Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients
Introduction: SARS-CoV-2 infection leads to a hypercoagulable state. The prevalence of pulmonary embolism (PE) seems to be higher in this subgroup of patients. Patients and methods: We combined data from two tertiary referral centers specialized in the management of PE. The aims of this study were a...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/12/3298 |
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| author | Michał Machowski Anna Polańska Magdalena Gałecka-Nowak Aleksandra Mamzer Marta Skowrońska Katarzyna Perzanowska-Brzeszkiewicz Barbara Zając Aisha Ou-Pokrzewińska Piotr Pruszczyk Jarosław D. Kasprzak |
| author_facet | Michał Machowski Anna Polańska Magdalena Gałecka-Nowak Aleksandra Mamzer Marta Skowrońska Katarzyna Perzanowska-Brzeszkiewicz Barbara Zając Aisha Ou-Pokrzewińska Piotr Pruszczyk Jarosław D. Kasprzak |
| author_sort | Michał Machowski |
| collection | DOAJ |
| description | Introduction: SARS-CoV-2 infection leads to a hypercoagulable state. The prevalence of pulmonary embolism (PE) seems to be higher in this subgroup of patients. Patients and methods: We combined data from two tertiary referral centers specialized in the management of PE. The aims of this study were as follows: (1) to evaluate the prevalence of PE among a large population of consecutive patients admitted for COVID-19 pneumonia in two centers, (2) to identify a plasma D-dimer threshold that may be useful in PE diagnostic assessment, (3) to characterize the abnormalities associated with PE and mortality in COVID-19 patients. Results: The incidence of symptomatic acute PE was 19.3%. For diagnosing PE in COVID-19 patients, based on ROC curve analysis, we identified a D-dimer concentration/patient’s age ratio of 70, which improved D-dimer diagnostic capacity for PE and led to a reclassification improvement of 14% (NRI 0.14, <i>p</i> = 0.03) when compared to a cut-off level of 1000 ng/mL. Especially in severe COVID-19 lung involvement, D-dimer/age ratio cut-off equal to 70 was characterized by high diagnostic feasibility (sensitivity, specificity, negative predictive value, positive predictive value of 83%, 94%, 96%, and 73%, respectively). Apart from PE status, lung involvement and troponin T concentration were also independent predictors of in-hospital mortality. In the subgroup of PE patients, mortality was comparable with non-PE patients (19/88 (21.5%) vs. 101/368 (27.4%) for non-PE, <i>p</i> = 0.26) and was associated with older age, higher Bova scores, and higher troponin T concentrations. Age was the sole independent predictor for mortality in this subgroup. Conclusions: PE in COVID-19 patients is common, but it may not influence mortality when managed at a specialized center. In suspected PE, age-adjusted D-dimer levels (upper limit of normal obtained from the formula patient’s age × 70) may still be a useful tool to start the diagnostic workup. In COVID-19 patients without PE, older age, more extensive parenchymal involvement, or higher D-dimer levels are factors predicting mortality. |
| first_indexed | 2024-03-09T23:28:02Z |
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| id | doaj.art-297a521fe90a4d85b89b373ed284ff43 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:28:02Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-297a521fe90a4d85b89b373ed284ff432023-11-23T17:13:40ZengMDPI AGJournal of Clinical Medicine2077-03832022-06-011112329810.3390/jcm11123298Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 PatientsMichał Machowski0Anna Polańska1Magdalena Gałecka-Nowak2Aleksandra Mamzer3Marta Skowrońska4Katarzyna Perzanowska-Brzeszkiewicz5Barbara Zając6Aisha Ou-Pokrzewińska7Piotr Pruszczyk8Jarosław D. Kasprzak9Department of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, PolandI Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Kniaziewicza 1/5 St., 91-347 Lodz, PolandDepartment of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, PolandI Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Kniaziewicza 1/5 St., 91-347 Lodz, PolandDepartment of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, PolandDepartment of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, PolandI Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Kniaziewicza 1/5 St., 91-347 Lodz, PolandDepartment of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, PolandDepartment of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, PolandI Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Kniaziewicza 1/5 St., 91-347 Lodz, PolandIntroduction: SARS-CoV-2 infection leads to a hypercoagulable state. The prevalence of pulmonary embolism (PE) seems to be higher in this subgroup of patients. Patients and methods: We combined data from two tertiary referral centers specialized in the management of PE. The aims of this study were as follows: (1) to evaluate the prevalence of PE among a large population of consecutive patients admitted for COVID-19 pneumonia in two centers, (2) to identify a plasma D-dimer threshold that may be useful in PE diagnostic assessment, (3) to characterize the abnormalities associated with PE and mortality in COVID-19 patients. Results: The incidence of symptomatic acute PE was 19.3%. For diagnosing PE in COVID-19 patients, based on ROC curve analysis, we identified a D-dimer concentration/patient’s age ratio of 70, which improved D-dimer diagnostic capacity for PE and led to a reclassification improvement of 14% (NRI 0.14, <i>p</i> = 0.03) when compared to a cut-off level of 1000 ng/mL. Especially in severe COVID-19 lung involvement, D-dimer/age ratio cut-off equal to 70 was characterized by high diagnostic feasibility (sensitivity, specificity, negative predictive value, positive predictive value of 83%, 94%, 96%, and 73%, respectively). Apart from PE status, lung involvement and troponin T concentration were also independent predictors of in-hospital mortality. In the subgroup of PE patients, mortality was comparable with non-PE patients (19/88 (21.5%) vs. 101/368 (27.4%) for non-PE, <i>p</i> = 0.26) and was associated with older age, higher Bova scores, and higher troponin T concentrations. Age was the sole independent predictor for mortality in this subgroup. Conclusions: PE in COVID-19 patients is common, but it may not influence mortality when managed at a specialized center. In suspected PE, age-adjusted D-dimer levels (upper limit of normal obtained from the formula patient’s age × 70) may still be a useful tool to start the diagnostic workup. In COVID-19 patients without PE, older age, more extensive parenchymal involvement, or higher D-dimer levels are factors predicting mortality.https://www.mdpi.com/2077-0383/11/12/3298acute pulmonary embolismvenous thromboembolic diseaseCOVID-19COVID-19-associated coagulopathy |
| spellingShingle | Michał Machowski Anna Polańska Magdalena Gałecka-Nowak Aleksandra Mamzer Marta Skowrońska Katarzyna Perzanowska-Brzeszkiewicz Barbara Zając Aisha Ou-Pokrzewińska Piotr Pruszczyk Jarosław D. Kasprzak Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients Journal of Clinical Medicine acute pulmonary embolism venous thromboembolic disease COVID-19 COVID-19-associated coagulopathy |
| title | Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients |
| title_full | Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients |
| title_fullStr | Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients |
| title_full_unstemmed | Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients |
| title_short | Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients |
| title_sort | age adjusted d dimer levels may improve diagnostic assessment for pulmonary embolism in covid 19 patients |
| topic | acute pulmonary embolism venous thromboembolic disease COVID-19 COVID-19-associated coagulopathy |
| url | https://www.mdpi.com/2077-0383/11/12/3298 |
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