Background Dynamic D-dimer level is a key biomarker for the severity and mortality of COVID-19 (coronavirus disease 2019). How aberrant fibrinolysis influences the clinical progression of COVID-19 presents a clinicopathological dilemma challenging intensivists. Methods We performed meta-analysis and meta regression to analyze the associations of plasma D-dimer with 106 clinical variables to identify a panoramic view of the derangements of fibrinolysis in 14,862 patients of 42 studies. There were no limitations of age, gender, race, and country. Raw data of each group were extracted separately by two investigators. Individual data of case series, median and interquartile range, and ranges of median or mean were converted to SDM (standard deviation of mean). Findings The weighted mean difference of D-dimer was 0.97 µg/mL (95% CI 0.65, 1.29) between mild and severe groups, as shown by meta-analysis. Publication bias was significant. Meta-regression identified 58 of 106 clinical variables were associated with plasma D-dimer levels. Of these, 11 readouts were negatively related to the level of plasma D-dimer. Further, age and gender were confounding factors. There were 22 variables independently correlated with the D-dimer level, including respiratory rate, dyspnea plasma K + , glucose, SpO2, BUN (blood urea nitrogen), bilirubin, ALT (alanine aminotransferase), AST (aspartate aminotransferase), systolic blood pressure, and CK (creatine kinase). Interpretation These findings support elevated D-dimer as an independent predictor for both mortality and complications. The identified D-dimer-associated clinical variables draw a landscape integrating the aggregate effects of systemically suppressive and pulmonary hyperactive derangements of fibrinolysis, and the D-dimer-associated clinical biomarkers, and conceptually parameters could be combined for risk stratification, potentially for tracking thrombolytic therapy or alternative interventions.
【저자키워드】 COVID-19, Comorbidity, D-dimer, fibrinolysis, fibrinogenolysis, meta-regression, 【초록키워드】 coronavirus disease, Meta-analysis, Coronavirus disease 2019, therapy, Biomarker, Biomarkers, Mortality, severity, creatine, Gender, D-dimer, progression, publication bias, fibrinolysis, meta-regression, risk stratification, Case series, Dyspnea, Patient, Aspartate aminotransferase, AST, Mild, complications, plasma, age, creatine kinase, Glucose, association, ALT, D-dimer level, Bilirubin, respiratory rate, nitrogen, urea, (COronaVIrus Disease 2019), alanine aminotransferase, Support, Blood urea nitrogen, interquartile range, Systolic blood pressure, Standard deviation, panoramic view, thrombolytic therapy, D-dimer levels, SpO2, 95% CI, individual, aspartate, dimer, investigators, Alanine, mean difference, landscape, raw data, limitation, confounding factors, finding, median and interquartile range, dynamic, aggregate effect, parameter, variable, country, independent, shown, identify, performed, elevated, median, correlated, groups, influence, systemically, age and gender, clinical variable, Publication bia, 【제목키워드】 review, clinical,