d -Dimer and COVID-19
2020; Radiological Society of North America; Volume: 297; Issue: 3 Linguagem: Inglês
10.1148/radiol.2020203481
ISSN1527-1315
AutoresMatthijs Oudkerk, Harry R. Büller, Dirkjan Kuijpers, Sytse F. Oudkerk, Edwin J.R. van Beek,
Tópico(s)Dermatological and COVID-19 studies
ResumoHomeRadiologyVol. 297, No. 3 PreviousNext CommunicationsFree AccessLetters to the Editord-Dimer and COVID-19Matthijs Oudkerk* , Harry R. Büller†, Dirkjan Kuijpers‡, Sytse F. Oudkerk§, Edwin J. R. van BeekǁMatthijs Oudkerk* , Harry R. Büller†, Dirkjan Kuijpers‡, Sytse F. Oudkerk§, Edwin J. R. van BeekǁAuthor AffiliationsFaculty of Medical Sciences, University of Groningen, Hanzeplein 1, Groningen 9700RB, the Netherlands* Institute for Diagnostic Accuracy, Prof Wiersmastraat 5 9713 GH, Groningen, the Netherlands*Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands†Department of Radiology, Haaglanden Medical Centre, the Hague, the Netherlands‡Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands§Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Scotlandǁe-mail: [email protected]Matthijs Oudkerk* Harry R. Büller†Dirkjan Kuijpers‡Sytse F. Oudkerk§Edwin J. R. van BeekǁPublished Online:Oct 13 2020https://doi.org/10.1148/radiol.2020203481See erratumMoreSectionsPDF ToolsAdd to favoritesCiteTrack Citations ShareShare onFacebookXLinked In Editor:In their article published online in Radiology on August 13, 2020, Dr Schalekamp and colleagues described the development of a risk score for patients who are more likely to develop severe coronavirus disease 2019 (COVID-19), with resultant worse outcome (1). In this retrospective analysis, Dr Schalekamp and colleagues point to findings in laboratory and chest radiographic reports combined with medical history and underlying morbidity. Interestingly, the plasma d-dimer values are not mentioned in this report.Based on a study in Wuhan, and reference 6 in their article, the plasma d-dimer levels were shown to be highly correlated with unfavorable outcomes (2). This was further confirmed by several other studies, summarized in a subsequent report, and included the first prospective data on the use of plasma d-dimer in patients in intensive care and the direct link with development of pulmonary embolism (3). Some of the authors of the present article also reported on the high incidence of vascular thrombotic complications in patients in intensive care (4).Was plasma d-dimer not available routinely, or was this biomarker not considered? If plasma d-dimer measurements were not considered routinely, this may be a shortcoming for this risk assessment tool given that plasma d-dimer consistently demonstrated high correlation with outcomes and has implications for thrombotic risk management. Alternatively, it would be useful to reassess this risk score by considering plasma d-dimer values, which should probably be performed as part of the prospective validation of the risk score.Disclosures of Conflicts of Interest: M.O. disclosed no relevant relationships. H.R.B. disclosed no relevant relationships. D.K. disclosed no relevant relationships. S.F.O. disclosed no relevant relationships. E.J.R.v.B. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: is founder/owner of QCTIS; is a consultant for Mentholatum; is on the advisory board for Aidence and Imbio; is an educational event speaker for Roche. Other relationships: disclosed no relevant relationships.References1. Schalekamp S, Huisman M, van Dijk RA, et al. Model-based prediction of critical illness in hospitalized patients with COVID-19. Radiology (in press). Google Scholar2. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–1062 [Published correction appears in Lancet 2020;395(10229):1038.]https://doi.org/10.1016/S0140-6736(20)30566-3. Crossref, Medline, Google Scholar3. Oudkerk M, Büller HR, Kuijpers DJ, et al. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands. Radiology 2020. 10.1148/radiol.2020201629. Published online April 23, 2020. Link, Google Scholar4. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145–147https://doi.org/10.1016/j.thromres.2020.04.013. Crossref, Medline, Google ScholarReferences1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–1062 [Published correction appears in Lancet 2020;395(10229):1038.]https://doi.org/10.1016/S0140-6736(20)30566-3. Crossref, Medline, Google Scholar2. Oudkerk M, Büller HR, Kuijpers D, et al. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands. Radiology 2020;297(1):E216–E222https://doi.org/10.1148/radiol.2020201629. Link, Google Scholar3. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145–147https://doi.org/10.1016/j.thromres.2020.04.013. Crossref, Medline, Google Scholar4. Schalekamp S, Huisman M, van Dijk RA, et al. Model-based prediction of critical illness in hospitalized patients with COVID-19. Radiology (in press). Google Scholar5. Yu B, Li X, Chen J, et al. Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis. J Thromb Thrombolysis 2020;50(3):548–557https://doi.org/10.1007/s11239-020-02171-y. Crossref, Medline, Google Scholar6. Vidali S, Morosetti D, Cossu E, et al. D-dimer as an indicator of prognosis in SARS-CoV-2 infection: a systematic review. ERJ Open Res 2020;6(2):00260-2020https://doi.org/10.1183/23120541.00260-2020. Crossref, Medline, Google ScholarReferences1. Schalekamp S, Huisman M, van Dijk RA, et al. Model-based prediction of critical illness in hospitalized patients with COVID-19. Radiology (in press). Google Scholar2. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–1062 [Published correction appears in Lancet 2020;395(10229):1038.]https://doi.org/10.1016/S0140-6736(20)30566-3. Crossref, Medline, Google Scholar3. Oudkerk M, Büller HR, Kuijpers DJ, et al. