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A 10-fold and greater increase in D-dimer at admission in COVID-19 patients is highly predictive of pulmonary embolism in a retrospective cohort study.
Perera, Adrian; Chowdary, Pratima; Johnson, James; Lamb, Lucy; Drebes, Anja; Mir, Naheed; Sood, Tara.
  • Perera A; Emergency Department, Royal Free London NHS Foundation Trust, London, UK.
  • Chowdary P; Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust, London, UK.
  • Johnson J; Emergency Department, Royal Free London NHS Foundation Trust, London, UK.
  • Lamb L; Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK.
  • Drebes A; Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust, London, UK.
  • Mir N; Department of Radiology, Royal Free London NHS Foundation Trust, London, UK.
  • Sood T; Consultant Emergency Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK, NW3 2QG.
Ther Adv Hematol ; 12: 20406207211048364, 2021.
Article in English | MEDLINE | ID: covidwho-1582496
ABSTRACT

BACKGROUND:

COVID-19 patients present with both elevated D-dimer and a higher incidence of pulmonary embolism (PE). This single-centre retrospective observational study investigated the prevalence of early PE in COVID-19 patients and its relation to D-dimer at presentation.

METHODS:

The study included 1038 COVID-19-positive patients, with 1222 emergency department (ED) attendances over 11 weeks (16 March to 31 May 2020). Computed tomography pulmonary angiogram (CTPA) for PE was performed in 123 patients within 48 h of ED presentation, of whom 118 had D-dimer results. The remaining 875 attendances had D-dimer performed.

RESULTS:

CTPA performed in 11.8% of patients within 48 h of ED presentation confirmed PE in 37.4% (46/123). Thrombosis was observed at all levels of pulmonary vasculature with and without right ventricular strain. In the CTPA cohort, patients with PE had significantly higher D-dimer, prothrombin time, C-reactive protein, troponin, total bilirubin, neutrophils, white cell count and lower albumin compared with non-PE patients. However, there was no difference in the median duration of inpatient stay or mortality. A receiver operator curve analysis demonstrated that D-dimer could discriminate between PE and non-PE COVID-19 patients (area under the curve of 0.79, p < 0.0001). Furthermore, 43% (n = 62/145) of patients with D-dimer >5000 ng/ml had CTPA with PE confirmed in 61% (n = 38/62), that is, 26% of >5000 ng/ml cohort. The sensitivity and specificity were related to D-dimer level; cutoffs of 2000, 3000, 4000, and 5000 ng/ml, respectively, had a sensitivity of 93%, 90%, 90% and 86%, and a specificity of 38%, 54%, 59% and 68%, and if implemented, an additional 229, 141, 106 and 83 CTPAs would be required.

CONCLUSION:

Our data suggested an increased PE prevalence in COVID-19 patients attending ED with an elevated D-dimer, and patients with levels >5000 ng/ml might benefit from CTPA to exclude concomitant PE.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: Ther Adv Hematol Year: 2021 Document Type: Article Affiliation country: 20406207211048364

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: Ther Adv Hematol Year: 2021 Document Type: Article Affiliation country: 20406207211048364