Elevated D-Dimer levels are strongly associated with High Mortality Rate in COVID-19 patients. An observational Study

Elevated D-Dimers in COVID-19 Patients


  • Humaira Farooqi Mayo Hospital, Lahore, Pakistan.
  • Safia Firdous Riphah College of Rehabilitation And Allied Health Sciences, Riphah International University, Lahore, Pakistan
  • Salman Kazmi Mayo Hospital, Lahore, Pakistan.
  • Ammar Anwer Mayo Hospital, Lahore, Pakistan.
  • Asifa Bashir Riphah College of Rehabilitation Sciences, Riphah InternationalUniversity, Lahore, Pakistan.
  • Zain Ul Abideen Mayo Hospital, Lahore, Pakistan.




COVID-19, SARS-CoV-2, D-dimer, Mortality, coagulation disorders, Biomarkers


Severe acute respiratory syndrome called COVID-19, was declared as global health emergency and a pandemic due to its worldwide distribution and frightful spread. Patients are presented with severe respiratory illness along with thrombotic disorders. Elevated d-dimer level (>2000ng/ml) is a potentialpredictive biomarker of the disease outcome and prognosis. The objective of the present study isto find the association ofhigh d-dimer levels and mortality rate in COVID-19 patients to establish the optimal cutoff value for use in clinical setting. Methods: Present study enrolled 318COVID-19 patients admitted to Mayo Hospital, Lahore, Pakistan and confirmed by RT-PCR. On admission d-dimer levelof enrolled patients was measured by fluorescence immuno assay and reported in ng/ml. The enrolled subjects were divided in groupsbased on their age, gender, on admission d-dimer levels (<2000ng/ml and >2000ng/ml), outcome (survivors, non-survivors) and variant (α, β, and γ). Wilcoxon test was used to check the d-dimer level difference in survivor and non-survivor group. Results:81%patients (257/316) died and were categorized as non-survivors while 19% (61/318) were discharged after recovery and were categorized as survivors. Mean d-dimer levelfor survivor group was 2070ng/ml (±3060ng/ml) whereas for non-survivor group was 8010ng/ml (±5404ng/ml) and mean difference was statistically significant (p<0.05).D-dimer level washighest (upto 20,000ng/ml) in second wave(β-variant) as compared to other two wavesand caused highest number of deaths (n=163). Conclusion: Present study reports the d-dimer levels (>2000ng/ml)are strongly associated withhigh mortality rate in COVID-19 patients.


Lotfi M, Hamblin MR and Rezaei NJCca. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clinica Chimica Acta 2020; 508: 254-66.


Zhai P, Ding Y, Wu X, Long J, Zhong Y and Li YJIjoaa. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents 2020; 55: 105955.


Yuki K, Fujiogi M and Koutsogiannaki SJCi. COVID-19 pathophysiology: A review. Clinic Immunol 2020; 215: 108427.


Sohrabi C, Alsafi Z, O'neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020; 76: 71-6.


Cucinotta D and Vanelli MJABMAP. WHO declares COVID-19 a pandemic. Acta Biomed 2020; 91: 157.

World Health Organization Corona virus dashboard, https://covid19.who.int/ (accessed on 22nd October, 2021).

Shereen MA, Khan S, Kazmi A, Bashir N and Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020;16(24):91-98.


Zhou P, Yang X-L, Wang X-G, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature2020; 579: 270-3.

Velavan TP and Meyer CG. The COVID‐19 epidemic. Trop Med Int Health 2020; 25: 278.


Rambaut A, Holmes EC, O'Toole Á, et al. A dynamic nomenclature proposal for SARS-CoV-2 lineages to assist genomic epidemiology. Nat microbiol 2020; 5: 1403-7.


Ghanchi NK, Nasir A, Masood KI, et al. Higher entropy observed in SARS-CoV-2 genomes from the first COVID-19 wave in Pakistan. PloS one 2021; 16: 0256451.


Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis 2013;13:752-61.


