D-dimer and COVID-19: A Prognostic Indicator or Pitfall?

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SUMMARY

D-dimer is a fibrin degradation product that indicates active fibrinolysis in the body. In the context of COVID-19, elevated D-dimer levels are associated with poor prognosis, as evidenced by studies showing that patients with D-dimer levels ≥2.0 μg/ml have a significantly higher mortality risk (HR 51.5) compared to those with levels ≤2.0 μg/ml. The discussion highlights the misconception that elevated D-dimer should be viewed positively, emphasizing that in inflammatory settings, such as COVID-19, it serves as an independent predictor of mortality. Understanding the implications of thrombocytopenia alongside elevated D-dimer levels is crucial for clinical decision-making.

PREREQUISITES
  • Understanding of D-dimer as a biomarker in clinical settings
  • Knowledge of fibrinolysis and its role in coagulation
  • Familiarity with COVID-19 pathology and its impact on coagulation parameters
  • Awareness of statistical measures such as hazard ratios (HR) in clinical studies
NEXT STEPS
  • Research the role of D-dimer in other inflammatory diseases
  • Explore the mechanisms of fibrinolysis and its regulation by plasminogen activator inhibitor (PAI)-1
  • Investigate the clinical implications of thrombocytopenia in COVID-19 patients
  • Study the statistical interpretation of hazard ratios in prognostic research
USEFUL FOR

This discussion is beneficial for healthcare professionals, including clinicians, researchers, and medical students, who are involved in the management of COVID-19 patients and are interested in understanding the prognostic indicators related to coagulation and inflammation.

mktsgm
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TL;DR
D-dimer indicates that fibrinolysis is going on. Is it not beneficial?
D-dimer is a fibrin degradation product, a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis.

So, the presence of D-dimer indicates that fibrinolysis is active in the body. Fibrinolysis should be considered beneficial against the backdrop of the danger of circulating clots.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357271/

This paper indicates under the heading - Discussion,
inflammatory settings, ... induce an upregulation of plasminogen activator inhibitor (PAI)-1 with consequent impairment of fibrinolysis.

  1. Hence, upregulation of fibrinolysis should be viewed favorably. Instead of viewing D-dimer elevation (consequent on upregulation of fibrinolysis) as an indicator that the body is trying to wriggle out of coagulation, the D-dimer elevation under Covid condition is considered as not good for prognosis. Why? Shouldn't it be the other way round?
  2. Also, how to interpret thrombocytopenia with elevated D-dimer in circulation?
Thanks,
 
Biology news on Phys.org
high D-dimer at admission was an independent predictor for mortality in COVID-19 patients from Wuhan. Patients with a D-dimer ≥2.0 μg/ml had a much higher mortality incidence than those with levels ≤2.0 μg/ml (HR 51.5),1 where the HR was 18.4 in D-dimers ≥1.0 μg/ml.
From:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448362/

You make your own determination - I'm staying out - this is purely an attending physician's call. Notice "pitfall" in the title of the clinical paper - PF is not the place to critique clinical decisions.

So, time to close the thread...
 

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