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The Role of D-Dimers in the Initial Evaluation of COVID-19 [Response To Letter]
Authors Baroiu L , Lese AC , Stefanopol IA , Iancu A , Dumitru C , Ciubara AB , Bujoreanu FC , Baroiu N , Ciubara A, Nechifor A, Anghel L , Tatu AL
Received 3 May 2022
Accepted for publication 14 May 2022
Published 20 May 2022 Volume 2022:18 Pages 593—594
Liliana Baroiu,1,* Ana Cristina Lese,2 Ioana Anca Stefanopol,3,* Alina Iancu,3,4,* Caterina Dumitru,4,5,* Alexandru Bogdan Ciubara,3,* Florin Ciprian Bujoreanu,6 Nicusor Baroiu,7,* Anamaria Ciubara,1,* Alexandru Nechifor,1,4,* Lucretia Anghel,1,* Alin Laurentiu Tatu1,4,6
1Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania; 2Faculty of Visual Arts and Design, “George Enescu” National University of Arts, Iasi, Romania; 3Departament of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania; 4Multidisciplinary Integrated Center of Dermatological Interface Research Center (MICDIR), “Dunărea de Jos” University, Galați, Romania; 5Pharmaceutical Sciences Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania; 6Dermatology Departament, “Sf. Parascheva” Infectious Diseases Clinical Hospital, Galati, Romania; 7Manufacturing Engineering Department, Faculty of Engineering, “Dunărea de Jos” University, Galati, Romania
*These authors contributed equally to this work
Correspondence: Ana Cristina Lese, Faculty of Visual Arts and Design, “George Enescu” National University of Arts, No. 29, str. Cuza Voda, Iasi, 700040, Romania, Tel +40232212549, Fax +40232212551, Email [email protected] Florin Ciprian Bujoreanu, “Sf. Parascheva” Infectious Diseases Clinical Hospital, No. 343, str. Traian, Galati, 800179, Romania, Tel +40236334477, Fax +40236467752, Email [email protected]
View the original paper by Dr Baroiu and colleagues
This is in response to the Letter to the Editor
Dear editor
I would like to begin by thanking Dr. Sachin Patel for his interest in our study on the role of D-dimers in the initial evaluation of the COVID-19 patient. We also thank the publisher for the opportunity to answer the questions in Dr. Sachin Patel’s letter.1,2
Patient inclusion in moderate or severe COVID-19 forms was performed according to the guidelines of the World Health Organization.3
Regarding the requested information on the procalcitonin levels of the patients included in our study, we highlight the following aspects:
- we found negative procalcitonin values at admission in 596 patients in the favorable evolution group (73.85%) and in 28 patients in the unfavorable evolution group (71.42%), the difference being statistically insignificant (p =0.9342).
- we found procalcitonin values between 0 and 0.49 ng/mL at admission in 170 patients in the group with favorable evolution (21.06%) and in 11 patients in the group with unfavorable evolution (26.19%), the difference being statistically insignificant (p =0.9818).
- procalcitonin values between 0.5–1.99ng/mL at admission were present in 34 patients in the group with favorable evolution (4.21%) and in 1 patient in the group with unfavorable evolution (2.38%), the difference being statistically significant (p =0.0142).
- procalcitonin values between 2–10 ng/mL of at admission were present in 7 patients in the group with favorable evolution (0.86%) and in no patient in the group with unfavorable evolution (0%).
Because we found a statistical significance only for procalcitonin values between 0.5–1.99 ng/mL, we consider that this parameter does not have high great importance in the patient’s evolution, so it has no major relevance in the initial decision of treatment or hospitalization of the COVID-19 patients. We consider that this parameter has a greater importance in monitoring the antibiotic treatment during the hospitalization of the COVID-19 patients.
Regarding the imaging screening for deep thrombosis in patients with much higher values of D-dimers, just like in the case of rare malformative diseases,4 we consider it to be extremely important and useful. We support the necessity of this screening all the more so as many clinicians have stated that deep thrombosis diagnosed, including in the mesenteric and renal arteries, may be the tip of the iceberg of the deep thrombosis of COVID-19 patients.
The high correlation between the D-dimers values, liver damage and the prognosis of COVID-19 patients supports the need for complete and periodic exploration of the liver functions.5
COVID-19 multi-organic involvement (including skin changes)6,7 justifies a complex and complete initial assessment, which may strongly influence the management and the prognosis of these patients.
Acknowledgments
The authors wish to acknowledge that the present study was supported by the ‘Dunarea de Jos’ University of Galati, Romania, through the research center - Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR.
Disclosure
The authors report no conflicts of interest in this communication.
References
1. Patel S. Letter to the editor: the role of D-Dimers in the initial evaluation of COVID-19 [Letter]. Ther Clin Risk Manag. 2022;18:511–512. doi:10.2147/TCRM.S369820
2. Baroiu L, Lese AC, Stefanopol IA, et al. The role of D-Dimers in the initial evaluation of COVID-19. Ther Clin Risk Manag. 2022;18:323–335. doi:10.2147/TCRM.S357214
3. Living guidance for clinical management of COVID-19: living guidance, 23 November 2021 – World Health Organization (WHO). Available from: WHO/2019-nCoV/clinical/2021.2. Accessed May 16, 2022.
4. Stefanopol IA, Baroiu L, Constantin GB, et al. Diagnostic and management of undescended ovary – a preoperative dilemma: a case-based systematic review. Int J Women’s Health. 2022;14:15–27. doi:10.2147/IJWH.S345742
5. Baroiu L, Dumitru C, Iancu A, et al. COVID-19 impact on the liver. World J Clin Cases. 2021;9(16):3814–3825. doi:10.12998/wjcc.v9.i16.0000
6. Tatu AL, Nadasdy T, Bujoreanu FC. Familial clustering of COVID-19 skin manifestations. Dermatol Ther. 2020;33(6):e14181. doi:10.1111/dth.14181
7. Niculet E, Chioncel V, Elisei AM, et al. Multifactorial expression of IL-6 with update on COVID-19 and the therapeutic strategies of its blockade (Review). Exp Ther Med. 2021;21(3):263. doi:10.3892/etm.2021.9693
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