Systematic Evaluation of the Effect of Bedside Ward Round Checklist on Clinical Outcomes of Critical Patients

Objective. To systematically evaluate the effect of bedside ward round checklists on the clinical outcomes of critical patients and thus provide a scientific and rational basis for decision-making in its clinical application. Methods. PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, and Wanfang databases were searched to collect the literature studies about randomized controlled trials (RCTs) and cohort studies involving the effect of bedside ward round checklists on the clinical outcomes of critical patients, and the retrieval time limit was from the establishment of the database to August 2019. After two researchers independently screened the literature studies, extracted the literature data, and evaluated the risk of bias in included studies, meta-analysis was carried out by using Stata 12.0 software. Results. Two RCTs and nine cohort studies were included in this study. The results of meta-analysis showed that compared with the ordinary bedside ward round, the application of checklist in bedside ward round could shorten the ICU hospitalization time (standardized mean difference (SMD) = – 0.37, 95% CI (– 0.78, 0.04), P ≤ 0.001) and mechanical ventilation time (SMD = – 0.24, 95% CI (– 0.44, −0.04), P = 0.037) and reduce the incidence of ventilator-associated pneumonia (VAP) (SMD = 0.61, 95% CI (0.38, 0.99), P = 0.057) in critical patients. However, there were no significant differences in central venous catheter (CVC) retention time and incidence and mortality of deep venous thrombosis (DVT) between ordinary ward round and bedside ward round checklist. Conclusion. The existing evidence shows that compared with the ordinary ward round, the application of bedside ward round checklists can shorten ICU hospitalization time and mechanical ventilation time and reduce VAP incidence and ICU mortality in critical patients. However, due to the limitations of the quality of the included studies, the above conclusions need to be verified with more high-quality studies.

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Machine Learning Algorithm-Based Analysis of Efficacy of Pulmonary Surfactant Combined with Mucosolvan in Meconium Aspiration Syndrome of Newborns through Ultrasonic Images

Scientific Programming ◽

10.1155/2021/8469487 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Yanni Ji ◽

Wenqian Lou ◽

Jianwei Ji

Keyword(s):

Machine Learning ◽

Mechanical Ventilation ◽

Learning Algorithm ◽

Combination Group ◽

Machine Learning Algorithm ◽

Ventilation Time ◽

Hospitalization Time ◽

Significant Difference ◽

Mechanical Ventilation Time ◽

Ultrasonic Images

Objective. The study aimed to explore the efficacy of pulmonary surfactant (PS) combined with Mucosolvan in the diagnosis of meconium aspiration syndrome (MAS) in newborns through ultrasonic images of lung based on machine learning. Methods. 138 cases of infants with MAS were selected as the research subjects and randomly divided into PS group (n = 46), Mucosolvan group (n = 46), and combination group (n = 46). Then, ultrasonic images based on machine learning algorithm were used for examination. On the basis of conventional treatment, the PS group accepted intratracheal PS drip treatment with 100 mg/kg. For the Mucosolvan group, 7.5 mg/kg of Mucosolvan was added with 50 g/L glucose, which was diluted to 3 mL. Then, the mixture was injected intravenously with a micropump for more than 5 min. The combination group received combined treatment of PS and Mucosolvan. If there was no relief or the symptoms aggravated after 12 h of PS treatment, the patient should be treated again. 7.5 mg/kg/d of Mucosolvan was given for 7 days. Mechanical ventilation time, hospitalization time, oxygenation index (OI) before treatment, at 3 d and at 7 d after treatment, and arterial/alveolar oxygen ratio (a/APO2) of the three groups were detected and compared. Besides, in-hospital mortality and complication rate of the three groups were statistically compared. Results. Ultrasonic image edge detection based on machine learning algorithm was more condensed and better than Sobel operator. Compared with the PS group and the Mucosolvan group, treatment efficiency, OI at 3 d and at 7 d after treatment, and a/APO2 of combination group were increased. Mechanical ventilation time and hospitalization time of the combination group were shortened, and mortality rate of the combination group was reduced ( P < 0.05). Compared with the situation before treatment, OI at 3 d and at 7 d after treatment and a/APO2 of the combination group were increased, and OI at 7 d after treatment and a/APO2 of the PS group and the Mucosolvan group were increased ( P < 0.05). Curative effect, mechanical ventilation time, hospitalization time, OI before and after treatment, a/APO2, and mortality rate during hospitalization of the PS group and the Mucosolvan group had no significant difference ( P > 0.05). There was no significant difference in the complications rates in the three groups ( P > 0.05). Conclusion. Pulmonary ultrasound based on machine learning algorithm can be used in the diagnosis of MAS in neonates. PS combined with Mucosolvan is feasible and safe in treating neonatal MAS and effectively improves the pulmonary oxygenation function. Therefore, it is worthy of clinical application.

