Relevância do dímero D na evolução clínica de pacientes com covid-19

Gabriella Letícia Bonone; Deborah de Castro Moreira; Gabriele Nascimento de Oliveira; Natan Nascimento de Oliveira; Dennis Armando Bertolini

doi:10.17765/2176-9206.2026v19e13104

Authors

Gabriella Letícia Bonone State University of Maringá https://orcid.org/0000-0003-2874-213X
Deborah de Castro Moreira State University of Maringá https://orcid.org/0000-0002-8901-071X
Gabriele Nascimento de Oliveira State University of Maringá https://orcid.org/0000-0002-5664-0299
Natan Nascimento de Oliveira State University of Maringá https://orcid.org/0000-0001-7239-4289
Dennis Armando Bertolini State University of Maringá https://orcid.org/0000-0002-6460-7560

DOI:

https://doi.org/10.17765/2176-9206.2026v19e13104

Keywords:

COVID-19, D-dimer, Prognosis, SARS-CoV-2, Fibrin Fibrinogen Degradation Products

Abstract

Patients with COVID-19 frequently present elevated D-dimer levels, indicating an increased risk of complications. This study evaluated the relevance of D-dimer in clinical management by analyzing data from 366 patients. Clinical, laboratory, epidemiological, and sociodemographic data were collected from 366 patients hospitalized in the ward and intensive care unit of the Regional University Hospital of Maringá, State University of Maringá (HUM), using the GSUS-HUM database. Pearson’s chi-square test, Fisher’s exact test, and Student’s t-test were applied for data analysis. Subsequently, a generalized linear regression model with Gamma distribution and log-link function was constructed. Odds ratios were estimated by exponentiating the obtained coefficients, along with their respective 95% confidence intervals. The results demonstrated that elevated D-dimer levels were correlated with higher mortality, ICU admission, thrombosis, acute renal failure, endocarditis, sepsis, and the need for anticoagulant therapy. The generalized linear regression analysis indicated a significant association between D-dimer levels and these outcomes. Serum D-dimer at admission is therefore a crucial marker for assessing COVID-19 severity and patient prognosis.

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Author Biographies

Gabriella Letícia Bonone, State University of Maringá

Graduated in Biomedicine from the State University of Maringá (2020). Has experience in the area of Morphology, with an emphasis on Histology. Master in Health Sciences in the area of infectious and parasitic diseases, sub-area of clinical virology, and PhD in Health Sciences in the area of infectious and parasitic diseases, sub-area of medical bacteriology also from the State University of Maringá.

Deborah de Castro Moreira, State University of Maringá

Biomedical scientist from the State University of Maringá (UEM), master's degree from the Postgraduate Program in Health Sciences (PCS) at UEM and PhD from the same Postgraduate Program, she works in the area of Clinical Virology. During her undergraduate studies, she had experience in the area of Microbiology, with an emphasis on Hospital Infection and in her Postgraduate studies she worked with arboviruses, especially Chikungunya and COVID-19.

Gabriele Nascimento de Oliveira , State University of Maringá

Graduated in Biomedicine from Centro Universitário Ingá - UNINGÁ (2018). Master's and PhD student in the Postgraduate Program in Health Sciences at the State University of Maringá (UEM) in the area of Infectious Diseases and Parasitology. Scholarship holder from the Coordination for the Improvement of Higher Education Personnel (CAPES). Her field of activity involves virology, epidemiology, health data analysis and geoprocessing in health.

Natan Nascimento de Oliveira, State University of Maringá

Graduated in Nursing from the Center for Higher Education of Maringá - UNICESUMAR (2019) and a Master's degree in Nursing from the Graduate Program in Nursing at the State University of Maringá (PSE/UEM). Currently, a doctoral student in nursing at the Graduate Program in Nursing at the State University of Maringá (PSE/UEM), under the guidance of Prof. Dr. Rosana Rosseto de Oliveira. Scholarship holder from the Coordination for the Improvement of Higher Education Personnel (CAPES). Participating researcher at the Research Group on Epidemiology and Health Technologies (GPETS) and the Global Emergency Medicine Innovation and Implementation Research Laboratory (GEMINI). Works mainly in the areas of Mental Health, Violence, Health of Vulnerable Populations, Studies on Ethnic Relations, Gender and Sexuality Studies, and LGBTQ+ Population. Has affinity in Epidemiology, Data Science in Health, and Geoprocessing in Health.

