D-dimers, specific degradation products of fibrin, are markers for activation of plasma coagulation and/or fibrinolysis.
An age-adjusted D-dimer cutoff combined with probability assessment can rule out the diagnosis of Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT) in emergency department patients with clinical suspicion.
The D-dimer result should be interpreted according to the age-adjusted cutoff
- In patients younger than 50 years, PE is excluded if D-dimer value < 500 μg/L.
- In patients 50 years or older, PE is excluded if D-dimer value < age multiplied by 10.
D-dimer concentrations are increased in patients with DIC. A normal level of D-dimer has excellent negative predictive value and generally excludes a diagnosis of DIC. Repeated and sequential measurements of D-dimer levels to capture the course of the disease may provide additional diagnostic information in patients when there is a strong clinical suspicion of DIC but the initial D-dimer value is normal.
D-dimer level is associated with the severity of COVID-19.
D-dimer can be used as a prognostic marker for Covid-19 disease mortality and severity in hospitalized patients.
D-dimer value ≥ 2.01 μg/mL can effectively predict in-hospital mortality in patients with COVID-19.
Some factors influence the sensitivity and specificity in D-dimer testing, such as the extent of thrombosis and fibrinolytic activity, duration of symptoms, age, surgical procedures, anticoagulants, and comorbid conditions such as inflammatory states, cancer, pregnancy and the postpartum period.
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Soni, Mamta et al. “D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases.” Diabetes & Metabolic Syndrome vol. 14,6 (2020): 2245–2249. doi:10.1016/j.dsx.2020.11.007
Wagner, J., Garcia-Rodriguez, V., Yu, A. et al. Elevated D-Dimer Is Associated with Multiple Clinical Outcomes in Hospitalized Covid-19 Patients: a Retrospective Cohort Study. SN Compr. Clin. Med. (2020).
Disseminated Intravascular Coagulation - DIC. ARUP Consult®. Retrieved November 30, 2020, arupconsult.com/content/disseminated-intravascular-coagulation
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