Role of D-Dimer in assessing severity, monitoring, and predicating outcome in COVID-19 pneumonia: A single center study

Abstract

Objectives: Robust data are available regarding role of D-dimer in analyzing coagulation status in pulmonary embolisms and deep vein thrombosis. As thrombogenic nature of coronavirus disease 2019 (COVID-19) has been evolved in this pandemic, we have studied its role in predicting disease severity, correlation with durations of illness and oxygenation status, and ventilatory support requirement with prediction of deep vein thrombosis and pulmonary embolism in these cases. Materials and Methods: Prospective, observational follow-up study, included 2000 COVID-19 cases confirmed with reverse transcription–polymerase chain reaction. All cases were assessed with high-resolution computed tomography (HRCT) thorax, oxygen saturation, inflammatory marker as D-Dimer at entry point and follow-up. Age, gender, comorbidity, and use of bilevel-positive airway pressure (BIPAP)/non-invasive ventilation (NIV) and outcome as with or without lung fibrosis were key observations. In selected cases, lower limb venous Doppler and computed tomography (CT) pulmonary angiography to rule out deep vein thrombosis or pulmonary thromboembolism. Statistical analysis is done using Chi-square test. Results: CT severity score at entry point with D-Dimer titer has significant correlation (P < 0.00001). Age (<50 and >50 years) and gender (male vs. female) have significant association with D-Dimer level (P < 0.00001) and (P < 0.010), respectively. D-Dimer titer has significant association with duration of illness before hospitalization (P < 0.00001). Comorbidities have significant association with D-Dimer level (P < 0.00001). D-Dimer titer has significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement has significant association with D-Dimer level (P < 0.00001). Timing of BIPAP/NIV requirement during hospitalization has significant association with D-Dimer level (P < 0.00001). Follow-up D-Dimer titer during hospitalization, as compared normal and abnormal to entry point level has significant association with post-COVID lung fibrosis, deep vein thrombosis and pulmonary thromboembolism (P < 0.00001). Conclusion: D-Dimer has documented very crucial role in COVID-19 pneumonia in predicting severity of illness, ventilatory support requirement and course in critical care setting. D-Dimer follow-up titer has documented role in predicting lung fibrosis and deep vein thrombosis and pulmonary embolism. D-Dimer serial titers have documented significant role in step-up or step-down interventions in critical care setting.