Revision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 Infection
Background: The need for computed tomography pulmonary angiography (CTPA) to rule out pulmonary embolism (PE) is based on clinical scores in association with D-dimer measurements. PE is a recognized complication in patients with SARS-CoV-2 infection due to a pro-thrombotic state which may reduce the...
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| Format: | Article |
| Language: | English |
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IMR Press
2023-01-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/24/1/10.31083/j.rcm2401018 |
| _version_ | 1797937842159091712 |
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| author | Mijo Meter Ognjen Barcot Irena Jelicic Ivana Gavran Ivan Skopljanac Mate Zvonimir Parcina Kresimir Dolic Mirela Pavicic Ivelja |
| author_facet | Mijo Meter Ognjen Barcot Irena Jelicic Ivana Gavran Ivan Skopljanac Mate Zvonimir Parcina Kresimir Dolic Mirela Pavicic Ivelja |
| author_sort | Mijo Meter |
| collection | DOAJ |
| description | Background: The need for computed tomography pulmonary angiography (CTPA) to rule out pulmonary embolism (PE) is based on clinical scores in association with D-dimer measurements. PE is a recognized complication in patients with SARS-CoV-2 infection due to a pro-thrombotic state which may reduce the usefulness of preexisting pre-test probability scores. Aim: The purpose was to analyze new clinical and laboratory parameters while comparing existing and newly proposed scoring system for PE detection in hospitalized COVID-19 patients (HCP). Methods: We conducted a retrospective study of 270 consecutive HCPs who underwent CTPA due to suspected PE. The Modified Wells, Revised Geneva, Simplified Geneva, YEARS, 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS), and PE rule-out criteria (PERC) scores were calculated and the area under the receiver operating characteristic curve (AuROC) was measured. Results: Overall incidence of PE among our study group of HCPs was 28.1%. The group of patients with PE had a significantly longer COVID-19 duration upon admission, at 10 vs 8 days, p = 0.006; higher D-dimer levels of 10.2 vs 5.3 μg/L, p < 0.001; and a larger proportion of underlying chronic kidney disease, at 16% vs 7%, p = 0.041. From already established scores, only 4PEPS and the modified Wells score reached statistical significance in detecting the difference between the HCP groups with or without PE. We proposed a new chronic kidney disease, D-dimers, 10 days of illness before admission (CDD-10) score consisting of the three aforementioned variables: C as chronic kidney disease (0.5 points if present), D as D-dimers (negative 1.5 points if normal, 2 points if over 10.0 μg/L), and D-10 as day-10 of illness carrying 2 points if lasting more than 10 days before admission or 1 point if longer than 8 days. The CDD-10 score ranged from –1.5 to 4.5 and had an AuROC of 0.672, p < 0.001 at cutoff value at 0.5 while 4PEPS score had an AuROC of 0.638 and Modified Wells score 0.611. The clinical probability of PE was low (0%) when the CDD-10 value was negative, moderate (24%) for CDD-10 ranging 0–2.5 and high (43%) when over 2.5. Conclusions: Better risk stratification is needed for HCPs who require CTPA for suspected PE. Our newly proposed CDD-10 score demonstrates the best accuracy in predicting PE in patients hospitalized for SARS-CoV-2 infection. |
| first_indexed | 2024-04-10T18:50:35Z |
| format | Article |
| id | doaj.art-9f28a3a799bf43048b8ce5117bde9cdd |
| institution | Directory Open Access Journal |
| issn | 1530-6550 |
| language | English |
| last_indexed | 2024-04-10T18:50:35Z |
