D-dimer Levels as a Prognostic Inpatient Mortality Indicator in COVID-19 Patients: Insights from a Cross-Sectional Study

Abstract

Background: Since the COVID-19 pandemic's start in December 2019, which was brought on by the SARS-CoV-2 beta coronavirus, this virus has claimed the lives of millions of people worldwide. D-dimer is a specific biomarker that shows enhanced activity of the body's fibrinolytic enzymes and activation of the coagulation cascade. Objectives: In this study, we determined that by measuring the amount of D-dimer and finding its relationship with the mortality rate in patients with COVID-19 hospitalized in Shohada-e Tajrish Hospital. Methods: This cross-sectional study involved all COVID-19 patients at Shohada-e Tajrish Hospital's emergency department (April 2020 - March 2021). Extracted data included demographics, clinical status, underlying conditions, and lab results from electronic medical records. Inclusion criteria: Age > 18, positive COVID-19 PCR. Lab tests were done on admission and during hospitalization. D-dimer levels were measured using Siemens immunoassay (cutoff 0.5 µg/mL, considering 2000 ng/mL based on previous studies). Results: This study at Shohada-e Tajrish Hospital with 230 patients (average age 62.61 ± 15.67) formed two groups based on D-dimer levels: ≥ 2.0 µg/mL (average age 67.83 ± 16.73) and < 2.0 µg/mL (average age 57.34 ± 16.2). The D-Dimer ≥ 2.0 µg/mL group had higher addiction and smoking rates, linked to increased mortality in addicted patients. COVID-19 symptoms were similar, while underlying disorders and some lab markers varied. Mortality was higher in the D-Dimer ≥2.0 µg/mL group, with no difference in hospital stay duration. Conclusions: The study finds that while D-dimer levels aid in categorizing COVID-19 patients' mortality, they aren't a precise marker. Elevated D-dimer signifies greater mortality risk influenced by age, gender, breathlessness, and underlying conditions. Monitoring helps detect complications early, reducing COVID-19 mortality via prevention. Larger, comprehensive studies are necessary for stronger insights.