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The Efficacy and Immunomodulatory Effects of Ulinastatin and Thymosinα1 for Sepsis: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2016/9508493 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Feng Yun Wang ◽

Bin Fang ◽

Xin Hua Qiang ◽

Tie Ou Yu ◽

Jia Rong Zhong ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

T Cells ◽

Survival Rate ◽

Meta Analysis ◽

Apache Ii Score ◽

Immunomodulatory Effects ◽

Ventilation Time ◽

Icu Stay ◽

Mechanical Ventilation Time

Objective. To systematically review the efficacy and potential immunomodulatory effect of ulinastatin combined with thymosinα1 (UTI) for sepsis.Design. A systematic review and meta-analysis of randomized controlled trials (RCTs).Data Sources. The following databases: PubMed, Embase, and Cochrane Central were searched to identify related clinical trials. The search terms were “ulinastatin”, “thymosin”, and “sepsis”.Results. Six RCTs, 944 septic patients in total, were included in this meta-analysis. The result shows UTI increased the 28-day survival rate of septic patients, odds ratio (OR) = 2.01, 95% CI [1.53, 2.64]. After the treatment with UTI, the APACHE II score (four studies) dropped 4.72 further, mean = −4.72, 95% CI [−6.54, −2.91] (p<0.00001). The mean time of ICU stay (four studies) in UTI group decreased 3.03 days further, mean = −3.03 [−6.99, 0.95] (p=0.14), and mechanical ventilation time (four studies) decreased 2.05 days, mean = −1.81 [−2.96, −0.66] (p=0.002). With the treatment of UTI, CD4+T cells raised 5.13%, mean = 5.13, 95% CI [2.75, 7.50] (p<0.0001); there was no significant change in CD8+T cells, mean = −0.74 [−2.93, 1.45] (p=0.51).Conclusion. According to this meta-analysis, with the treatment of UTI, the short-term survival rate of septic patients was increased and the illness severity was alleviated. ICU stay and mechanical ventilation time were effectively shortened. The beneficial effect of UTI might be due to the potential immunomodulatory effects of these two drugs.

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The Benefit of Individualized Vancomycin Dosing Via Pharmacokinetic Tools: A Systematic Review and Meta-analysis

Annals of Pharmacotherapy ◽

10.1177/1060028019887363 ◽

2019 ◽

Vol 54 (4) ◽

pp. 331-343 ◽

Cited By ~ 2

Author(s):

Na He ◽

Shan Su ◽

Yingying Yan ◽

Wenxi Liu ◽

Suodi Zhai

Keyword(s):

Cohort Studies ◽

Clinical Outcomes ◽

Trough Concentration ◽

Chinese Literature ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Clinical Effectiveness ◽

Cochrane Library ◽

Clinical Response Rate ◽

Target Area

Background: Various pharmacokinetic (PK) equations and software have been developed to individualize vancomycin dosing. However, the benefit of using any PK information to guide vancomycin dosing has not been fully elucidated. Objective: To appraise available evidence on the effectiveness and safety of individualized vancomycin dosing via PK tools. Methods: PubMed, EMBASE, the Cochrane Library, and 2 Chinese literature databases were searched through August 1, 2019. Randomized controlled trials (RCTs) and cohort studies that reported the PK and clinical outcomes of individualized vancomycin dosing versus empirical dosing were included. Pooled risk ratios (RRs) and mean differences were calculated for dichotomous and continuous outcomes, respectively. Results: A total of 21 studies involving 4346 patients were finally included, of which 3 were RCTs and 18 were cohort studies. Meta-analysis revealed that PK-guided vancomycin dosing significantly increased the attainment of target trough concentration (RR = 1.59; 95% CI = 1.49-1.70) and decreased the incidence of nephrotoxicity (RR = 0.57; 95% CI = 0.46-0.71). Additionally, the available evidence showed that target area under the curve/minimum inhibitory concentration attainment rate and time to target concentration could improve. However, the evidence on clinical outcomes was scarce, and no significant differences were detected in clinical response rate, microbiological eradication rate, mortality, and length of hospital stay between PK-guided vancomycin dosing and empirical dosing strategies. Conclusion and Relevance: Individualized vancomycin dosing via PK tools significantly increases the attainment of target trough concentration and decreases the incidence of nephrotoxicity. Evidence on clinical effectiveness was limited and showed no significant benefit. Further well-designed studies are warranted to assess its clinical effectiveness and inform routine care.

