D-DIMER VARIABILITY WITH COMORBIDITIES AND MULTIMORBIDITIES DURING COVID-19 INFECTION
Main Article Content
Keywords
COVID-19, D-dimer, Comorbidities, multimorbidity, thrombotic disorders
Abstract
Coronavirus infection 2019 (COVID-19), a respiratory illness, is also linked to thrombotic disorders. The elevation of D-dimer is a prognostic biomarker for adverse outcomes in COVID-19. Nevertheless, the association between elevated D-dimer levels and different comorbidities and Multimorbidities lacks understanding. This study is designed to bridge this knowledge gap by focusing on this research side.
The study involved a cohort of 618 COVID-19 patients and explored the relationship of D-dimer level with different factors including age groups, comorbidities, medical interventions and disease outcomes. The mean D-dimer level at the time of hospitalization was 2664.08 ng/mL (2.7µg/mL), displaying significant variation (range: 96 to 12900 ng/mL). Old Age patients demonstrated a significant correlation (p=.000) with D-dimer levels, particularly elevated levels at the old age (≥65) group. A significant connection between D-dimer levels and comorbidities, including diabetes (p=.000), hypertension (p=.000), asthma (p=.003), ischemic heart disease (p=.000), and chronic kidney diseases (p=.000) and Tuberculosis (p=.001) revealed the occurrence of high coagulation activity due to these comorbidities. Furthermore, the elevated D-dimer was associated with high requirements of medical interventions including non-invasive ventilation (p=.000), mechanical ventilation (p=.000), and Intensive care unit admission (p=.000) with a high probability to cause deaths (p=.000). Cox regression analysis indicated a significant correlation of D-dimer levels with the duration of hospitalization in recovered COVID-19 patients (Chi-square = 32.839, df = 1, p < .001) as well as in deceased COVID-19 patients (Chi-square = 62.906, df = 1, p < .001). However, the hazard ratio for D-dimer level was found to be 1.000, representing no change in the hazard of duration of hospitalization with a one-unit increase in D-dimer values. In addition, logistic regression analysis revealed a significant association (p < 0.001) between elevated D-dimer levels at the time of admission increased likelihood of death. These findings provide crucial insights into the role of D-dimer in disease severity, prognosis, and personalized patient management strategies in the context of COVID-19.
In conclusion, this study underscores the intricate associations of D-dimer levels with comorbidities and multimorbidities ultimately affecting the medical interventions, and disease outcomes in COVID-19 patients.
References
[2] Y. V Chudasama et al., “Patterns of multimorbidity and risk of severe SARS-CoV-2 infection: an observational study in the UK,” BMC Infect. Dis., vol. 21, no. 1, pp. 1–12, 2021.
[3] F. A. Klok et al., “Incidence of thrombotic complications in critically ill ICU patients with COVID-19,” Thromb. Res., vol. 191, pp. 145–147, 2020.
[4] I. Tusheva, K. Damevska, I. Dimitrovska, Z. Markovska, and L. Malinovska-Nikolovska, “Unilateral livedo reticularis in a COVID-19 patient: Case with fatal outcome,” JAAD Case Reports, vol. 7, pp. 120–121, 2021.
[5] F. Rongioletti and V. Caputo, “COVID-19-Related Cutaneous Manifestations,” New Emerg. Entities Dermatology Dermatopathol., pp. 287–311, 2021.
[6] S. Rashid, A. Zulfiqar, A. A. Sattar, M. Rizwan, W. Ali, and A. Ilyas, “Platelets and D-dimer as the Biomarkers for COVID-19: Platelets and D-dimers as Biomarkers for COVID-19,” Pakistan Biomed. J., vol. 4, no. 2, pp. 103–106, 2021.
[7] R. Yu and M. Ferri, “An unusual cause of pulmonary nodules in the emergency department,” Case Rep. Emerg. Med., vol. 2015, 2015.
[8] P. Zubiate Orzanco et al., “Fiber-based early diagnosis of venous thromboembolic disease by label-free D-dimer detection,” Biosens. Bioelectron. X 2 2019 100026, 2019.
[9] F. Alzoughool, L. Alanagreh, S. Abumweis, and M. Atoum, “Cerebrovascular comorbidity, high blood levels of C-reactive protein and D-dimer are associated with disease outcomes in COVID-19 patients,” Clin. Hemorheol. Microcirc., vol. 77, no. 3, pp. 311–322, 2021.
