D-dimer level in systemic lupus erythematosus and its correlation with diseaseactivity, a systematic review and meta-analysis

Document Type : Original Article

Authors
Zahra Geraili 1
Ayat Abbasi-Shahkouh 2
Fatemeh Niksolat 3
Nasim Hafezi 4
1 Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
2 Department of Immunology, Babol University of Medical Sciences, Babol, Iran.
3 Department of Internal Medicine and Rheumatology, Orthopedic Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
4 Cellular and Molecular Biology Research Center, Babol University of Medical Sciences, Babol, Iran.
10.22088/IJMCM.BUMS.15.1.1240
Abstract
In systemic lupus erythematosus (SLE), thrombotic events represent a high-risk
manifestation associated with autoantibody-induced damage. This underscores the
necessity of utilizing biomarkers to assess thrombotic risk and monitor the thrombotic
status of patients. D-dimer is a widely used and inexpensive marker routinely-used to
assess coagulation disorders. A systematic literature search was conducted from 1990-
2024 using the PubMed, Scopus, and Web of Science databases. Included articles
reported D-dimer serum levels in both SLE patients and healthy individuals. Data were
analyzed using standard mean difference (SMD) with a 95% confidence interval using
random effect models. Heterogeneity was assessed based on the Cochran chi-square and
I2 statistic. Article quality was assessed via the Newcastle-Ottawa scale. This study
incorporated data from 14 studies, encompassing individuals diagnosed with SLE and
1785 healthy participants serving as controls. The results indicated a significant increase
in serum D-dimer level in the SLE group compared to the control group (SMD= 0.74,
95% CI 0.49, 1.00, p < 0.001; I2 =87.47%, p < 0.001). Moreover, patients with high SLE
disease activity had higher D-dimer levels compared to those with low SLE disease
activity (SMD=0.78, 95% CI 0.46, 1.11; I2 =0, p=0.77). Moreover, a significant positive
correlation was found between SLE disease activity and D-dimer concentrations (r=0.45,
95% CI 0.34, 0.55, p<0.0001). D-dimer may serve as an indicator of thrombotic status
and disease severity in SLE patients. Establishing D-dimer as a reliable biomarker for
tracking SLE activity will require well-designed prospective studies that consider
standardized assays, control for confounding factors, and incorporate predictive
modelling.

Keywords
D-dimer
Systemic lupus erythematosus
Disease activity