Evaluation of D-Dimer Levels as a Prognostic Marker for Severe Respiratory Failure in Hospitalized COVID-19 Patients

International Journal of Medicine and Medical Sciences | Vol. 10, No. 11, November 2020 | pp. 83–90

DOI: 10.46882/2020/IJMMS/100083

Original Research Article

Evaluation of D-Dimer Levels as a Prognostic Marker for Severe Respiratory Failure in Hospitalized COVID-19 Patients

Ibrahim K. Diallo¹, Victoria N. Eke², Jean-Baptiste M. Diop¹*

¹Department of Haematology, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.

Abstract:

Coagulopathy characterized by microvascular thrombosis is a prominent feature of severe COVID-19 illness. This retrospective observational study examined the clinical utility of sequential serum D-dimer monitoring for predicting the progression toward severe acute respiratory distress syndrome (ARDS) and mechanical ventilation requirements. We evaluated the clinical files of 150 adults admitted with moderate SARS-CoV-2 infection. Patients were grouped based on whether they clinical progressed to severe respiratory failure requiring intensive care unit (ICU) admission (n = 45) or remained stable in general medical wards (n = 105). Baseline and serial daily D-dimer values were extracted and analyzed. The mean baseline D-dimer level was significantly higher in patients who subsequently required intensive care and mechanical ventilation (1.85 ± 0.42 μg/mL) than in the non-ICU cohort (0.62 ± 0.15 μg/mL, p < 0.001). Serial analysis showed a rising kinetic pattern of D-dimer in the severe group, spiking over 3.0 μg/mL 48 hours prior to acute clinical deterioration. Receiver operating characteristic (ROC) analysis showed that a baseline D-dimer cutoff value of 1.5 μg/mL had a sensitivity of 84.4% and a specificity of 81.0% for predicting respiratory failure (Area Under the Curve = 0.88, 95% CI = 0.81–0.94). Elevated D-dimer at admission and rising concentrations over time are highly predictive of hypercoagulability-induced pulmonary failure. Early risk assessment using this assay can help identify high-risk patients who could benefit from early, targeted therapeutic anticoagulation.

Keywords: COVID-19, Coagulopathy, D-Dimer, Acute Respiratory Distress Syndrome, Prognostic Marker, Anticoagulation

Manuscript Timeline: Received: August 01, 2020; Revised: September 10, 2020; Accepted: October 05, 2020; Published: November 12, 2020.

Citation: Diallo IK, Eke VN, Diop JBM. Evaluation of D-Dimer Levels as a Prognostic Marker for Severe Respiratory Failure in Hospitalized COVID-19 Patients. International Journal of Medicine and Medical Sciences, 2020, 10(11): 83–90. DOI: 10.46882/2020/IJMMS/100083

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