Relationship of serial D-dimer measurement results with clinical and radiological findings, laboratory data and disease course in cases diagnosed with COVİD-19

AİM: The frequency of thromboembolic events due to coagulopathy in COVID-19 infection is high. D-dimer molecule, which is a fibrin degradation product and shows the thrombosis load, is detected to be high in COVID-19. The aim of this study is to determine the contribution of serial D-dimer measurements in patients diagnosed with COVID-19 to prognosis, mortality and concurrent venous thromboembolic diseases by observing their relationship with clinical, radiological and laboratory values. METHOD: All the cases that met the inclusion and exclusion criteria, which were followed up in the pandemic service and/or COVID-19 intensive care unit of Dokuz Eylül University Faculty of Medicine Hospital between 16.03.2020 and 16.03.2021, with COVID-19 PCR test positivity and/or typical COVID-19 pneumonia findings on thorax CT, were retrospectively scanned from electronic records and patients whose D-dimer levels were measured at least 5 times in a one-month period were included in the study. RESULTS: A total of 350 patients were evaluated in the study and 140 (40%) died during the follow-up. While the mean admission D-dimer value in the whole patient group was 3.4∓7.1, the last measured mean D-dimer value was 4.5∓8.3. Whereas the mean admission D-dimer value in patients who died was 4.2∓7.7, the mean D-dimer value last measured was 9.7∓11 and while in patients who survived, the mean admission D-dimer value was 2.9∓6.6, the last measured mean D-dimer value was 1.1∓2.1. In line with these findings, a significant relationship was found with mortality (p:< 0.05). When the D-dimer course in the first 8 days; was taken into account D dimer levels were seen to be higher in patients who deceased and/or had high CALL, GRAM scores, and their levels were observed to go up increasingly. In patients who did not die and/or had low CALL, GRAM scores, D-dimer remained stable at low levels and showed a decreasing trend. In the course of D-dimer; no significant difference was found in patients who did not die, while a significant difference was found in patients who died (p=0.037). As the CALL score, GRAM score and Radiological score increased, the last measured D-dimer level displayed an increase in relation to them (rspearman: 0,41, rspearman: 0,492, rspearman: 0,2, p:<0,001). D-dimer levels of patients who developed PTE during follow-up were significantly high at admission and decreased with anticoagulant treatment in the following days. It is observed that the "admission D-dimer levels" of cases in which PTE cannot be shown to develop during follow-up are lower, increase in the first 14 days and remain stable thereafter. A significant relationship was found between the presence of oxygen support, HFO, NIMV and IMV need and the last measured D-dimer levels (p≤0.001). CONCLUSİON: It has been shown that the measurement of serial D-dimer levels in COVID-19 cases may be valuable and useful in predicting prognosis, and this strategic approach can be used in all venous thromboembolic disease processes. Keywords: COVID-19, prognosis, serial D-dimer measurement, thromboembolism