Wool GD and Miller JL. The impact of COVID-19 disease on platelets and coagulation. Pathobiology 2021; 88: 14-26.


Poudel A, Poudel Y, Adhikari A, et al. D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. Plos one 2021; 16: 0256744.


Henry BM, De Oliveira MHS, Benoit S, Plebani M and Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med2020; 58: 1021-8.


Gaffney P. Breakdown products of fibrin and fibrinogen: molecular mechanisms and clinical implications. J. clin. pathol. Suppl. R. Coll. Pathol. symp 1980; 14: 10.


Shi C, Wang C, Wang H, et al. The potential of low molecular weight heparin to mitigate cytokine storm in severe COVID‐19 patients: a retrospective cohort study. Clin Transl Sci 2020;13:1087-95.


Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med 2020; 382:38.


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. Lancet2020;395:1054-62.


Querol-Ribelles JM, Tenias JM, Grau E, et al. Plasma d-dimer levels correlate with outcomes in patients with community-acquired pneumonia. Chest 2004;126:1087-92.


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;395:1054-62.


Yao Y, Cao J, Wang Q, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J. Intensive Care2020; 8:1-11.


Zhang L, Yan X, Fan Q, et al. D‐dimer levels on admission to predict in‐hospital mortality in patients with Covid‐19. J. Thromb. Haemost 2020;18:1324-9.


Soni M, Gopalakrishnan R, Vaishya R and Prabu P. D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases. Diabetes Metab. Syndr.Clin. Res. Rev 2020;14:2245-9.


Wakai A, Gleeson A and Winter DJEMJ. Role of fibrin D-dimer testing in emergency medicine. Emerg Med J2003;20:319-25.


Hayakawa M, Maekawa K, Kushimoto S, et al. High D-dimer levels predict a poor outcome in patients with severe trauma, even with high fibrinogen levels on arrival: a multicenter retrospective study. Shock2016; 45: 308-14.


Schutte T, Thijs A and Smulders YJNJM. Never ignore extremely elevated D-dimer levels: they are specific for serious illness. Neth J Med2016;74:443-8.

Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb. Res2020;191:9-14.


Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID‐19 patients. J. Thromb. Haemost 2020;18:1743-6.


Deshpande CJAoim. Thromboembolic findings in COVID-19 autopsies: pulmonary thrombosis or embolism? Ann. Intern. Med 2020;173:394-5.


Khaleghi M, Saleem U, McBane R, Mosley Jr T, Kullo IJJJoT and Haemostasis. African‐American ethnicity is associated with higher plasma levels of D‐dimer in adults with hypertension. J. Thromb. Haemost2009; 7: 34-40.


Yan Z, Ip IK, Raja AS, Gupta A, Kosowsky JM and Khorasani RJR. Yield of CT pulmonary angiography in the emergency department when providers override evidence-based clinical decision support. Radiology 2017; 282: 717-25.


Pulivarthi S and Gurram MKJNAjoms. Effectiveness of d-dimer as a screening test for venous thromboembolism: an update. N Am J Med Sci2014;6:491.


Reitsma MB, Fullman N, Ng M, et al. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017; 389:1885-906.


Griswold MG, Fullman N, Hawley C, et al. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018;392:1015-35.


Jin J-M, Bai P, He W, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Front. Public Health2020;8:152.


Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med2020;382:1787-1799.

Velavan TP and Meyer CG. Mild versus severe COVID-19: laboratory markers. Int J Infect Dis 2020; 95: 304-7.




DOI: 10.54393/pbmj.v5i1.166
Published: 2022-01-31

How to Cite

Farooqi, H. ., Firdous, S. ., Kazmi , S. ., Anwer, A. ., Bashir , A. ., & Abideen , Z. U. (2022). Elevated D-Dimer levels are strongly associated with High Mortality Rate in COVID-19 patients. An observational Study: Elevated D-Dimers in COVID-19 Patients. Pakistan BioMedical Journal, 5(1), 83–89. https://doi.org/10.54393/pbmj.v5i1.166



Original Article