ANALYSIS OF D-DIMER LEVELS IN THE EVOLUTION OF THE CLINICAL CONDITION OF PATIENTS AFFECTED BY COVID-19

Abstract

COVID-19 is caused by the etiological agent SARS-CoV-2, a beta coronavirus, of the order Nidovirales, family Coronaviridae, and subfamily Orthocoronaviridae, the seventh virus of the coronavirus family already reported as causing infections in humans. The disease emerged in Wuhan province, China, allegedly due to the inappropriate consumption of wild animals such as bats, pangolins, and snakes, and quickly spread around the world, becoming a pandemic. To date, Brazil has been the third most affected country by the disease, behind only the United States and India. Endothelial damage caused by the inflammatory reaction of the infection leads to impairment and consequent release of D-dimer into the circulation, which can favor the development of circulatory disorders in patients with COVID-19. The objective of this study was to analyze the relevance of D-dimer in the evolution of the clinical condition of patients with COVID-19, in order to contribute to the improvement of clinical practices through cooperation between the scientific community and the public health service. Clinical, laboratory, epidemiological, and sociodemographic data were collected from 366 patients admitted to the ward and ICU of the Regional University Hospital of Maringá of the State University of Maringá (HUM) through the GSUS-HUM database. Pearson's chi-square test, Fisher's exact test, and Student's t-test were used for data analysis. Subsequently, a generalized linear regression model with Gamma distribution and logarithmic link function was constructed. Odds ratios were estimated from the exponentiation of the coefficients obtained, together with a 95% confidence interval. We found that for each unit of elevated serum D-dimer, there is an increase of: 8% in the chances of death; 6% in the need for ICU admission; 14% in thrombosis; 7% in ARF; 31% in endocarditis; 10% in sepsis; and 6% in the need for anticoagulants. The findings show that serum D-dimer measurement at hospital admission of patients with COVID-19 qualifies as an important prognostic marker of severity for each unit of D-dimer that rises.