S, Diaz J, et al. A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis 2020; 20: e192-e7.
• [15] Talon L, Fourneyron V, Trapani A, Pereira B, Sinegre T, Lebreton A. Analytical performance of a new immunoturbidimetric D-dimer assay and comparison with available assays. Res Pract Thromb Haemost 2022; 6: e12660. doi: 10.1002/rth2.12660.
• [16] Rodelo JR, De la Rosa G, Valencia ML, et al. D-dimer is a significant prognostic factor in patients with suspected infection and sepsis. Am J Emerg Med 2012; 30: 1991-9. doi: 10.1016/j.ajem.2012.04.033.
• [17] Yin S, Huang M, Li D, Tang N. Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2. J Thromb Thrombolysis 2021; 51: 1107-10. doi: 10.1007/s11239.020.02105-8.
• [18] Atallah B, Mallah SI, AlMahmeed W. Anticoagulation in COVID-19. Eur Heart J Cardiovasc Pharmacother 2020; 6: 260-1. doi: 10.1093/ehjcvp/pvaa036.
• [19] Paranjpe I, Fuster V, Lala A, et al. Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19. J Am Coll Cardiol 2020; 76: 122-4. doi: 10.1016/j.jacc.2020.05.001.
• [20] Taylor FB, Jr., Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86: 1327-30. 2002/01/31.
• [21] Hunt BJ, Levi M. Re The source of elevated plasma D-dimer levels in COVID-19 infection. Br J Haematol 2020; 190: e133-e4. doi: 10.1111/bjh.16907.
• [22] Loscalzo J. The macrophage and fibrinolysis. Semin Thromb Hemost 1996; 22: 503-6. doi: 10.1055/s-2007-999051.
• [23] White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107: I4-8. doi: 10.1161/01. Cir.000.007.8468.11849.66.
• [24] Svensson PJ, Dahlbäck B. Resistance to activated protein C as a basis for venous thrombosis. N Engl J Med 1994; 330: 517- 22. doi: 10.1056/nejm199.402.243300801.
• [25] Franco RF, Reitsma PH. Genetic risk factors of venous thrombosis. Hum Genet 2001; 109: 369-84. doi: 10.1007/ s004.390.100593.
• [26] Liem TK, Deloughery TG. First episode and recurrent venous thromboembolism: who is identifiably at risk? Semin Vasc Surg 2008; 21: 132-8. doi: 10.1053/j.semvascsurg.2008.05.006.
• [27] Akar N, Akar E, Dalgin G, Sözüöz A, Omürlü K, Cin S. Frequency of Factor V (1691 G – -> A) mutation in Turkish population. Thromb Haemost 1997; 78: 1527-8. 1998/01/10.
• [28] Iso H, Folsom AR, Wu KK, et al. Hemostatic variables in Japanese and Caucasian men. Plasma fibrinogen, factor VIIc, factor VIIIc, and von Willebrand factor and their relations to cardiovascular disease risk factors. Am J Epidemiol 1989; 130: 925-34. doi: 10.1093/oxfordjournals.aje.a115425.
• [29] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506. doi: 10.1016/s0140-6736(20)30183-5.
• [30] White RH, Keenan CR. Effects of race and ethnicity on the incidence of venous thromboembolism. Thromb Res 2009; 123 Suppl 4: S11-7. doi: 10.1016/s0049-3848(09)70136-7.
• [31] Gurumurthy G, Gaddam A, Patel V, Patel RS. Coagulopathy and hospital outcomes in patients with spontaneous bacterial peritonitis: a call for action to improve care of inpatients. Cureus 2020; 12: e8926. doi: 10.7759/cureus.8926.
• [32] Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18: 844-7. doi: 10.1111/jth.14768.