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Abstract
Background. Coronavirus Disease 2019 (COVID-19) has been a global pandemic since March 2020. The number of patients is massive and clinical symptoms vary from mild to severe symptoms. Several laboratory results showed abnormal values in Covid-19 patients, including an increase in the value of D-dimer. Elevated levels of D-dimer in COVID-19 patients are strongly associated with severity and increased mortality. We report a case of a severe symptomatic COVID-19 patient with high D dimer levels at the start of treatment and showing clinical improvement according to a decrease in D dimer levels.
Methods. We treat and follow the clinical and laboratory developments of COVID-19 patients with severe symptoms from the time they enter the Intensive Care Unit (ICU) until they move to a regular ward.
Results. A 53-year-old male patient diagnosed with viral pneumonia et causa covid-19 was admitted to the ICU with severe symptoms and high initial d-dimer levels (1,413 ug/ml). The patient received ventilator assistance and standard therapy according to the Covid 19 management protocol of the Ministry of Health of the Republic of Indonesia. Anticoagulation using heparin intravenously with a dose adjusted to the level of d dimer, aPTT, and clinical condition of the patient who is monitored regularly. The trend of d dimers decreased parallel to the decrease in C reactive protein (CRP) levels, increased lung gas exchange function was evaluated from the PaO2/Fio2 ratio (PF ratio) and the clinical improvement of the patients.
Conclusion. D-dimer is closely related to the severity of covid 19 patients. D dimer can be used as one of the parameters of patient clinical improvement.
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References
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References
Coronaviridae Study Group of the International Committee on Taxonomy of Viruses .The species Severe acute respiratory syndrome related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536- 544. https://doi.org/10.1038/s41564-020-0695-z
WHO : Coronavirus disease (covid-19) pandemic.2022. available from https://www.who.int/emergencies/diseases/novel-coronavirus-2019. cited 23 september 2022
COVID-19 Hotline 119. Peta Sebaran COVID-19. Available from https://covid19.go.id/peta-sebaran-covid19. cited 23 september 2022
JDIH Kemenko Bidang Kemaritiman dan Investasi. Penetapan status faktual pandemi covid-19 di Indonesia. Available from https://jdih.maritim.go.id/id/penetapan-status-faktual-pandemi-covid-19-di-indonesia. Cited 23 september 2022
Centers for Disease Control and Prevention. Symptom of COVID-19. Available from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Cited 23 september 2022
Lippi G, Plebani M : Laboratory abnormalities in patients with COVID-2019 infection. Clinical Chemistry and Laboratory Medicine. Clin Chem Lab Med. 2020; 1-4. https://doi.org/10.1515/cclm-2020-0198
Weitz ji, fredenburgh JC, eikelboom JW. A Test in Context: D-Dimer. Journal of American Colledge of cardiology. 2017;70(19); 2411-20. https://doi.org/10.1016/j.jacc.2017.09.024
Citu C, Burlea B, Gorun F, Motoc A, Gorun OM, Malita D, et al. Predictive Value of Blood Coagulation Parameters in Poor Outcomes in COVID-19 Patients: A Retrospective Observational Study in Romania. J. Clin. Med. 2022;11:2831. https:// doi.org/10.3390/jcm11102831
Soni M, Gopalakrishnan R, Vaishya R, Prabu P. D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020;14:2245-9. https://doi.org/10.1016/j.dsx.2020.11.007
Xiong M, Liang X, Wei YD. Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. British Journal of Haematology, 2020; 189:1050–63
Berger JS, Kunichoff D, Adhikari S, Ahuja T, Amoroso N, Aphinyanaphongs Y,et al. Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19 . Arterioscler Thromb Vasc Biol. 2020;40:2539–47. DOI: 10.1161/ATVBAHA.120.314872
Yorike D, Kurniawan MR, Syafaat M. Analysis of D-Dimer Level and Prothombin Time (PT) Activated Prothombin Thromboplastin (APTT) on Heparin Administration to COVID-19 Patients. Ina. J. Med. Lab. Sci. Tech 2022; 4(1): 91–98. DOI: 10.33086/ijmlst.v4i1.2487