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands. Radiology 2020. 10.1148/radiol.2020201629. Published online April 23, 2020. Link, Google Scholar4. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145–147https://doi.org/10.1016/j.thromres.2020.04.013. Crossref, Medline, Google ScholarResponseSteven Schalekamp*,† , Merel Huisman*Steven Schalekamp*,† , Merel Huisman*Author AffiliationsDepartment of Radiology, Meander Medisch Centrum, Maatweg 3, 3813 TZ Amersfoort, the Netherlands*Department of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Nijmegen, the Netherlands†e-mail: [email protected]We acknowledge that d-dimer carries important prognostic value for the prediction of poor outcome in patients with COVID-19 as demonstrated by the literature presented by the responder (1–3).At the start of the first wave of COVID-19 in the Netherlands there was limited knowledge about the potential prognostic information of d-dimer levels, and determination of d-dimer was not part of the routine workup of patients suspected of having COVID-19 in our emergency departments. We explicitly mentioned this in our methods and discussion (4). There were of course instances that d-dimer was administered during the course of the hospitalization, especially in the most ill patients. However, these values were not included in our risk model because of the selective nature of data accrual and timing; we only considered laboratory values taken at emergency department presentation.The correlation between C-reactive protein and d-dimer is well known, also in patients with COVID-19 (5). Furthermore, by now a number of publications reported an association between degree of elevation of d-dimer, severity of disease, rate of complications, and prognosis during COVID-19 infection as nicely summarized in a systematic review by Vidali et al (6).Whether d-dimer would add prognostic information in our risk model beyond C-reactive protein remains to be investigated. However, based on the evolving knowledge, we therefore would advise to include d-dimer, among possibly other risk factors, as a parameter in the development of future prognostic models in patients with COVID-19. Disclosures of Conflicts of Interest: S.S. disclosed no relevant relationships. M.H. disclosed no relevant relationships.References1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–1062 [Published correction appears in Lancet 2020;395(10229):1038.]https://doi.org/10.1016/S0140-6736(20)30566-3. Crossref, Medline, Google Scholar2. Oudkerk M, Büller HR, Kuijpers D, et al. Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands. Radiology 2020;297(1):E216–E222https://doi.org/10.1148/radiol.2020201629. Link, Google Scholar3. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145–147https://doi.org/10.1016/j.thromres.2020.04.013. Crossref, Medline, Google Scholar4. Schalekamp S, Huisman M, van Dijk RA, et al. Model-based prediction of critical illness in hospitalized patients with COVID-19. Radiology (in press). Google Scholar5. Yu B, Li X, Chen J, et al. Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis. J Thromb Thrombolysis 2020;50(3):548–557https://doi.org/10.1007/s11239-020-02171-y. Crossref, Medline, Google Scholar6. Vidali S, Morosetti D, Cossu E, et al. D-dimer as an indicator of prognosis in SARS-CoV-2 infection: a systematic review. ERJ Open Res 2020;6(2):00260-2020https://doi.org/10.1183/23120541.00260-2020. Crossref, Medline, Google ScholarArticle HistoryPublished online: Oct 13 2020Published in print: Dec 2020 FiguresReferencesRelatedDetailsCited BySafety and efficacy of Paxlovid in the treatment of adults with mild to moderate COVID-19 during the omicron epidemic: a multicentre study from ChinaPulinLi, LingHuang, RuiHan, MinTang, GuangheFei, DaxiongZeng, RanWang1 February 2024 | Expert Review of Anti-infective TherapyDevelopment of aptamer‐based ELISA method for d‐dimer detectionNimetYildirim‐Tirgil2023 | Biotechnology and Applied Biochemistry, Vol. 70, No. 1A Review of Routine Laboratory Biomarkers for the Detection of Severe COVID-19 DiseaseKeynazKeykavousi, FahimehNourbakhsh, NooshinAbdollahpour, FarzanehFazeli, AlirezaSedaghat, VahidSoheili, AmirhosseinSahebkar, WaleedAlahmad2022 | International Journal of Analytical Chemistry, Vol. 2022Accompanying This Articled-Dimer and COVID-19Dec 21 2020RadiologyRecommended Articles Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-AnalysisRadiology2020Volume: 298Issue: 2pp. E70-E80Pulmonary Embolism in Hospitalized Patients with COVID-19: A Multicenter StudyRadiology2021Volume: 301Issue: 3pp. E426-E433Acute Pulmonary Embolism and COVID-19Radiology2020Volume: 297Issue: 3pp. E335-E338Stratification, Imaging, and Management of Acute Massive and Submassive Pulmonary EmbolismRadiology2017Volume: 284Issue: 1pp. 5-24Pulmonary Embolism in COVID-19: The Actual Prevalence Remains UnclearRadiology2021Volume: 299Issue: 2pp. E254See More RSNA Education Exhibits Pulmonary Embolism on COVID-19 Pneumonia: The Perfect StormDigital Posters2020Collateral Damage: CTA of Acute Pulmonary Embolism and Its Correlation with Evolution of COVID-19 PneumoniaDigital Posters2020Alert The PERT: Leveraging Artificial Intelligence To Optimize Diagnosis And Management Of Acute Pulmonary Embolism Within A Large Urban Health SystemDigital Posters2021 RSNA Case Collection Acute pulmonary embolismRSNA Case Collection2022Pulmonary Embolism with Right Heart StrainRSNA Case Collection2020COVID-19 pneumonia and pulmonary embolismRSNA Case Collection2020 Vol. 297, No. 3 Metrics Altmetric Score Open AccessThis article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. 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