[10] H. Zhan et al., “Diagnostic value of D-dimer in COVID-19: a meta-analysis and meta-regression,” Clin. Appl. Thromb., vol. 27, p. 10760296211010976, 2021.
[11] L. Zhang et al., “D‐dimer levels on admission to predict in‐hospital mortality in patients with Covid‐19,” J. Thromb. Haemost., vol. 18, no. 6, pp. 1324–1329, 2020.
[12] X. He et al., “The poor prognosis and influencing factors of high D-dimer levels for COVID-19 patients,” Sci. Rep., vol. 11, no. 1, p. 1830, 2021.
[13] H. Debi, Z. T. Itu, M. T. Amin, F. Hussain, and M. S. Hossain, “Association of serum C-reactive protein (CRP) and D-dimer concentration on the severity of COVID-19 cases with or without diabetes: a systematic review and meta-analysis,” Expert Rev. Endocrinol. Metab., vol. 17, no. 1, pp. 83–93, 2022.
[14] G. Lippi, F. Mullier, and E. J. Favaloro, “D-dimer: old dogmas, new (COVID-19) tricks,” Clin. Chem. Lab. Med., vol. 61, no. 5, pp. 841–850, 2023.
[15] L. Roncon, M. Zuin, and P. Zonzin, “Age-adjusted D-dimer cut-off levels to rule out venous thromboembolism in COVID-19 patients,” Thromb. Res., vol. 190, p. 102, 2020.
[16] A. Alsrhani, A. Alshomar, A. Y. Elderdery, Z. Rasheed, and A. Farhana, “Diagnosis and Stratification of COVID-19 Infections Using Differential Plasma Levels of D-Dimer: A Two-Center Study from Saudi Arabia,” Microbiol. Res. (Pavia)., vol. 14, no. 1, pp. 67–76, 2023.
[17] I. Hashim Ibrahim Elbashir, H. Kamal Ali Mohamed, M. E. Adam Essa, and A. Seri, “Comparison between D‐dimer levels in diabetic and non‐diabetic positive COVID‐19 adult patients: A hospital‐based study,” Endocrinol. Diabetes Metab., vol. 5, no. 4, p. e349, 2022.
[18] E. Manalu, J. Josafat, and D. E. J. Luhulima, “D-Dimer Levels in Covid-19 Patients with Moderate and Severe Symptoms,” Int. J. Heal. Sci. Res., vol. 13, no. 2, pp. 210–216, 2023.
[19] S. Patil, S. Khule, and S. Toshniwal, “Role of D-Dimer in assessing severity, monitoring, and predicating outcome in COVID-19 pneumonia: A single center study,” Glob J Heal. Sci Res, vol. 1, pp. 31–37, 2023.
[20] O.-Z. Akácsos-Szász et al., “Pathways of Coagulopathy and Inflammatory Response in SARS-CoV-2 Infection among Type 2 Diabetic Patients,” Int. J. Mol. Sci., vol. 24, no. 5, p. 4319, 2023.
[21] A. Bonaventura et al., “Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19,” Nat. Rev. Immunol., vol. 21, no. 5, pp. 319–329, 2021.
[22] M. Kannan, F. Ahmad, and R. Saxena, “Platelet activation markers in evaluation of thrombotic risk factors in various clinical settings,” Blood Rev., vol. 37, p. 100583, 2019.
[23] S. Vinayagam and K. Sattu, “SARS-CoV-2 and coagulation disorders in different organs,” Life Sci., vol. 260, p. 118431, 2020.
[24] W. Zhao, H. Li, J. Li, B. Xu, and J. Xu, “The mechanism of multiple organ dysfunction syndrome in patients with COVID‐19,” J. Med. Virol., vol. 94, no. 5, pp. 1886–1892, 2022.
[25] H. Lu et al., “Fibrinolysis regulation: A promising approach to promote osteogenesis,” Tissue Eng. Part B Rev., vol. 28, no. 6, pp. 1192–1208, 2022.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Maria Shoukat
Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
Wajid Munir
Isolation Hospital and Infections Treatment Center, Islamabad, Pakistan.
Moona Nazish
Department of Botany, Rawalpindi Women University, Rawalpindi-46300, Pakistan.
Anwar Ali Khan
Medicine University Hospital Kerry, Ireland.
Afsheen Mansoor
Department of Dental Materials, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan.
Malik Badshah
Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan.