Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study
Background: D-dimer levels are significantly higher in COVID-19 patients with Pulmonary Thromboembolism (PTE) as compared to those without PTE, but its clinical utility is still uncertain. Purpose: To determine the D-dimer performance for ruling out PTE in patients with COVID-19. We also assessed cl...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | Brazilian Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1413867022003944 |
| _version_ | 1828105597537484800 |
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| author | Manoela Astolfi Vivan Brenda Rigatti Sainan Voss da Cunha Guilherme Cristianetti Frison Lucas Quadros Antoniazzi Paulo Henrique Kranz de Oliveira Joao Pedro Souza Oliveira Clara Fontanari Beatriz Graeff Santos Seligman Renato Seligman |
| author_facet | Manoela Astolfi Vivan Brenda Rigatti Sainan Voss da Cunha Guilherme Cristianetti Frison Lucas Quadros Antoniazzi Paulo Henrique Kranz de Oliveira Joao Pedro Souza Oliveira Clara Fontanari Beatriz Graeff Santos Seligman Renato Seligman |
| author_sort | Manoela Astolfi Vivan |
| collection | DOAJ |
| description | Background: D-dimer levels are significantly higher in COVID-19 patients with Pulmonary Thromboembolism (PTE) as compared to those without PTE, but its clinical utility is still uncertain. Purpose: To determine the D-dimer performance for ruling out PTE in patients with COVID-19. We also assessed clinical and laboratory factors associated with the presence of PTE on CT Pulmonary Angiogram (CTPA). Methods: Retrospective study involving all patients who presented at a tertiary care hospital from March 2020 to May 2021 with severe acute respiratory syndrome from COVID-19, who underwent CTPA and had D-dimer collected within 48 hours from CTPA. The D-dimer ability to classify patients with or without PTE according to CTPA was evaluated. Results: A total of 697 patients [382 (54.8%) men; mean (SD) age, 59 (20.5) years] were included, of which 71.5% required intensive care admission, 32.4% had PTE, and 35.6% died during hospitalization. PTE was independently associated with mortality [42.5% vs. 32.3%; p = 0.038]. D-dimer levels were higher in patients with PTE [9.1 (3.9; 20) vs. 2.3 (1.2; 5.1); p < 0.001]. Using the D-dimer cutoff of 0.5 μg/mL or above, sensitivity was 98.2% and specificity 5.7%. The 0.3 μg/mL threshold was associated with 100% of sensitivity for the presence of PTE, with which 99.1% of patients had increased values. ROC curve AUC was 0.77, demonstrating moderate discriminative power of D-dimers to detect PTE. Conclusions: D-dimer levels are higher among COVID-19 hospitalized patients with PTE as compared to those without PTE and have moderate discriminative power to detect PTE, but its use to exclude PTE in this population may have limited clinical utility. |
| first_indexed | 2024-04-11T10:05:34Z |
| format | Article |
| id | doaj.art-cbf236c7dea4434cbd3b0bb461840629 |
| institution | Directory Open Access Journal |
| issn | 1413-8670 |
| language | English |
| last_indexed | 2024-04-11T10:05:34Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Infectious Diseases |
| spelling | doaj.art-cbf236c7dea4434cbd3b0bb4618406292022-12-22T04:30:16ZengElsevierBrazilian Journal of Infectious Diseases1413-86702022-11-01266102702Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective studyManoela Astolfi Vivan0Brenda Rigatti1Sainan Voss da Cunha2Guilherme Cristianetti Frison3Lucas Quadros Antoniazzi4Paulo Henrique Kranz de Oliveira5Joao Pedro Souza Oliveira6Clara Fontanari7Beatriz Graeff Santos Seligman8Renato Seligman9Universidade Federal de Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Cardiologia, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Divisão de Medicina Interna, Porto Alegre, RS, Brazil; Corresponding author.Hospital de Clínicas de Porto Alegre (HCPA), Divisão de Medicina Interna, Porto Alegre, RS, BrazilUniversidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, RS, BrazilUniversidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, RS, BrazilUniversidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, RS, BrazilUniversidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, RS, BrazilUniversidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, RS, BrazilUniversidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, BrazilHospital de Clínicas de Porto Alegre (HCPA), Divisão de Medicina Interna, Porto Alegre, RS, Brazil; Universidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, RS, BrazilHospital de Clínicas de Porto Alegre (HCPA), Divisão de Medicina Interna, Porto Alegre, RS, Brazil; Universidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, RS, BrazilBackground: D-dimer levels are significantly higher in COVID-19 patients with Pulmonary Thromboembolism (PTE) as compared to those without PTE, but its clinical utility is still uncertain. Purpose: To determine the D-dimer performance for ruling out PTE in patients with COVID-19. We also assessed clinical and laboratory factors associated with the presence of PTE on CT Pulmonary Angiogram (CTPA). Methods: Retrospective study involving all patients who presented at a tertiary care hospital from March 2020 to May 2021 with severe acute respiratory syndrome from COVID-19, who underwent CTPA and had D-dimer collected within 48 hours from CTPA. The D-dimer ability to classify patients with or without PTE according to CTPA was evaluated. Results: A total of 697 patients [382 (54.8%) men; mean (SD) age, 59 (20.5) years] were included, of which 71.5% required intensive care admission, 32.4% had PTE, and 35.6% died during hospitalization. PTE was independently associated with mortality [42.5% vs. 32.3%; p = 0.038]. D-dimer levels were higher in patients with PTE [9.1 (3.9; 20) vs. 2.3 (1.2; 5.1); p < 0.001]. Using the D-dimer cutoff of 0.5 μg/mL or above, sensitivity was 98.2% and specificity 5.7%. The 0.3 μg/mL threshold was associated with 100% of sensitivity for the presence of PTE, with which 99.1% of patients had increased values. ROC curve AUC was 0.77, demonstrating moderate discriminative power of D-dimers to detect PTE. Conclusions: D-dimer levels are higher among COVID-19 hospitalized patients with PTE as compared to those without PTE and have moderate discriminative power to detect PTE, but its use to exclude PTE in this population may have limited clinical utility.http://www.sciencedirect.com/science/article/pii/S1413867022003944COVID-19Pulmonary embolismD-dimer |
| spellingShingle | Manoela Astolfi Vivan Brenda Rigatti Sainan Voss da Cunha Guilherme Cristianetti Frison Lucas Quadros Antoniazzi Paulo Henrique Kranz de Oliveira Joao Pedro Souza Oliveira Clara Fontanari Beatriz Graeff Santos Seligman Renato Seligman Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study Brazilian Journal of Infectious Diseases COVID-19 Pulmonary embolism D-dimer |
| title | Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study |
| title_full | Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study |
| title_fullStr | Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study |
| title_full_unstemmed | Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study |
| title_short | Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study |
| title_sort | pulmonary embolism in patients with covid 19 and d dimer diagnostic value a retrospective study |
| topic | COVID-19 Pulmonary embolism D-dimer |
| url | http://www.sciencedirect.com/science/article/pii/S1413867022003944 |
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