Predictive roles of D-dimer for mortality of patients with community-acquired pneumonia: a systematic review and meta-analysis

Yang, Cheng; Zeng, Han-Hua; Huang, Juan; Zhang, Qian-Yun; Lin, Kun

doi:10.36416/1806-3756/e20210072

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SYSTEMATIC REVIEW AND META-ANALYSIS • J. bras. pneumol. 47 (06) • 2021 • https://doi.org/10.36416/1806-3756/e20210072 copy

Predictive roles of D-dimer for mortality of patients with community-acquired pneumonia: a systematic review and meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To explore the predictive roles of D-dimer for the mortality of patients with community-acquired pneumonia (CAP).

Methods:

This was a systematic review and meta-analysis. We searched the following databases: PubMed, EMBASE, Web of Science, Ovid MEDLINE, and Cochrane Library from their inception to July 26, 2020. Studies exploring the relationship between blood D-dimer levels and CAP-related mortality were selected. In this meta-analysis, we calculated mortality rates, sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios.

Results:

The search identified 1,073 articles, 8 of which (a total of 2,126 patients) were included in this meta-analysis. The pooled mortality rate of the overall sample was 0.10 (95% CI, 0.08-0.14). The levels of blood D-dimer in the nonsurvivors were significantly higher than those in the survivors (weighted mean difference = 1.03 mg/L [95% CI, 0.81-1.26]; p < 0.00001). The area under the summary ROC curve for the optimal cutoff value of D-dimer as a predictor of mortality was 0.848 (SE = 0.046), and the pooled negative likelihood ratio for D-dimer within the normal range was 0.24 (95% CI, 0.11-0.53).

Conclusions:

Blood D-dimer might be helpful for the initial assessment of mortality risk of patients with CAP. D-dimer levels within the normal range indicate low risk of mortality. Because of the small sample size in our study, our findings should be further explored and validated in future studies with larger sample sizes.

Keywords:
Fibrin fibrinogen degradation products; Community-acquired infections/mortality; Pneumonia/mortality; Meta-analysis

Study	Year of publication	Country	Sample size	Age, years^a	P/R	Clinical setting	Optimal cutoff value	Normal range	Blood collection	Type of specimen	Detection method	Hospital setting	Mortality rate, % (n/N)	Primary outcome	NOS score
Chalmers et al.¹¹11 Chalmers JD, Singanayagam A, Scally C, Hill AT. Admission D-dimer can identify low-risk patients with community-acquired pneumonia. Ann Emerg Med. 2009;53(5):633-638. https://doi.org/10.1016/j.annemergmed.2008.12.022 https://doi.org/10.1016/j.annemergmed.20...	2009	United Kingdom	314	61 [42-73]	P	CAP	N/A	0-0.5 mg/L	On admission	N/A	ELISA	Teaching hospital	7.0 (22/314)	30-day mortality	5
Dai et al.¹²12 Dai RX, Kong QH, Mao B, Xu W, Tao RJ, Wang XR, et al. The mortality risk factor of community acquired pneumonia patients with chronic obstructive pulmonary disease: a retrospective cohort study. BMC Pulm Med. 2018;18(1):12. https://doi.org/10.1186/s12890-018-0587-7 https://doi.org/10.1186/s12890-018-0587-...	2018	China	230	82 [74-87]	R	CAP with COPD	2.0 µg/mL	N/A	N/A	N/A	N/A	A tertiary specialized teaching hospital and a secondary hospital	6.6 (19/290)	In-hospital mortality	6
	2018	China	290	79 [67-86]	R	CAP without COPD	2.0 µg/mL	N/A	N/A	N/A	N/A		8.3 (19/230)	In-hospital mortality	6
Milbrandt et al.¹³13 Milbrandt EB, Reade MC, Lee M, Shook SL, Angus DC, Kong L, et al. Prevalence and significance of coagulation abnormalities in community-acquired pneumonia. Mol Med. 2009;15(11-12):438-445. https://doi.org/10.2119/molmed.2009.00091 https://doi.org/10.2119/molmed.2009.0009...	2009	USA	732	N/A	P	CAP	N/A	0-0.256 mg/L	ER admission	Plasma	Latex immunoassay	Academic and community hospitals	11.5 (84/732)	90-day mortality	7
Nastasijević Borovac et al.⁷7 Nastasijevic Borovac D, Radjenovic Petkovic T, Pejcic T, Stankovic I, Jankovic I, Ciric Z, Rancic M. Role of D-dimer in predicting mortality in patients with community-acquired pneumonia. Med Glas (Zenica). 2014;11(1):37-43. PMID: 24496339.	2014	Serbia	129	64.8 ± 13.3	P	CAP	1.538 mg/L	N/A	On admission	Plasma	Quantitative latex method	Teaching hospital	10.1 (13/129)	Mortality	4
Salluh et al.⁶6 Salluh JIF, Rabello LSCF, Rosolem MM, Soares M, Bozza FA, Verdeal JCR, et al. The impact of coagulation parameters on the outcomes of patients with severe community-acquired pneumonia requiring intensive care unit admission. J Crit Care. 2011;26(5):496-501.	2011	Brazil	90	73.5 [57.7-83.0]	P	Severe CAP	1.798 mg/L	N/A	First day of ICU admission	N/A	Immunoturbidimetry	Tertiary hospital	15.6 (14/90)	In-hospital mortality	6
Shilon et al^.(⁹9 Shilon Y, Shitrit AB, Rudensky B, Yinnon AM, Margalit M, Sulkes J, et al. A rapid quantitative D-dimer assay at admission correlates with the severity of community acquired pneumonia. Blood Coagul Fibrinolysis. 2003;14(8):745-748. https://doi.org/10.1097/00001721-200312000-00009 https://doi.org/10.1097/00001721-2003120...	2003	Israel	68	67.0 ± 20.8	P	CAP	N/A	0-0.375 mg/L	At admission	Plasma	Miniquant D-dimer assay	Primary care hospital	4.4 (3/68)	In-hospital mortality	7
Snijders et al.¹⁴14 Snijders D, Schoorl M, Schoorl M, Bartels PC, van der Werf TS, Boersma WG. D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial. Eur J Intern Med. 2012;23(5):436-441. https://doi.org/10.1016/j.ejim.2011.10.019 https://doi.org/10.1016/j.ejim.2011.10.0...	2012	The Netherlands	147	63.1 ± 17.8	P	CAP	N/A	0-0.5 mg/L	First day of admission	Serum	ELISA	A teaching hospital	5.4 (8/147)	30-day mortality	6
Xu et al.⁸8 Xu YJ, Shen GZ, Shen JY, Sun WM, Chen SL. Value of serum PCT, D-D, and NT-proBNP in evaluation of illness condition of patients with community-acquired pulmonary infection [Article in Chinese]. Chin J Nosocomiol. 2017;27:2972-2975. https://doi.org/10.11816/cn.ni.2017-170386 https://doi.org/10.11816/cn.ni.2017-1703...	2017	China	126	62.5 ± 8.9	P	CAP	N/A	N/A	N/A	Serum	Immunoturbidimetry	A tertiary hospital	14.3 (18/126)	In-hospital mortality	6

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[1] Correspondence to: Qian-Yun Zhang. Department of Pulmonary and Critical Care Medicine, Meizhou People’s Hospital, 63 Huangtang Rd, Meijiang District, Meizhou, 514031, China. Tel.: 86 075 3220-2723. Fax: 86 075 3220-4840. E-mail: qianyunzhangmzh@163.com