| publishDate | 2023-01-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj.art-9f28a3a799bf43048b8ce5117bde9cdd2023-02-01T07:32:12ZengIMR PressReviews in Cardiovascular Medicine1530-65502023-01-012411810.31083/j.rcm2401018S1530-6550(22)00816-XRevision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 InfectionMijo Meter0Ognjen Barcot1Irena Jelicic2Ivana Gavran3Ivan Skopljanac4Mate Zvonimir Parcina5Kresimir Dolic6Mirela Pavicic Ivelja7Department of Cardiology, University Hospital of Split, 21000 Split, CroatiaDepartment of Surgery, University Hospital of Split, 21000 Split, CroatiaDepartment of Infectious Diseases, University Hospital of Split, 21000 Split, CroatiaDepartment of Cardiology, University Hospital of Split, 21000 Split, CroatiaDepartment of Pulmology, University Hospital of Split, 21000 Split, CroatiaDepartment of Cardiology, University Hospital of Split, 21000 Split, CroatiaDepartment of Radiology, University Hospital of Split, 21000 Split, CroatiaDepartment of Infectious Diseases, University Hospital of Split, 21000 Split, CroatiaBackground: The need for computed tomography pulmonary angiography (CTPA) to rule out pulmonary embolism (PE) is based on clinical scores in association with D-dimer measurements. PE is a recognized complication in patients with SARS-CoV-2 infection due to a pro-thrombotic state which may reduce the usefulness of preexisting pre-test probability scores. Aim: The purpose was to analyze new clinical and laboratory parameters while comparing existing and newly proposed scoring system for PE detection in hospitalized COVID-19 patients (HCP). Methods: We conducted a retrospective study of 270 consecutive HCPs who underwent CTPA due to suspected PE. The Modified Wells, Revised Geneva, Simplified Geneva, YEARS, 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS), and PE rule-out criteria (PERC) scores were calculated and the area under the receiver operating characteristic curve (AuROC) was measured. Results: Overall incidence of PE among our study group of HCPs was 28.1%. The group of patients with PE had a significantly longer COVID-19 duration upon admission, at 10 vs 8 days, p = 0.006; higher D-dimer levels of 10.2 vs 5.3 μg/L, p < 0.001; and a larger proportion of underlying chronic kidney disease, at 16% vs 7%, p = 0.041. From already established scores, only 4PEPS and the modified Wells score reached statistical significance in detecting the difference between the HCP groups with or without PE. We proposed a new chronic kidney disease, D-dimers, 10 days of illness before admission (CDD-10) score consisting of the three aforementioned variables: C as chronic kidney disease (0.5 points if present), D as D-dimers (negative 1.5 points if normal, 2 points if over 10.0 μg/L), and D-10 as day-10 of illness carrying 2 points if lasting more than 10 days before admission or 1 point if longer than 8 days. The CDD-10 score ranged from –1.5 to 4.5 and had an AuROC of 0.672, p < 0.001 at cutoff value at 0.5 while 4PEPS score had an AuROC of 0.638 and Modified Wells score 0.611. The clinical probability of PE was low (0%) when the CDD-10 value was negative, moderate (24%) for CDD-10 ranging 0–2.5 and high (43%) when over 2.5. Conclusions: Better risk stratification is needed for HCPs who require CTPA for suspected PE. Our newly proposed CDD-10 score demonstrates the best accuracy in predicting PE in patients hospitalized for SARS-CoV-2 infection.https://www.imrpress.com/journal/RCM/24/1/10.31083/j.rcm2401018pulmonary embolismsars-cov-2 infectionpre-test probability scores |
| spellingShingle | Mijo Meter Ognjen Barcot Irena Jelicic Ivana Gavran Ivan Skopljanac Mate Zvonimir Parcina Kresimir Dolic Mirela Pavicic Ivelja Revision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 Infection Reviews in Cardiovascular Medicine pulmonary embolism sars-cov-2 infection pre-test probability scores |
| title | Revision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 Infection |
| title_full | Revision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 Infection |
| title_fullStr | Revision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 Infection |
| title_full_unstemmed | Revision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 Infection |
| title_short | Revision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 Infection |
| title_sort | revision of clinical pre test probability scores in hospitalized patients with pulmonary embolism and sars cov 2 infection |
| topic | pulmonary embolism sars-cov-2 infection pre-test probability scores |
| url | https://www.imrpress.com/journal/RCM/24/1/10.31083/j.rcm2401018 |
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