Iroungou BA, Nze O A, M Kandet Y H, Longo-Pendy NM, Mezogho-Obame ND, Dikoumba AC, Mangouka GL. Interest of D-dimer level, severity of COVID-19 and cost of management in Gabon. World J Crit Care Med 2025; 14(1): 100486 [DOI: 10.5492/wjccm.v14.i1.100486]
Corresponding Author of This Article
Berthe A Iroungou, DSc, MHSc, PhD, Assistant Professor, Research Scientist, Unité Mixte de Recherche, Centre International de Recherches Médicales de Franceville et le Service de Santé Militaire, Pk9, Libreville 20404, Estuaire, Gabon.abertheamelie@gmail.com
Research Domain of This Article
Health Care Sciences & Services
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Mar 9, 2025; 14(1): 100486 Published online Mar 9, 2025. doi: 10.5492/wjccm.v14.i1.100486
Interest of D-dimer level, severity of COVID-19 and cost of management in Gabon
Berthe A Iroungou, Arnaud Nze O, Helga M Kandet Y, Neil-Michel Longo-Pendy, Nina D Mezogho-Obame, Annicet-Clotaire Dikoumba, Guignali L Mangouka
Berthe A Iroungou, Annicet-Clotaire Dikoumba, Unité Mixte de Recherche, Centre International de Recherches Médicales de Franceville et le Service de Santé Militaire, Libreville 20404, Estuaire, Gabon
Arnaud Nze O, AP-HP Health Economics, Research Unit, Htel Dieu Hospital, Paris 75004, Ile-de-France, France
Helga M Kandet Y, Laboratory, Hôpital D'Instruction des Armées D'Akanda, Libreville 20404, Estuaire, Gabon
Neil-Michel Longo-Pendy, Unité de Recherche en Écologie de la Santé, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville 769, Gabon
Nina D Mezogho-Obame, Laboratory, Hôpital D'Instruction des Armées Omar Bongo Ondimba, Libreville 20404, Estuaire, Gabon
Guignali L Mangouka, Department of Medecine Polyvalente, Hôpital D'Instruction des Armées Omar Bongo Ondimba, Libreville 20404, Estuaire, Gabon
Co-corresponding authors: Berthe A Iroungou and Guignali L Mangouka.
Author contributions: Iroungou BA served as the guarantor of the study and was responsible for its design; Iroungou BA, Nze OA, and Mangouka GL played key roles in data analysis, interpretation, and drafting the initial manuscript; Kandet YHM and Mezogho-Obame ND were involved in data acquisition; Longo-Pendy NM contributed to data analysis; Dikoumba AC provided additional support in data analysis; Mangouka GL critically revised the manuscript for important intellectual content; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study was reviewed and approved by National Ethical Committee CNER.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Berthe A Iroungou, DSc, MHSc, PhD, Assistant Professor, Research Scientist, Unité Mixte de Recherche, Centre International de Recherches Médicales de Franceville et le Service de Santé Militaire, Pk9, Libreville 20404, Estuaire, Gabon.abertheamelie@gmail.com
Received: August 18, 2024 Revised: October 2, 2024 Accepted: October 30, 2024 Published online: March 9, 2025 Processing time: 115 Days and 13.5 Hours
Abstract
BACKGROUND
Coronavirus disease 2019 (COVID-19) is strongly associated with an increased risk of thrombotic events, including severe outcomes such as pulmonary embolism. Elevated D-dimer levels are a critical biomarker for assessing this risk. In Gabon, early implementation of anticoagulation therapy and D-dimer testing has been crucial in managing COVID-19. This study hypothesizes that elevated D-dimer levels are linked to increased COVID-19 severity.
AIM
To determine the impact of D-dimer levels on COVID-19 severity and their role in guiding clinical decisions.
METHODS
This retrospective study analyzed COVID-19 patients admitted to two hospitals in Gabon between March 2020 and December 2023. The study included patients with confirmed COVID-19 diagnoses and available D-dimer measurements at admission. Data on demographics, clinical outcomes, D-dimer levels, and healthcare costs were collected. COVID-19 severity was classified as non-severe (outpatients) or severe (inpatients). A multivariable logistic regression model was used to assess the relationship between D-dimer levels and disease severity, with adjusted odds ratios (OR) and 95%CI.
RESULTS
A total of 3004 patients were included, with a mean age of 50.17 years, and the majority were female (53.43%). Elevated D-dimer levels were found in 65.81% of patients, and 57.21% of these experienced severe COVID-19. Univariate analysis showed that patients with elevated D-dimer levels had 3.33 times higher odds of severe COVID-19 (OR = 3.33, 95%CI: 2.84-3.92, P < 0.001), and this association remained significant in the multivariable analysis, adjusted for age, sex, and year of collection. The financial analysis revealed a substantial burden, particularly for uninsured patients.
CONCLUSION
D-dimer predicts COVID-19 severity and guides treatment, but the high cost of anticoagulant therapy highlights the need for policies ensuring affordable access in resource-limited settings like Gabon.
Core Tip: D-dimer, a key biomarker produced during blood clot breakdown, is widely used to diagnose thrombotic conditions such as deep vein thrombosis and pulmonary embolism. Elevated D-dimer levels have been consistently linked to increased coronavirus disease 2019 (COVID-19) severity and mortality risk. This study highlights the role of D-dimer in predicting COVID-19 outcomes in Gabon. Understanding its role can help optimize healthcare resource allocation, improve patient outcomes, and mitigate the economic burden associated with severe COVID-19 cases in resource-limited settings.
