Sakka M, Connors J M, Hékimian G, Martin-Toutain I, Crichi B, Colmegna I, Bonnefont-Rousselot D, Farge D, Frere C
Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Metabolic Biochemistry, 75013 Paris, France.
Hematology Division, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
J Med Vasc. 2020 Sep;45(5):268-274. doi: 10.1016/j.jdmv.2020.05.003. Epub 2020 May 27.
Several observational studies have reported elevated baseline D-dimer levels in patients hospitalized for moderate to severe coronavirus disease 2019 (COVID-19). These elevated baseline D-dimer levels have been associated with disease severity and mortality in retrospective cohorts.
To review current available data on the association between D-Dimer levels and mortality in patients admitted to hospital for COVID-19.
We performed a systematic review of published studies using MEDLINE and EMBASE through 13 April 2020. Two authors independently screened all records and extracted the outcomes. A random effects model was used to estimate the standardized mean difference (SMD) with 95% confidence intervals (CI).
Six original studies enrolling 1355 hospitalized patients with moderate to critical COVID-19 (391 in the non-survivor group and 964 in the survivor group) were considered for the final pooled analysis. When pooling together the results of these studies, D-Dimer levels were found to be higher in non-survivors than in-survivors. The SMD in D-Dimer levels between non-survivors and survivors was 3.59μg/L (95% CI 2.79-4.40μg/L), and the Z-score for overall effect was 8.74 (P<0.00001), with a high heterogeneity across studies (I=95%).
Despite high heterogeneity across included studies, the present pooled analysis indicates that D-Dimer levels are significantly associated with the risk of mortality in COVID-19 patients. Early integration of D-Dimer testing, which is a rapid, inexpensive, and easily accessible biological test, can be useful to better risk stratification and management of COVID-19 patients.
多项观察性研究报告称，因中度至重度2019冠状病毒病（COVID-19）住院的患者基线D-二聚体水平升高。在回顾性队列研究中，这些升高的基线D-二聚体水平与疾病严重程度和死亡率相关。
综述目前关于COVID-19住院患者D-二聚体水平与死亡率之间关联的现有数据。
我们使用MEDLINE和EMBASE对截至2020年4月13日发表的研究进行了系统综述。两位作者独立筛选所有记录并提取结果。采用随机效应模型估计标准化平均差（SMD）及其95%置信区间（CI）。
六项纳入1355例中度至重症COVID-19住院患者的原始研究（非存活组391例，存活组964例）被纳入最终汇总分析。汇总这些研究结果时，发现非存活者的D-二聚体水平高于存活者。非存活者与存活者之间D-二聚体水平的SMD为3.59μg/L（95%CI 2.79 - 4.40μg/L），总体效应的Z值为8.74（P<0.00001），各研究间异质性较高（I=95%）。
尽管纳入的研究存在高度异质性，但目前的汇总分析表明，D-二聚体水平与COVID-19患者的死亡风险显著相关。D-二聚体检测是一种快速、廉价且易于进行的生物学检测，早期将其纳入可有助于更好地对COVID-19患者进行风险分层和管理。
