Department of Clinical Laboratory, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
State Key Laboratory of Complex, Severe and Rare Diseases, 34732Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211010976. doi: 10.1177/10760296211010976.
The prognostic role of hypercoagulability in COVID-19 patients is ambiguous. D-dimer, may be regarded as a global marker of hemostasis activation in COVID-19. Our study was to assess the predictive value of D-dimer for the severity, mortality and incidence of venous thromboembolism (VTE) events in COVID-19 patients. PubMed, EMBASE, Cochrane Library and Web of Science databases were searched. The pooled diagnostic value (95% confidence interval [CI]) of D-dimer was evaluated with a bivariate mixed-effects binary regression modeling framework. Sensitivity analysis and meta regression were used to determine heterogeneity and test robustness. A Spearman rank correlation tested threshold effect caused by different cut offs and units in D-dimer reports. The pooled sensitivity of the prognostic performance of D-dimer for the severity, mortality and VTE in COVID-19 were 77% (95% CI: 73%-80%), 75% (95% CI: 65%-82%) and 90% (95% CI: 90%-90%) respectively, and the specificity were 71% (95% CI: 64%-77%), 83% (95% CI: 77%-87%) and 60% (95% CI: 60%-60%). D-dimer can predict severe and fatal cases of COVID-19 with moderate accuracy. It also shows high sensitivity but relatively low specificity for detecting COVID-19-related VTE events, indicating that it can be used to screen for patients with VTE.
新冠肺炎患者高凝状态的预后作用尚不清楚。D-二聚体可能被视为新冠肺炎中止血激活的整体标志物。本研究旨在评估 D-二聚体对新冠肺炎患者严重程度、死亡率和静脉血栓栓塞（VTE）事件发生率的预测价值。检索了 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 数据库。采用双变量混合效应二分类回归模型框架评估 D-二聚体的汇总诊断价值（95%置信区间[CI]）。使用敏感性分析和荟萃回归来确定异质性并检验稳健性。Spearman 秩相关检验了 D-二聚体报告中不同截断值和单位引起的阈值效应。D-二聚体对新冠肺炎严重程度、死亡率和 VTE 的预后性能的汇总敏感性分别为 77%（95%CI：73%-80%）、75%（95%CI：65%-82%）和 90%（95%CI：90%-90%），特异性分别为 71%（95%CI：64%-77%）、83%（95%CI：77%-87%）和 60%（95%CI：60%-60%）。D-二聚体可以预测新冠肺炎的严重和致命病例，具有中等准确性。它对检测新冠肺炎相关 VTE 事件的灵敏度较高，但特异性相对较低，表明它可用于筛选 VTE 患者。
