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ERJ Open Res.2020 Apr;6(2). 00260-2020. doi: 10.1183/23120541.00260-2020.Epub 2020-07-13.

SARS-CoV-2 感染における予後の指標としての D-ダイマー:システマティックレビュー

D-dimer as an indicator of prognosis in SARS-CoV-2 infection: a systematic review.

  • Sofia Vidali
  • Daniele Morosetti
  • Elsa Cossu
  • Maria Luisa Eliana Luisi
  • Silvia Pancani
  • Vittorio Semeraro
  • Guglielmo Consales
PMID: 32685436 PMCID: PMC7357271. DOI: 10.1183/23120541.00260-2020.




Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stimulates pro-thrombotic changes. This, combined with its tropism for endothelium and lung structures, may explain its association with thrombotic events, reduction of pulmonary gas exchange, acute respiratory distress syndrome (ARDS) and a composite end-point (intensive care unit, invasive ventilation, death). This study aims to highlight the correlation between elevated D-dimer (an indirect thrombosis marker) and the increased rate of poor prognosis-associated conditions, and to introduce D-dimer-labelled anticoagulant administration as a potentially useful tool to prevent complications and positively influence coronavirus disease 2019 (COVID-19) course.


オンラインデータベース検索(PubMed、Google Scholar、Scopus、Web of Science、Cochrane)を3月13日から2020年4月10日の間に実施した。最も関連性の高いキーワードは、「Dダイマー」、「SARS-CoV-2」、「COVID-19」、「血栓症」、「ARDS」であった。選定は3人の査読者が独自に行った。採択された論文の参考文献およびプレビューを評価した。データの包含/抽出の不正確さは3人のレビュアーの作業によって制限された。選定バイアスの低減は、検索プロトコルを思慮深く設計することで対応した。質の評価は Newcastle-Ottawa スケールを用いて行った。システマティックレビューのプロトコルは登録されていないが、これは、このトピックに関する利用可能なエビデンスが非常に限られていることと、研究の緊急性を考慮したためである。

Methods: An online database search (PubMed, Google Scholar, Scopus, Web of Science and Cochrane) was performed between 13 March and 10 April 2020. The most relevant keywords were "D-dimer", "SARS-CoV-2", "COVID-19", "thrombosis" and "ARDS". Selection was independently conducted by three reviewers. References and previews of accepted articles were evaluated. Data inclusion/extraction inaccuracy was limited by the work of three reviewers. Selection bias reduction was addressed by thoughtfully designing the search protocol. Quality assessment was performed with the Newcastle-Ottawa Scale. The systematic review protocol was not registered because we anticipated the very limited available evidence on the topic and due to the urgency of the study.



Results: 16 studies were evaluated. Good-quality criteria were reached in 13 out of 16 studies. D-dimer was increased and significantly higher in COVID-19 patients compared with healthy controls, in COVID-19 patients with severe disease or a composite end-point compared with non-severe disease, in ARDS compared with non-ARDS patients and in deceased ARDS patients compared with ARDS patients who survived (all p<0.001). COVID-19 patients treated with anticoagulants demonstrated lower mortality compared with those not treated (p=0.017).



Conclusions: Correlations exist between COVID-19 infection, severe elevation of D-dimer levels, and increase in the rate of complications and composite end-point. The appropriateness of early and continuous D-dimer monitoring and labelled anticoagulation as management tools for COVID-19 disease deserves accurate investigation, to prevent complications and reduce interventions.

Copyright ©ERS 2020.