A higher D-dimer threshold for predicting pulmonary embolism in patients with COVID-19: a retrospective study
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ORIGINAL ARTICLE
A higher D-dimer threshold for predicting pulmonary embolism in patients with COVID-19: a retrospective study Sofía Ventura-Díaz 1 & Juan V. Quintana-Pérez 1 & Almudena Gil-Boronat 1 & Marina Herrero-Huertas 1 & Luis Gorospe-Sarasúa 2 & José Montilla 3 & Jóse Acosta-Batlle 2 & Javier Blázquez-Sánchez 1 & Agustina Vicente-Bártulos 3 Received: 4 August 2020 / Accepted: 27 September 2020 # American Society of Emergency Radiology 2020
Abstract Purpose COVID-19 raises D-dimer (DD) levels even in the absence of pulmonary embolism (PE), resulting in an increase in computed tomography pulmonary angiogram (CTPA) requests. Our purpose is to determine whether there are differences between DD values in PE-positive and PE-negative COVID-19 patients and, if so, to establish a new cutoff value which accurately determines when a CTPA is needed. Methods This study retrospectively analyzed all COVID-19 patients who underwent a CTPA due to suspected PE between March 1 and April 30, 2020, at Ramón y Cajal University Hospital, Madrid (Spain). DD level comparisons between PE-positive and PE-negative groups were made using Student’s t test. The optimal DD cutoff value to predict PE risk in COVID-19 patients was calculated in the ROC curve. Results Two hundred forty-two patients were included in the study. One hundred fifty-one (62%) were men and the median age was 68 years (IQR 55–78). An increase of DD (median 3260; IQR 1203–9625 ng/mL) was detected in 205/242 (96%) patients. 73/242 (30%) of the patients were diagnosed with PE on CTPA. The DD median value was significantly higher (p < .001) in the PE-positive group (7872, IQR 3150–22,494 ng/mL) compared with the PE-negative group (2009, IQR 5675–15,705 ng/mL). The optimal cutoff value for DD to predict PE was 2903 ng/mL (AUC was 0.76 [CI 95% 0.69–0.83], sensitivity 81%). The overall mortality rate was 16% (39/242). Conclusion A higher threshold (2903 ng/mL) for D-dimer could predict the risk of PE in COVID-19 patients with a sensitivity of 81%. Keywords COVID-19 . Pulmonary embolism . Computed tomography pulmonary angiogram . D-dimer . Retrospective study
Key points • Pneumonia and coagulation disorders are some of the clinical manifestations of COVID-19. In this regard, coagulation markers such as D-dimer can be increased even in the absence of pulmonary embolism. • D-dimer role in pulmonary embolism (PE) risk estimation in COVID-19 patients is limited. Dyspnea can be present in uncomplicated COVID-19 pneumonia as well as in PE. Elevated D-dimer values could be a normal finding in COVID-19 patients but they could also be a reflection of PE. • A higher D-dimer threshold for pulmonary embolism risk prediction in COVID-19 patients could lead to a reduction in computed tomography pulmonary angiogram requests, avoiding health system overwhelming. * Sofía Ventura-Díaz [email protected]; [email protected] 1
Radiology Department, Ramón y Cajal University Hospital Ctra, de Colmenar Viejo km. 9,100, 28034 Madrid, Spain
2
Radiology Department, Chest Radiolog
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