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Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽

10.1186/s13054-021-03540-6 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Eleni Papoutsi ◽

Vassilis G. Giannakoulis ◽

Eleni Xourgia ◽

Christina Routsi ◽

Anastasia Kotanidou ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Mortality And Morbidity ◽

Icu Admission ◽

All Cause Mortality ◽

Detectable Difference

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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Risk of dementia in gout and hyperuricaemia: a meta-analysis of cohort studies

BMJ Open ◽

10.1136/bmjopen-2020-041680 ◽

2021 ◽

Vol 11 (6) ◽

pp. e041680

Author(s):

Shu-Yue Pan ◽

Rui-Juan Cheng ◽

Zi-Jing Xia ◽

Qiu-Ping Zhang ◽

Yi Liu

Keyword(s):

Cohort Studies ◽

Quality Assessment ◽

Publication Bias ◽

Data Extraction ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Crystal Formation ◽

Medical Subject Headings ◽

Eligibility Criteria

ObjectivesGout, characterised by hyperuricaemia with monosodium urate crystal formation and inflammation, is the most common inflammatory arthritis in adults. Recent studies have found that elevated uric acid levels are related to the occurrence of dementia. We conducted a study to investigate the association between dementia and gout or hyperuricaemia.DesignSystematic review and meta-analysis of cohort studies.Data sourcesStudies were screened from inception to 28 June 2019 by searching Medline, Embase and the Cochrane Library databases.Eligibility criteriaCohort studies comparing the risk of dementia in patients with gout and hyperuricaemia versus non-gout and non-hyperuricaemia controls were enrolled.Data extraction and analysisTwo reviewers separately selected studies and extracted data using the Medical Subject Headings without restriction on languages or countries. The adjusted HRs were pooled using the DerSimonian and Laird random effects model. Sensitivity analyses were conducted to evaluate the stability of the results. Publication bias was evaluated using Egger’s and Begg’s tests. Quality assessment was performed according to the Newcastle-Ottawa Scale.ResultsFour cohort studies that met the inclusion criteria were included in our meta-analysis. We found that gout and hyperuricaemia did not increase the risk of dementia, with a pooled HR of 0.94 (95% CI 0.69 to 1.28), but might decrease the risk of Alzheimer’s disease (AD), with a pooled HR of 0.78 (95% CI 0.64 to 0.95). There was little evidence of publication bias. Quality assessment of the included studies was high (range: 6–8 points).ConclusionsOur study shows that gout and hyperuricaemia do not increase the risk of dementia. However, gout and hyperuricaemia might have a protective effect against AD. Due to the limited number of research articles, more investigations are needed to demonstrate the potential relationship between dementia and gout or hyperuricaemia.

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EXPRESS: Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion, a systematic review and meta-analysis

International Journal of Stroke ◽

10.1177/17474930211012545 ◽

2021 ◽

pp. 174749302110125

Author(s):

Mingming Zha ◽

Qingwen Yang ◽

Shuo Liu ◽

Min Wu ◽

Kangmo Huang ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Meta Analysis ◽

Working Hours ◽

Good Prognosis ◽

Large Vessel ◽

Cochrane Library ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Significant Difference

Background There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO). Aims This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours. Summary of review Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through February 23rd, 2021. The primary outcomes were onset to door, door to imaging, door to puncture, puncture to recanalization, procedural time, successful recanalization, symptomatic intracerebral hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale [mRS] score 0-2), and 90-day mortality. The secondary outcomes were imaging to puncture, onset to puncture, onset to recanalization, door to recanalization time, mRS 0-2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer onset to door (WMD [95%CI], 12.83 [1.84-23.82] min), door to puncture (WMD [95%CI], 11.45 [5.93-16.97] min), imaging to puncture (WMD [95%CI], 10.39 [4.61-16.17] min), onset to puncture (WMD [95%CI], 25.30 [13.11-37.50] min), onset to recanalization (WMD [95%CI], 25.16 [10.28-40.04] min), and door to recanalization (WMD [95%CI], 18.02 [10.01-26.03] min) time. Significantly lower successful recanalization rate (OR [95%CI], 0.85 [0.76-0.95]; P=0.004; I2=0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend towards lower OR of good prognosis was witnessed in the off-hour group (OR [95%CI], 0.92 [0.84-1.01]; P=0.084; I2=0%). Conclusions Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend towards worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.

