D-Dimer Level on Admission as an Outcome Predictor of   COVID-19 Patients in Tertiary Care Hospitals in Bangladesh

Background: Worldwide, along with clinical scenario and imaging techniques, biochemical markers have been used in management of Coronavirus Disease-2019 (COVID-19). Different haematological, biochemical and immunological markers are being used to identify high risk group of patients early for prompt initiation of treatment. Coagulopathy is a mainstay of COVID-19 disease pathogenesis and D-dimer is one of the markers elevated markedly earlier, even when there is no significant clinical symptom of severity and imaging changes. However, there is no conclusive data regarding this issue in our country. Objective: This study aimed to evaluate the association of on admission D-dimer level with in-hospital outcome. Methodology: This prospective observational study was conducted in Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital from June 2020 to May 2021. Ethical clearance was obtained from institutional review board (IRB) of BSMMU. Total 186 COVID-19 admitted patients were enrolled in accordance with inclusion & exclusion criteria. A detailed history and thorough clinical examination were carried out in each patient. D–dimer level was detected by standard procedure on the first day of admission by SYSMEX CS-1600 analyser. Clinical and laboratory information were recorded with a semi-structured questionnaire. Severity of COVID-19 patients was categorized according to WHO classification. After collection of all the required data, analysis was done by SPSS 24.0. Results: Mean age of all patients was 58.60±12.30 years (range: 22-90 years) wherein maximum belonged to 51-70 years of age (62.3%) and male gender (71.5%). Maximum study patients were diabetic (57%) and hypertensive (57%) for average duration more than 10 years. Most of the study patients (71%) were in severe category of COVID-19, followed by moderate (25.8%), mild (2.7%) and critical (0.5%) category. Median D-dimer of all patients was 0.96 µg/mL. On admission D-dimer level was significantly higher among severe/critical COVID-19 patients compared to mild/moderate (1.11 vs 0.54µg/mL, p <0.05). Twenty-eight (28) days mortality rate of admitted COVID-19 patients was 18.3%. Receiver operator curve analysis found highly significant cut-off value for D-dimer (1.62 µg/mL) with 70.6% sensitivity and 78.3% specificity in predicting 28-days hospital mortality of COVID-19 patients (AUC= 0.839, p value <0.001). Besides, patients with D-dimer ≥1.62 µg/mL had significantly higher NLR (8.6 vs 4.6), CRP (107 vs 57mg/L) and serum LDH (512 vs 370 IU/L) level compared to patients with D-dimer <1.62 µg/mL. Conclusion: On admission D-dimer was significantly associated with severity as well as 28-days mortality of COVID-19. Keyword: COVID-19, Corona virus, D-dimer.