Associations of D-Dimer on Admission and Clinical Features of COVID-19 Patients: A Systematic Review, Meta-Analysis, and Meta-Regression.
Associations of D-Dimer on Admission and Clinical Features of COVID-19 Patients: A Systematic Review, Meta-Analysis, and Meta-Regression.
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DOI：
10.3389/fimmu.2021.691249
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发表时间：
2021
影响因子：
7.3
通讯作者：
Ji HL
中科院分区：
文献类型：
--
作者：
Zhao R;Su Z;Komissarov AA;Liu SL;Yi G;Idell S;Matthay MA;Ji HL
动态D-二聚体水平是COVID-19（2019冠状病毒病）严重程度和死亡率的关键生物标志物。异常纤维蛋白溶解如何影响COVID-19的临床进展是一个挑战重症监护医师的临床病理学难题。我们进行了荟萃分析和Meta回归分析，以分析血浆D-二聚体与106个临床变量的相关性，以确定42项研究中14，862例患者纤溶紊乱的全景。没有年龄、性别、种族和国家的限制。每组的原始数据由两名研究者分别提取。将病例系列的个体数据、中位数和四分位距以及中位数或平均值的范围转换为SDM（平均值的标准差）。荟萃分析显示，轻度和重度组之间D-二聚体的加权平均差异为0.97 µg/mL（95% CI 0.65，1.29）。发表偏倚显著。荟萃回归分析发现106个临床变量中有58个与血浆D-二聚体水平相关。其中，11个读数与血浆D-二聚体水平呈负相关。此外，年龄和性别是混杂因素。有22个变量与D-二聚体水平独立相关，包括呼吸频率、呼吸困难、血浆K+、血糖、SpO 2、BUN（血尿素氮）、胆红素、ALT（丙氨酸氨基转移酶）、AST（天冬氨酸氨基转移酶）、收缩压和CK（肌酸激酶）。这些发现支持D-二聚体升高作为死亡率和并发症的独立预测因子。确定的D-二聚体相关临床变量绘制了一幅景观，整合了全身抑制性和肺过度活跃的纤溶紊乱的综合效应，D-二聚体相关临床生物标志物和概念参数可以组合用于风险分层，可能用于跟踪溶栓治疗或替代干预。
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. 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). 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). 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.
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DOI：
10.1164/rccm.202002-0445oc
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影响因子：
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