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The association between neutrophil–lymphocyte ratio and poor outcomes following infant cardiac surgery

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02345-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Peng Gao ◽

Jinping Liu ◽

Xu Wang ◽

Peiyao Zhang ◽

Yu Jin ◽

...

Keyword(s):

Mechanical Ventilation ◽

Logistic Regression ◽

Cardiac Surgery ◽

Hospital Stay ◽

Clinical Outcomes ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Time Length ◽

Mechanical Ventilation Time ◽

Poor Outcomes

Abstract Background Neutrophil–lymphocyte ratio (NLR) is a valuable indicator for evaluating inflammation and adverse outcomes after cardiac surgery. The objective of this study was to evaluate the association of perioperative NLR with clinical outcomes in infants undergoing congenital heart surgery with cardiopulmonary bypass. Methods We performed a retrospective review of 424 consecutive infants (≤ 1 year) undergoing cardiac surgery between January 2019 and September 2019. Neonates (≤ 28 days) and patients with incomplete NLR data were excluded. The study endpoint was a composite of poor outcomes after surgery. We assess the correlation between perioperative NLR and clinical outcomes. A receiver operating characteristic curve and multivariable logistic regression were applied to identify the prognosis performance of postoperative NLR for poor outcomes. Results A total of 68 (16%) infants experienced at least one of the poor outcomes. Postoperative NLR on the third day after the surgery showed the best prognostic significance (AUC = 0.763, 95%CI 0.700–0.826) among perioperative period, with a cut-off value of 2.05. Postoperative NLR was also strongly correlated with mechanical ventilation time, length of ICU and hospital stay (p < 0.001). Multivariable logistic regression revealed that elevated postoperative NLR (OR 3.722, 95%CI 1.895–7.309, p < 0.001) was an independent risk factor for poor outcomes in infants after cardiac surgery. Conclusions Postoperative NLR was correlated with increased mechanical ventilation time, length of ICU and hospital stay. Elevated postoperative NLR was an independent predictor for poor outcomes after cardiac surgery in infants.

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The Effects of Different Types of Steroids on Clinical Outcomes in Neonates with Meconium Aspiration Syndrome: A Systematic Review, Meta-Analysis, and GRADE Assessment

Medicina ◽

10.3390/medicina57111281 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1281

Author(s):

Nanthida Phattraprayoon ◽

Teerapat Ungtrakul ◽

Wimonchat Tangamornsuksan

Keyword(s):

Respiratory Distress ◽

Clinical Outcomes ◽

Meta Analysis ◽

Pulmonary Inflammation ◽

Neonatal Morbidity ◽

Meconium Aspiration Syndrome ◽

Cochrane Library ◽

Oxygen Requirement ◽

Meconium Aspiration ◽

Relative Risks

Background and Objectives: Meconium aspiration syndrome (MAS) is a condition caused by the aspiration of meconium-stainted amniotic fluid into the lungs, resulting in pulmonary inflammation, neonatal morbidity, and mortality. It is important that these MAS infants receive appropriate care to avoid further complications. Steroids have an anti-inflammatory effect and may be effective in the management of MAS. The objective of the this study was to evaluate the effect of different steroids on clinical outcomes in infants with MAS. Materials and Methods: We systematically searched of PubMed/Medline, Scopus, Embase, Clinical Trials.gov, and Cochrane Library databases from inception to 24 January 2021 without language restriction. Only randomized controlled trials (RCTs) evaluating the effects of steroids in neonates with MAS were included. We calculated relative risks and weighted mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model to determine the associations between MAS and steroids and GRADE approach was employed for quality of evidence. The main outcomes measures were duration of respiratory distress, oxygen requirement, hospitalization, need for mechanical ventilation, death, and adverse drug reactions. Results: Seven RCTs involving 397 patients were analyzed. Nebulized budesonide and intravenous (IV) methylprednisolone shortened the duration of respiratory distress (MD, −2.46 days; 95% CI, −3.09 to −1.83 and MD, −3.30 days; 95% CI, −4.07 to −2.52, respectively) (moderate certainty). There was a reduction in duration of oxygen requirement in nebulized budesonide use (MD, −2.40 days; 95% CI, −3.40 to −1.40) (low certainty) and IV methylprednisolone use (MD, −3.30 days; 95% CI, −4.07 to −2.52) (moderate certainty). Nebulized budesonide shortened hospitalization stay (MD, −4.47 days; 95% CI, −8.64 to −0.30 days) (low certainty) as IV methylprednisolone use (MD, −7.23 days; 95% CI, −8.19 to −6.07 days) (moderate certainty). None of steroids benefits in death (low certainty). Conclusions: Certain types of steroids may benefit the respiratory aspect, but there was no decrease in mortality in MAS infants.

