Hilda Fadhilatul, Liana Phey, Nurtjahyo Awan, Hudari Harun, Sari Nurmalia Purnama, Umar Tungki Pratama, Amin Chris Alberto, Afifah Astari Rahayu
Medical Profession Program, Universitas Sriwijaya Faculty of Medicine, Palembang, Indonesia.
Department of Clinical Pathology, Universitas Sriwijaya - Mohammad Hoesin General Hospital, Palembang, Indonesia; Biomedicine Doctoral Program, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia.
Eurasian J Med. 2022 Oct;54(3):219-224. doi: 10.5152/eurasianjmed.2022.21145.
The global case fatality rate of coronavirus disease 2019 is 2.16% as announced by the World Health Organization. In Indonesia, according to the Ministry of Health, the number is even higher, reaching a 2.8% case fatality rate. D-dimer levels were found to affect coronavirus disease 2019 patient's survival in several studies. The study aimed to determine whether the amount of D-dimer predicted survival in coronavirus disease 2019 patients.
This research was performed in a retrospective cohort design and used survival analysis. From March 1, 2020, to August 31, 2020, the samples were collected from polymerase chain reaction-confirmed coronavirus disease 2019 patients at Mohammad Hoesin General Hospital in Palembang, South Sumatera, Indonesia. We used electronic medical records to obtain demographic (age and gender), coexisting condition, laboratory (coagulation and hematologic test), and outcome (non-survivors or survivors) data. The chi-square and Mann-Whitney tests were used to evaluate the results. The Kaplan-Meier method and the Mantel-Haenszel log-rank test were used to examine D-dimer levels and patient outcomes. Youden index was calculated to determine the optimal cut-off value of D-dimer.
There were 52 non-survivors and 235 survivors among the 287 patients who met the inclusion criterion. Non-survivors had D-dimer levels of more than 1.49 mg/L in 82.69%of cases. Males had lower cut-off compared to females (>1.49 mg/L vs. >2.2 mg/L). The researchers discovered a highly significant correlation between D-dimer levels and coronavirus disease 2019 mortality (P=.001). The c-index analysis showed that D-dimer (0.79, 95% CI: 0.73-0.83) ability for mortality prediction was the second-best compared with other laboratory markers.
D-dimer can be used as a predictor of coronavirus disease 2019 in-hospital mortality for early identification of coagulopathy.
世界卫生组织公布的2019冠状病毒病全球病死率为2.16%。在印度尼西亚，据卫生部称，这一数字甚至更高，病死率达到2.8%。在多项研究中发现，D-二聚体水平会影响2019冠状病毒病患者的生存情况。本研究旨在确定D-二聚体的量是否可预测2019冠状病毒病患者的生存情况。
本研究采用回顾性队列设计并进行生存分析。2020年3月1日至2020年8月31日期间，样本取自印度尼西亚南苏门答腊省巨港穆罕默德·霍辛综合医院经聚合酶链反应确诊的2019冠状病毒病患者。我们使用电子病历获取人口统计学信息（年龄和性别）、并存疾病、实验室检查结果（凝血和血液学检查）以及结局（非幸存者或幸存者）数据。采用卡方检验和曼-惠特尼检验评估结果。使用Kaplan-Meier法和Mantel-Haenszel对数秩检验来分析D-二聚体水平与患者结局的关系。计算约登指数以确定D-二聚体的最佳临界值。
在符合纳入标准的287例患者中，有52例非幸存者和235例幸存者。82.69%的非幸存者D-二聚体水平超过1.49mg/L。男性的临界值低于女性（>1.49mg/L对>2.2mg/L）。研究人员发现D-二聚体水平与2019冠状病毒病死亡率之间存在高度显著的相关性（P=0.001）。c指数分析表明，与其他实验室指标相比，D-二聚体预测死亡率的能力（0.79，95%CI：0.73-0.83）排第二。
D-二聚体可作为2019冠状病毒病院内死亡率的预测指标，用于早期识别凝血病。
