D-Dimer Concentrations and COVID-19 Severity: A Systematic Review and Meta-Analysis
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Date
2020-08-04Author
Paliogiannis, PanagiotisMangoni, Arduino
Dettori, Paola
Nasrallah, Gheyath
Pintus, Gianfranco
Zinellu, Angelo
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Show full item recordAbstract
Coronavirus disease 2019 (COVID-19) is a recently described infectious disease caused
by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since late 2019,
COVID-19 has rapidly spread in virtually all countries, imposing the adoption of significant
lockdown and social distancing measures. The activation of the coagulation cascade
is a common feature of disseminated intravascular coagulation and adverse clinical
outcomes in COVID-19 patients. In this study, we conducted a meta-analysis aiming
to investigate differences in serum D-dimer concentrations in patients with and without
severe COVID-19 disease. An electronic search in Medline (PubMed), Scopus and Web
of Science was performed with no language restrictions, and 13 articles were reporting on
1,807 patients (585, 32.4% with severe disease) were finally identified and included in the
meta-analysis. The pooled results of all studies revealed that the D-dimer concentrations
were significantly higher in patients with more severe COVID-19 (SMD: 0.91 mg/L; 95%
CI, 0.75 to 1.07 mg/L, p < 0.0001). The heterogeneity was moderate (I
2 = 46.5%;
p = 0.033). Sensitivity analysis showed that the effect size was not modified when any
single study was in turn removed (effect size range, 0.87 mg/L to 0.93 mg/L). The Begg’s
(p = 0.76) and Egger’s tests (p = 0.38) showed no publication bias. In conclusion,
our systematic review and meta-analysis showed that serum D-dimer concentrations
in patients with severe COVID-19 are significantly higher when compared to those with
non-severe forms.
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