Department of Pulmonary Medicine, MIMSR Medical College, Latur, Maharashtra, India.
Department of Pathology, MIMSR Medical College, Latur, Maharashtra, India.
Ann Afr Med. 2023 Jul-Sep;22(3):286-292. doi: 10.4103/aam.aam_47_22.
Coronavirus disease 2019 (COVID-19) pneumonia is a heterogeneous disease with variable effects on lung parenchyma, airways, and vasculature, leading to long-term effects on lung functions.
This multicentric, prospective, observational, and interventional study included 1000 COVID-19 cases confirmed with reverse transcription-polymerase chain reaction. All cases were assessed with high-resolution computed tomography thorax, oxygen saturation, inflammatory marker as D-dimer at the entry point, and follow-up. Age, gender, comorbidity, use of bilevel positive airway pressure/noninvasive ventilation (BiPAP/NIV), and outcome as with or without lung fibrosis as per CT severity were key observations. In selected cases, we have performed lower limb venous Doppler and computed tomography (CT) pulmonary angiography to rule out deep-vein thrombosis (DVT) or pulmonary thromboembolism (PTE) respectively. Statistical analysis is performed by using Chi-square test.
Age (<50 and >50 years) and gender (male vs. female) has a significant association with D-dimer level (P < 0.00001 and P < 0.010, respectively). CT severity score at the entry point with the D-dimer level has a significant correlation (P < 0.00001). The D-dimer level has a significant association with the duration of illness before hospitalization (P < 0.00001). Comorbidities have a significant association with D-dimer levels (P < 0.00001). D-dimer level has a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement has a significant association with the D-dimer level (P < 0.00001). Timing of BIPAP/NIV requirement during hospitalization has a significant association with D-dimer level (P < 0.00001). Follow-up D-dimer titer during hospitalization as compared to normal and abnormal to entry point level has a significant association with post-COVID lung fibrosis, DVT, and PTE (P < 0.00001).
D-dimer has documented a very crucial role in COVID-19 pneumonia in predicting the severity of illness and assessing response to treatment during hospitalization, and follow-up titers have a significant role in step-up or step-down interventions in a critical care setting.
新型冠状病毒病 2019（COVID-19）肺炎是一种异质性疾病，对肺实质、气道和血管有不同的影响，导致肺功能的长期影响。
这项多中心、前瞻性、观察性和干预性研究纳入了 1000 例经逆转录-聚合酶链反应（RT-PCR）确诊的 COVID-19 病例。所有病例均行高分辨率胸部 CT、血氧饱和度、炎症标志物（如 D-二聚体）检测，并在入组时进行随访。年龄、性别、合并症、使用双水平正压通气/无创通气（BiPAP/NIV）以及 CT 严重程度评估的结果（有无肺纤维化）是关键观察指标。在部分病例中，我们进行了下肢静脉多普勒超声和 CT 肺动脉造影以排除深静脉血栓形成（DVT）或肺血栓栓塞症（PTE）。采用卡方检验进行统计学分析。
年龄（<50 岁和>50 岁）和性别（男性与女性）与 D-二聚体水平有显著相关性（P<0.00001 和 P<0.010）。入组时 CT 严重程度评分与 D-二聚体水平有显著相关性（P<0.00001）。D-二聚体水平与住院前疾病持续时间有显著相关性（P<0.00001）。合并症与 D-二聚体水平有显著相关性（P<0.00001）。D-二聚体水平与血氧饱和度有显著相关性（P<0.00001）。BIPAP/NIV 需求与 D-二聚体水平有显著相关性（P<0.00001）。住院期间 BIPAP/NIV 需求的时机与 D-二聚体水平有显著相关性（P<0.00001）。与入组时水平相比，住院期间 D-二聚体滴度的随访结果与 COVID 后肺纤维化、DVT 和 PTE 有显著相关性（P<0.00001）。
D-二聚体在 COVID-19 肺炎中已证明在预测疾病严重程度和评估住院期间治疗反应方面具有非常重要的作用，随访滴度在重症监护环境中的升阶梯或降阶梯干预中具有重要作用。