Dennis Armando Bertolini , State University of Maringá

I graduated in Pharmacy from the State University of Maringá (1984), master's degree in Biological Sciences (Cell Biology) from the State University of Maringá (1994) and PhD in Sciences (Infectious and Parasitic Diseases) from the Federal University of São Paulo (2002). I am currently an associate professor level C at the State University of Maringá. I have experience in the area of Microbiology, with emphasis on Medical Microbiology, working mainly on the following topics: hepatitis B, HIV/AIDS, hepatitis C, arboviruses, prevalence, genotyping, resistance to treatment.

References

1. World Health Organization (WHO). WHO Coronavirus (COVID-19) Dashboard [Internet]. Geneva: WHO; [cited 2022 Apr 16]. Available from: https://covid19.who.int

2. Ministério da Saúde (BR). Coronavirus - Brasil [Internet]. [cited 2022 Apr 16]. Available from: https://covid.saude.gov.br

3. Iba T, Levy JH, Levi M, Connors JM, Thachil J. Coagulopathy of coronavirus disease 2019. Crit Care Med. 2020;Publish Ahead of Print. https://doi.org/10.1097/ccm.0000000000004458

4. Zhan H, Chen H, Liu C, Cheng L, Yan S, Li H, Li Y. Diagnostic value of D-dimer in COVID-19: a meta-analysis and meta-regression. Clin Appl Thromb Hemost. 2021;27:10760296211010976. https://doi.org/10.1177/10760296211010976

5. Melo AK, Milby KM, Caparroz AL, Pinto AC, Santos RR, Rocha AP, et al. Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: a living systematic review and meta-analysis. PLoS One. 2021;16(6):e0253894. https://doi.org/10.1371/journal.pone.0253894

6. Iwamura AP, Tavares da Silva MR, Hümmelgen AL, Soeiro Pereira PV, Falcai A, Grumach AS, et al. Immunity and inflammatory biomarkers in COVID-19: a systematic review. Rev Med Virol. 2020 Dec;30(6):1–10. https://doi.org/10.1002/rmv.2199

7. Dolhnikoff M, Duarte-Neto AN, Almeida Monteiro RA, Silva LF, Oliveira EP, Saldiva PH, et al. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost. 2020 Jun;18(6):1517–9. https://doi.org/10.1111/jth.14844

8. Lopes RD, de Barros e Silva PGM, Furtado RHM, Macedo AVS, Bronhara B, Damiani LP, et al. Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicenter, randomised, controlled trial. Lancet. 2021 Jun;397(10291):2253–63. https://doi.org/10.1016/s0140-6736(21)01203-4

9. Lemos ACB, do Espírito Santo DA, Salvetti MC, Gilio RN, Agra LB, Pazin-Filho A, et al. Therapeutic versus prophylactic anticoagulation for severe COVID-19: a randomized phase II clinical trial (HESACOVID). Thromb Res. 2020 Dec;196:359–66. https://doi.org/10.1016/j.thromres.2020.09.026

10. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344–9.

11. Teuwen LA, Geldhof V, Pasut A, Carmeliet P. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020 Jul;20(7):389–91. https://doi.org/10.1038/s41577-020-0343-0

12. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020 May;18(5):1094–9. https://doi.org/10.1111/jth.14817

13. Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020 Jun;20(6):363–74. https://doi.org/10.1038/s41577-020-0311-8

14. Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the ACE2 receptor expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med. 2020 Mar;14(2):185–92. https://doi.org/10.1007/s11684-020-0754-0

15. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020 Feb;12(1):8. https://doi.org/10.1038/s41368-020-0074-x

16. Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020 Jul;98(1):219–27. https://doi.org/10.1016/j.kint.2020.04.003

17. Nord CE, Heimdahl A. Cardiovascular infections: bacterial endocarditis of oral origin. Pathogenesis and prophylaxis. J Clin Periodontol. 1990 Aug;17(8):494–6. https://doi.org/10.1111/j.1365-2710.1992.tb01221.x