The Role of Fibrin Monomer Compared to D-dimer and CRP in Determining COVID-19 Severity

Authors

  • Anggraini Iriani Department of Clinical Pathology, Faculty of Medicine Yarsi University/Yarsi Hospital, Jakarta https://orcid.org/0000-0002-6994-2552
  • Usi Sukorini Department of Clinical Pathology, Faculty of Medicine Gajah Mada University/Sardjito Hospital, Yogyakarta https://orcid.org/0000-0001-6928-6957
  • Marsya Kaila Fatina Faculty of Medicine Andalas University, Padang
  • Naja F Aflah Faculty of Medicine Yarsi University, Jakarta
  • Sarah A Aiman Faculty of Medicine Yarsi University, Jakarta
  • Rizka K Gemilang Faculty of Medicine Yarsi University, Jakarta
  • Telly Kamelia Department of Internal Medicine, Division of Pulmonology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta

DOI:

https://doi.org/10.24293/ijcpml.v30i2.2110

Keywords:

Fibrin monomer, D-dimer, CRP, COVID-19

Abstract

Fibrin Monomer (FM), as a product of thrombin activity in cleaving fibrinogen, can be used as an early marker of thrombotic events in COVID-19 patients. D-dimer is a commonly used marker of hemostasis as a product of plasmin activity in cleaving polymeric fibrin. D-dimer is often used to help decide whether to initiate anticoagulant administration. This study aims to know whether FM can be used as a marker for thrombotic events such as D-dimer in COVID-19 patients; CRP levels were also examined to determine how inflammation affected the two hemostatic indicators. A total of 93 patients were confirmed with COVID-19 by PCR. The median (min-max) FM in the severe stage was 4.53 (2.26-58.20)ug/mL, whereas, in the mild-moderate stage, it was 4.21 (2.19-32.35 ug/mL. There are significant differences in median D-dimer levels in severe stages to mild-moderate, respectively 0.46 (0.14–7.58) and 0.7890, and ages. The level of FM that can be used to differentiate the severe stage  is > 4.46 ug/mL (sensitivity 56.3%, specificity 58.0%) as in the D-dimer level is > 0.58 ug/mL ((sensitivity 75.0%, specificity 65.2%). There is a moderate positive correlation between fibrin monomer and D-dimer, a weak positive correlation between D-dimer and CRP, and no correlation between FM and CRP. This study concludes that the FM median level is higher in severe COVID-19 than in D-dimer. Fibrin monomer levels have a positive correlation with D-dimer. Fibrin Monomer levels are not affected by CRP.

 

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References

Ortega-Paz L, Capodanno D, Montalescot G, Angiolilo DJ. Coronavirus disease 2019 associated thrombosis and coagulopathy: Review of the pathophysiological characteristics and implications for antithrombotic management. J Am Heart Assoc, 2021; 10: e019650.

Hosseini SF, Roudsari SB, Alavinia G, Emami A, Toghyani A, et al. Diagnostic and prognostic value of sepsis-induced coagulopathy and International Society on Thrombosis and Hemostasis scoring systems in COVID-19-associated disseminated intravascular coagulopathy. J Res Med Sci, 2021; 26(102): 1-11.

Innocenti F, Lazzari C, Ricci F, Paolucci E, Agishev I, Pini R. D-dimer test in the emergency department current insights. Open Acc Emerg Med, 2021(13): 465-79.

Dahlan S. Statistik untuk kedokteran dan kesehatan. 6 Ed., Jakarta, Epidemiologi Indonesia, 2022; 163-217.

Godon A, Durand Z, Agier L, Lecompte T, Mullier F, et al. Comparison of fibrin monomers and D-dimers to predict thrombotic events in critically ill patients with COVID-19 pneumonia: A retrospective study. Thromb Res, 2021; 205: 8-10.

