Evidence suggests considering the use of D-Dimer on hospital admission.
A range of coagulation tests supplied by Helena Biosciences (including D-Dimer and Prothrombin Time) are proving useful in the stratification and monitoring of serious COVID-19 patients upon admission to hospital. We have reviewed and summarised a number of recent topical publications below. Please contact the Helena team for more information with any aspect of this story.
In new guidance published recently by the International Society on Thrombosis and Haemostasis, D-Dimer (among other coagulation tests) is recommended as a routine stratification tool upon admission to hospital.
The new document is produced by experts from a variety of renowned institutions including Manchester University Hospitals and Huazhong University of Science and Technology. It discusses how, despite the majority of the most severely ill patients initially presenting with single organ failure, some of them progress to more systemic disease and multiple organ dysfunction. One of the most significant poor prognostic features in those patients is the development of coagulopathy.
Also mentioned are recent studies indicating that one of the commonest laboratory findings noted in COVID-19 patients requiring hospitalisation has been the increase in D-dimers. It is already well-established that older individuals and those who have co-morbidities — both of which tend to have higher D-dimer — are more likely to die from COVID-19 infection.
As the guidance says:
“ we would recommend measuring D-dimers, prothrombin time and platelet count (decreasing order of importance) in all patients who present with COVID-19 infection. This may help in stratifying patients who may need admission and close monitoring or not.”
The guidance goes on to recommend how D-Dimer can be used with a range of other tests including prothrombin time, platelet count and fibrinogen can be used to help stratify patients upon admission.
For more details and links to the ISTH guidance, please visit the ISTH website.
Evidence from a number of early major COVID-19 outbreaks points to D-Dimer playing a part in being able to identify serious patients with a relatively poor prognosis. A recent publication (see The Lancet, 9th March 2020) described a retrospective, multicentre cohort study of patients with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China).
The findings indicated that in particular, as well as older age and higher SOFA (Sequential Organ Failure Assessment) score on admission, D-Dimer levels greater than 1 μg/L were associated with a fatal outcome of COVID-19. About 90% of inpatients with pneumonia had increased coagulation activity.
Read the full study on The Lancet website.
A recently published letter in Clinical Chemistry and Laboratory Medicine reviewed results of various studies on laboratory diagnostic tests for hospitalised COVID-19 patients, which again point to the use of D-Dimer as part of a routine panel of tests for serious cases.
Cohort sizes and methodologies naturally varied from group to group, but an overall picture emerges of an association between the presence of coagulopathies upon admission and fatalities in hospital. In one reviewed study, 71.4% of patients who died fulfilled the criteria for diagnosing disseminated intravascular coagulation (DIC) compared to only 0.6% of those who survived.
Another study based on 140 COVID-19 patients reported that significantly higher values of D-dimer (2-fold) could be observed in patients with severe disease compared to those with a milder form.
The article concludes:
“ the evidence that laboratory criteria for diagnosing DIC are present in nearly three-fourths of patients who died underscores the critical role of these tests in this and other clinical settings , thus suggesting that their assessment shall be considered a routine part of COVID- 19 patient monitoring.”
You can read the entire review on the CCLM website.
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21 April 2020 19:00