Adjusting D-dimer to Lung Disease Extent to Exclude Pulmonary Embolism in COVID-19 Patients (Co-LEAD)

Planquette, Benjamin; Khider, Lina; Berre, Alice Le; Soudet, S.; Pernod, Gilles; Mao, Raphaël Le; Besutti, Matthieu; Gendron, Nicolas; Yannoutsos, Alexandra; Smadja, David M.; Goudot, Guillaume; Kahf, Salma Al; Mohammedi, Nassim; Hamoud, Antoine Al; Philippe, Aurélien; Fournier, Laure; Rance, Bastien; Diehl, Jean‐Luc; Mirault, Tristan; Messas, Emmanuel; Emmerich, Joseph; Chocron, Richard; Couturaud, Francis; Ferreti, Gilbert; Sevestre‐Pietri, Marie‐Antoinette; Meneveau, Nicolas; Châtellier, Gilles; Sanchez, Olivier

doi:10.1055/a-1768-4371

Cited by 8 publications

(12 citation statements)

References 48 publications

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“…In the recently published Co-LEAD study, authors stratified D-dimer levels by the extent of parenchymal lung involvement, concluding two different D-dimer thresholds for continuing to CTPA [ 13 ]. In this study, we sought a similar approach and found that a dichotomous threshold, depending on lung tissue involvement (D-dimer/age > 20 for non-severe lesions, D-dimer/age > 70 for severe lesions), may be diagnostically useful.…”

Section: Discussionmentioning

confidence: 99%

Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients

Machowski

Polańska

Gałecka-Nowak

et al. 2022

JCM

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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, p = 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, p = 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.

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Section: Discussionmentioning

confidence: 99%

Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients

Machowski

Polańska

Gałecka-Nowak

et al. 2022

JCM

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“…20 Several studies advocate the use of higher Ddimer thresholds (between 2500 and 2900 µg/L), or adjusted to computed tomography extent of lung damage, despite a lower sensitivity. 21 Conversely, a recent study used the YEARS algorithm with no D-dimer threshold adjustment, and PE was confirmed in 13% of patients who underwent CTPA. 22 Currently, the ISTH committee recommends standard-of-care objective testing in case of clinical suspicion of VTE (CTPA, ventilation/perfusion scan, magnetic resonance imaging, venography, Doppler ultrasonography).…”

Section: -D Imer Te S Ting In Patients With Cov I D -19mentioning

confidence: 99%

“…Cutoff values for VTE exclusion need to be defined in patients with COVID‐19 20 . Several studies advocate the use of higher D‐dimer thresholds (between 2500 and 2900 µg/L), or adjusted to computed tomography extent of lung damage, despite a lower sensitivity 21 . Conversely, a recent study used the YEARS algorithm with no D‐dimer threshold adjustment, and PE was confirmed in 13% of patients who underwent CTPA 22 .…”

Section: D‐dimer Testing In Patients With Covid‐19mentioning

confidence: 99%

D‐dimer testing in clinical practice in the era of COVID‐19

Auditeau

Khider

Planquette

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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“…COVID-19 susceptibility, severity, and disease outcome reflect an association with gene expression patterns, mutations, deletions, and polymorphisms [8,9]. Some genetic polymorphisms in host ACE1, APOE, and IFITM3 genes demonstrate an increased infection risk, while polymorphisms in ACE2, AGTR1, TMPRSS2, VDR, and TNFA are associated with the severity of disease [10][11][12][13][14][15][16][17]. Studies have also indicated a high infectivity potential and increased severity of COVID-19 in the A blood group serotype, while the O blood group serotype is observed to be protective against infection [18].…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, D-dimer holds promise as a prognostic biomarker, alongside procalcitonin, Creactive protein, and ferritin, for assessing COVID-19 severity. Hence, the difference in the plasma levels of D-dimer can be used to detect underlying comorbidities and co-infections in patients with COVID-19 [15,41,42]. This will help to facilitate clinical management that is both more personalized and more efficient, allowing speedier recovery and significantly reducing the mortality rate.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Stratification of COVID-19 Infections Using Differential Plasma Levels of D-Dimer: A Two-Center Study from Saudi Arabia

Alsrhani

Alshomar

Elderdery

et al. 2023

Microbiology Research

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Background: D-dimer, generated upon the degradation of fibrin, is extensively used to detect thrombosis in various diseases. It is also explored as a marker for thrombosis in cases with COVID-19 disease. Few studies have confirmed its utility as a marker for assessing disease severity. Objectives: The current research was undertaken to determine the role of D-dimer in patients with COVID-19 and to investigate any association with the progression and severity of the disease in the Saudi population. Methods: Clinical indices in confirmed COVID-19 patients were collected from tertiary care hospitals in Aljouf and Qassim regions. The plasma D-dimer levels were quantified directly in the samples collected from COVID-19 patients (n = 148) using an immunofluorescence assay, and the data were presented in Fibrinogen Equivalent Units (mg/L). The collected data of D-dimer were analyzed based on COVID-19 severity, age, and the gender of patients. Results: The findings show that the plasma D-dimer concentrations were significantly (p = 0.0027) elevated in COVID-19 cases (n = 148), compared to in the normal healthy uninfected controls (n = 309). Moreover, the D-dimer levels were analyzed according to the severity of the disease in the patients. The data revealed that D-dimer concentrations were significantly increased in patients with mild infection to moderate disease, and the levels were the highest in patients with severe COVID-19 disease (p < 0.05). Our analysis demonstrates that the D-dimer levels have no association with the age or gender of COVID-19 patients (p > 0.05) in the study population. Conclusions: D-dimer can serve as a biomarker not only for the detection of COVID-19 infection, but also for determining the severity of infection of COVID-19 disease.

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Adjusting D-dimer to Lung Disease Extent to Exclude Pulmonary Embolism in COVID-19 Patients (Co-LEAD)

Cited by 8 publications

References 48 publications

Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients

Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients

D‐dimer testing in clinical practice in the era of COVID‐19

Diagnosis and Stratification of COVID-19 Infections Using Differential Plasma Levels of D-Dimer: A Two-Center Study from Saudi Arabia

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