Sridharan M, Ashrani AA, Chen D, Heikal NM, Marshall AL, Pruthi RK. Evaluation of soluble fibrin monomer complex in patients with Sars-Cov-2 COVID-19 infection. Blood, 2020; 136(27): 1-4.

Hardy M, Michaux I, Dive A, Lecompte T, Mullier F. Could daily monitoring of fibrin-related markers help suspect a thrombotic event in COVID-19 patients? A prospective pilot study. TH Open, 2021; 5(2): e152-e154.

Moosavi M, Wooten M, Goodman A, Nahab FB, Duncan A, et al. Retrospective analyses associate hemostasis activation biomarkers with poor outcomes in patients with COVID-19. Am J Clin Pathol, 2021; 155(4): 498-505.

Hardy M, Michaux I, Dive A, Lecompte T, Mullier F. Could daily monitoring of fibrin-related markers help suspect a thrombotic event in COVID-19 patients? A prospective pilot study. TH Open, 2021; 5: e152-4.

Mubarak AR, Esa T, Widianingsih Y, Bahrun U. D-dimer analysis in COVID-10 patients. Ind J of Clin Pathol and Med Lab, 2021; 28(1): 5-9.

Uaprasert N, Moola C, Sosothikul D, Rojnuckarin P, Chiasakul T. Systemic coagulopathy in hospitalized patients with Coronavirus disease 2019: A systematic review and meta-analysis. Clin Appl Thromb Hemost, 2021; 27: 1-9.

Trimaille A, Tachil J, Marchandot B, Curtiaud A, Lorant AL, et al. D-dimers level as a possible marker of extravascular fibrinolysis in COVID-19 patients. J Clin Med, 2021; 10(39): 1-11.

Refaai MA, Riley P, Mardovina T, Bell PD. The clinical significance of fibrin monomers. Thromb Haemost, 2018; 118(11): 1856-66.

Kristoffersen AH, Petersen PH, Bjørge L, Røraas T, Sandberg S. Concentration of fibrin monomer in pregnancy and during the postpartum period. Ann Clin Biochem, 2019; 56(6): 692-700.

Nugroho J, Wardhana A, Mulia EP, Maghfirah I, Rachmi DA, et al. Elevated fibrinogen and fibrin degradation product are associated with poor outcome in COVID-19 patients: A meta-analysis. Clin Hemorheol Microcirc, 2021; 77(2): 221-231.

Stringer D, Braude P, Myint PK, Evans L, Collins JT, et al. The role of C-reactive protein as a prognostic marker in COVID-19. Int J Epidemiol, 2021; 50(2): 420-429.

Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci, 2020; 57(6): 389-399.

Mosquera-Sulbaran JA, Pedreanez A, Carrero Y, Callejas D. C-reactive protein as an effector molecule in COVID-19 pathogenesis. Rev Med Virol, 2021; 31(6): e2221.

Iba T, Connors JM, Levy JH. The coagulopathy endotheliopathy and vasculitis of COVID-19. Inflamm Res, 2020; 69(12): 1181-9.

Iba T, Levy JH, Levi M, Thachil J. Coagulopathy in COVID-19. J Thromb Haemost, 2020; 18: 2103-2109.

Otifi HM, Adiga BK. Endothelial dysfunction in COVID-19 infection. Am J Med Sci, 2021; 363: 281-287.

Althaus K, Zlamal J, Bakchoul T. Antibody-mediated platelet activation in COVID-19: A coincidence or a new mechanism of the dysregulated coagulation system. J Thromb Haemost, 2021; 19: 1171-3.

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Submitted

2023-03-16

Published

2024-02-16

How to Cite

[1]
Iriani, A., Sukorini, U., Fatina, M.K., Aflah, N.F., Aiman, S.A., Gemilang, R.K. and Kamelia, T. 2024. The Role of Fibrin Monomer Compared to D-dimer and CRP in Determining COVID-19 Severity. INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY. 30, 2 (Feb. 2024), 147–152. DOI:https://doi.org/10.24293/ijcpml.v30i2.2110.

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