D-dimer levels as a biomarker for disease severity and mortality in Covid-19 critically ill patients

Lazarova, Biljana and Eftimova, Biljana and Gazepov, Strahil and Naumovska, Zorica (2021) D-dimer levels as a biomarker for disease severity and mortality in Covid-19 critically ill patients. Knowledge - International Journal, Scientific Papers, 45 (4). pp. 761-765. ISSN 2545-4439


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Purpose As the critically ill patients with COVID-19 pneumonia suffered from high thrombotic risk and the effect of COVID-19 on coagulation is still not well determined, the aim of our study was to evaluate the risk factors associated with mortality in COVID-19 patients and assess the use of D-dimer as a biomarker for disease severity and clinical outcome.
Methodology We conducted a retrospective study of critically ill patients admitted to an intensive care unit (ICU) because of severe COVID-19 pneumonia Fifty five critical COVID-19 patients in the intensive care unit of the Clinical Hospital in Stip-The Republic of North Macedonia in three mounths period December, 2020 - Fevruary, 2021 were enrolled in the study and were divided into survivors and non-survivors. The diagnosis of severe COVID-19 pneumonia was according to World Health Organization (WHO) interim guidance and it was confirmed by RNA detection of the SARS-CoV-2 in clinical laboratory. The demographic and clinical information were collected. Peripheral venous blood sample was taken and routine blood examination with platelet counts and D�dimers was performed on day of admission and at the time of discharged the ICU unit for the survivor group of the patients and the day of death of the non-survivor group. All patients receive appropriate supportive therapies during the hospital stay and tromboprophylaxis with low molecular weight heparin (LMWH, 40-60mg enoxaparin/day) in line with adopted guidelines.
Statistical analysis of the data was performed and appropriate parametric and non-parametric test were conducted. Continuous variables were expressed as median (interquartile range) and compared with the Mann-Whitney U test. A p-value of < 0.05 was considered statistically significant. Stat Graphics centurion 19 was used for statistical analysis.
Results Fifty five patients were enrolled into the study. The mean age was 67 ± 10 years; most of them were male (63.6%). Seventeen patients (31%) survived and 38 patient (69%) have died during the treatment in the ICU in the clinical hospital in Stip. The mean age in the survived group of patients was 66 ± 9 years; most of them were male (76.5%), whereas in the group of non-survivors mean age of patients was 68 ± 10 years with 42.1% women. Our results have suggested that the age does not influents the rate of survival (p=0.4). Our results have suggested that the D-dimer values depend on the gender. Our result have confirmed statistically significant higher D-dimer value on the admission in the ICU in female patients (p=0.05) and on the leave of ICU unit (p=0.024). The present study shows that abnormal coagulation results, especially markedly elevated D‐dimer are common in deaths with NCP. Conclusions Recent clinical experience suggests that severe COVID-19 is commonly complicated with coagulopathy with elevated D-dimer values and severe disease is accompanied with higher D-dimer values in comparison with patients with mild Covid-19 clinical form of disease. In severe cases hypercoagulability is accelerated and disseminated intravascular coagulation is possible clinical outcome. The effect of Coid-19 infection on hemostatic function remains still unknown.
Recommendations Abnormal coagulation results, especially markedly elevated D‐dimer may have the potential to guide therapy and prognosis evaluation in criticaly ill patients with confirmed Covid-19 infection.

Item Type: Article
Uncontrolled Keywords: D-dimer levels, biomarkers, Covid 19
Subjects: Medical and Health Sciences > Health sciences
Divisions: Faculty of Medical Science
Depositing User: Strahil Gazepov
Date Deposited: 11 May 2021 10:30
Last Modified: 11 May 2021 10:30
URI: https://eprints.ugd.edu.mk/id/eprint/28066

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