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Outcomes of digital biomarker-based interventions: protocol for a systematic review of systematic reviews (Preprint)

10.2196/preprints.28204 ◽

2021 ◽

Author(s):

Hossein Motahari-Nezhad ◽

Márta Péntek ◽

László Gulácsi ◽

Zsombor Zrubka

Keyword(s):

Clinical Outcomes ◽

Systematic Reviews ◽

Meta Analysis ◽

Cochrane Library ◽

Level Of Evidence ◽

Clinical Benefits ◽

The Cochrane Library ◽

The Impact ◽

Digital Biomarkers

BACKGROUND Digital biomarkers are defined as objective, quantifiable physiological and behavioral data that are collected and measured by means of digital devices such as portables, wearables, implantables or digestibles. For their widespread adoption in publicly financed healthcare systems, it is important to understand how their benefits translate into improved patient outcomes, which is essential for demonstrating their value. OBJECTIVE To assess the quality and strength of evidence of the impact of digital biomarkers on clinical outcomes compared to interventions without digital biomarkers, reported in systematic reviews. METHODS A comprehensive search for 2019-2020 will be conducted in the PubMed and the Cochrane Library using keywords related to digital biomarkers and a filter for systematic reviews. Original full-text English publications of systematic reviews comparing clinical outcomes of interventions with and without digital biomarkers via meta-analysis will be included. The AMSTAR-2 tool will be used to assess the methodological quality of reviews. To assess the quality of evidence, we will evaluate systematic reviews using the GRADE tool. To detect the possible presence of reporting bias, we will record whether the protocol of the systematic reviews was published before the start of the study. A qualitative summary of results by digital biomarker technology and outcome will be provided. RESULTS This protocol was submitted before data collection. The next steps in this review will be initiated after the protocol is accepted for publication. CONCLUSIONS Our study will provide a comprehensive summary of the highest level of evidence available on digital biomarker interventions. Our results will help identify clinical areas where the use of digital biomarkers leads to favorable clinical outcomes. In addition, our findings will highlight areas of evidence gaps where the clinical benefits of digital biomarkers have not yet been demonstrated.

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The Association between D-dimer Levels and Thromboembolism, Worsening Severity, and Mortality among Hospitalized Adults with COVID-19

Acta Medica Philippina ◽

10.47895/amp.vi0.4153 ◽

2021 ◽

Author(s):

Patricia Pauline M. Remalante-Rayco ◽

Evelyn O. Salido ◽

Joey A. Tabula ◽

Maria Teresa S. Tolosa

Keyword(s):

Mechanical Ventilation ◽

Critical Illness ◽

Open Access ◽

Clinical Outcomes ◽

Observational Studies ◽

Prognostic Indicator ◽

Cochrane Library ◽

Increased Risk ◽

D Dimer

Objective. To assess the association between D-dimer and clinical outcomes in adults with COVID-19. Methods. We reviewed published articles and preprints from MEDLINE, Cochrane Library, Cornell Open Access Publication (COAP), MedRxiv, and BioRxiv databases. We included cohort studies on the association between D-dimer and the outcomes of thromboembolism, mortality, and worsening severity among hospitalized adults with COVID-19. Results. We found 25 observational studies on the association between D-dimer and the outcomes of thromboembolism, mortality, or worsening severity. There was an increased risk of thromboembolism (OR 5.61 [95% CI 3.97, 7.94]) with higher D-dimer levels across different COVID-19 severities. D-dimer levels are associated with higher in-hospital mortality (OR 5.57 [95% CI 2.74, 11.31]) and worsening severity manifesting as critical illness (OR 1.91 [95% CI 1.05, 3.48] to 2.58 [95% CI 1.57, 4.24]), disease progression (HR 2.846 [95% CI 2.10, 3.85]), or need for mechanical ventilation (HR 3.28 [95% CI 1.07, 10.10]). However, some methodological flaws, such as incomplete laboratory or follow-up data and concern on varied D-dimer cut-offs and definitions of worsening disease, raise some uncertainty in the widespread use of D-dimer as a prognostic marker. Conclusion. A higher D-dimer value is associated with worse clinical outcomes among hospitalized adults with COVID-19 and may be a useful prognostic indicator.

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