Association between D Dimer and Inflammatory Markers in COVID-19 Patients with Preexisting Chronic Kidney Disease

Abstract

Background: Renal involvement in Covid 19 disease is an independent predictor of mortality in Covid 19 patients. Hyperinflammation and hypercoagulability  are the important key factors for assessing severity of Covid 19 disease. Management of Covid 19 infection in preexisting CKD patients is a challenge. Aim:  1. To compare D- Dimer, CRP, PCT, Lactate, LDH and Ferritin  of  Covid 19  CKD patients with that of  Covid 19 patiets without CKD 2.To evaluate the correlation between D-Dimer levels and Inflammatory markers in Covid 19 CKD patients.  Study Design: An observational cross sectional study Place and Duration of Study: Dept of Biochemistry, Institute of nephrourology,  Bangalore, India. from July 2020 to Dec 2020 Methodology: Study popoulation were categorised into 3 groups, Group 1 (Covid 19 with preexisting CKD), Group 2 (Covid 19 without CKD) and Group 3 (CKD without Covid 19) . All the groups were assayed for D dimer, CRP, PCT, Lactate and LDH using Abbott ci4000 chemistry and immuno assay analyser,  in Biochemistry laboratory. Student t test was  used to to analyse the significance between Group 1&2 also Group 1&3. Pearson correlation was done to analyse the association between d dimer and inflammatory markers in Group 1. Results : In our study, a peaked and statistically significant (P value = <0.0001)  D-Dimer values were observed in Group 1 (7.4±2.5), compared to Group 2 (3.4±2.1)  and Group 3 (1.5±0.4)]. Similarly CRP, PCT, LDH, Ferritin, and Lactate levels were higher in Group 1 compared to other two groups. D- Dimer had strong positive correlation with CRP (r= 0.702), PCT (r= 0.66) , LDH (r=0.67) and moderately positive correlation with Lactate  (r=0.42) in Group1. Conclusion: This study shows Covid -19 patients with preexisting CKD  had significantly higher levels of hypercoagulability marker (D-Dimer ) and of  hyperinflammatory markers (CRP. PCT, Lactate, and Ferritin). Therefore, it is possible that COVID-19 infection in CKD is  more likely to cause severe hyperinflammatory and hypercoagulable state with a worse prognosis.