D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19

Logothetis, Constantine; Weppelmann, Thomas A.; Jordan, Aryanna; Hanna, Catherine; Zhang, Sherry; Charkowick, Shaun; Oxner, Asa

doi:10.1001/jamanetworkopen.2021.28802

Cited by 22 publications

(25 citation statements)

References 7 publications

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“…Unfortunately, both these tools are affected by low sensitivity or specificity in case of COVID-19. Indeed, Wells score in COVID-19 patients is reliable only when it is equal or superior to 4 while D-Dimer assay needs a higher threshold than not-COVID patients to achieve a satisfactory specificity [ 5 , 6 ]. Thus, other predictive markers are needed for address suspicion of aPE in COVID-19 patients and reduce the risk of short-term events.…”

Section: Introductionmentioning

confidence: 99%

The Predictive Value of Cell Blood Count Parameters to Diagnose Pulmonary Embolism in Patients with SARS-CoV-2 Infection: A Case Control Study

Strazzulla¹,

Halima²,

Chouchane³

et al. 2022

Antibiotics

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Introduction: Acute pulmonary embolism (aPE) is frequently associated with coronavirus infectious disease-2019 (COVID-19) with an incidence of more than 16%. Among the new promising biomarkers of aPE, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) showed correlations with aPE prognosis. The aim of this study was to conduct an exploratory analysis to check the possible role of cell blood count (CBC) parameters as diagnostic and prognostic biomarkers of aPE in COVID-19 patients. Materials and Methods: A case control study was conducted. Two populations were compared: (i) patients hospitalised from 31 January 2020 to 30 June 2021 with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection and aPE confirmed at angio computed tomography (aCT) or pulmonary scintigraphy (COVID-19 aPE group); (ii) patients hospitalised from 31 January 2017 to 30 June 2021 without SARS-CoV-2 infection whose suspicion of aPE was excluded by aCT or pulmonary scintigraphy (no-aPE group). Results: Overall, 184 patients were included in the study, 83 in COVID-19 aPE group and 101 in no-aPE group. At the univariate analysis, COVID-19 patients with aPE had higher NLR, PLR, neutrophil and lymphocyte counts than patients without aPE (p < 0.05). No significant difference was found in mean platelet volume and platelet counts. No difference in mortality rate was detected. At the multivariate analysis, neutrophil and lymphocyte counts were both associated with diagnostic of aPE while no CBC parameters were associated with mortality at day#7. Conclusions: Neutrophiland lymphocyte counts could be predictors of the early detection of aPE in COVID-19 patients. The value of CBC indices as biomarkers of aPE in daily clinical practice needs to be investigated in further studies.

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Section: Introductionmentioning

confidence: 99%

The Predictive Value of Cell Blood Count Parameters to Diagnose Pulmonary Embolism in Patients with SARS-CoV-2 Infection: A Case Control Study

Strazzulla¹,

Halima²,

Chouchane³

et al. 2022

Antibiotics

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“…In the first study, a level of 3.0 µg/mL had a sensitivity of 70.0%, specificity of 96.7% with a positive predictive value of 87.5% for underlying thrombosis 6. In the second study, a level >2.5 µg/mL had a sensitivity of 63% and a specificity of 85% for the diagnosis of PE 7…”

Section: Introductionmentioning

confidence: 95%

“…6 In the second study, a level >2.5 µg/mL had a sensitivity of 63% and a specificity of 85% for the diagnosis of PE. 7 The elevated thrombotic risk of males relative to females was well established in the medical literature long before the emergence of COVID-19. In multiple studies of unprovoked deep vein thrombosis (DVT) and PE where hereditary thrombophilia was excluded, the rate of recurrent thrombosis in males has been reported to be anywhere from two to more than three times higher than females.…”

Section: Open Accessmentioning

confidence: 99%

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Contribution of the elevated thrombosis risk of males to the excess male mortality observed in COVID-19: an observational study

et al. 2022

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BackgroundThe mortality rate of COVID-19 is elevated in males compared with females.ObjectiveDetermine the extent that the elevated thrombotic risk in males relative to females contributes to excess COVID-19 mortality in males.DesignObservational study.SettingData sourced from electronic medical records from over 200 US hospital systems.Participants60 877 patients aged 18 years and older hospitalised with COVID-19.ExposureExposure variable: biological sex; key variable of interest: thrombosis.Primary outcome measuresPrimary outcome was COVID-19 mortality. We measured: (1) mortality rate of males relative to females, (2) rate of thrombotic diagnoses occurring during hospitalisation for COVID-19 in both sexes and (3) mortality rate when evidence of thrombosis was present.ResultsThe COVID-19 mortality rate of males was 29.9% higher than that of females. Males had a 35.8% higher rate of receiving a thrombotic diagnosis compared with females. The mortality rate of all patients with a thrombotic diagnosis was 40.0%—over twice that of patients with COVID-19 without a thrombotic diagnosis (adjusted OR 2.50 (2.37 to 2.64), p<0.001). When defining thrombosis as either a documented thrombotic diagnosis or a D-dimer level ≥3.0 µg/mL, 16.4% of the excess mortality in male patients could be explained by increased thrombotic risk.ConclusionsOur findings suggest the higher COVID-19 mortality rate in males may be significantly accounted for by the elevated risk of thrombosis among males. Understanding the mechanisms that underlie increased male thrombotic risk may allow for the advancement of effective anticoagulation strategies that reduce COVID-19 mortality in males.

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“…6 In the second study, a level >2.5 ug/mL had a sensitivity of 63% and a speci city of 85% for the diagnosis of pulmonary embolism. 7 The elevated thrombotic risk of males relative to females was well-established in the medical literature long before the emergence of COVID-19. In multiple studies of unprovoked deep venous thrombosis and pulmonary embolus (DVT/PE) where hereditary thrombophilia was excluded, the rate of recurrent thrombosis in males has been reported to be anywhere from two to more than three times higher than females.…”

Section: Introductionmentioning

confidence: 99%

Contribution of the Elevated Thrombosis Risk of Males to the Excess Male Mortality Observed in COVID-19: An Observational Study

Cohen

BSAE

Ren

et al. 2021

Preprint

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Background: The mortality rate of COVID-19 is elevated in males compared to females.Objective: Determine the extent that the elevated thrombotic risk in males relative to females contributes to excess COVID-19 mortality in males.Design: Observational study.Setting: Data sourced from electronic medical records from over 200 US hospital systems.Participants: 60,877 patients hospitalized with COVID-19.Exposure: Exposure variable: biological sex; key variable of interest: thrombosis.Main outcome measures: Primary outcome was COVID-19 mortality. We measured: 1) mortality rate of males relative to females, 2) rate of thrombotic diagnoses occurring during hospitalization for COVID-19 in both sexes, and 3) mortality rate when evidence of thrombosis was present.Results: The COVID-19 mortality rate of males was 29.9% higher than that of females. Males had a 35.8% higher rate of receiving a thrombotic diagnosis compared to females. The mortality rate of all patients with a thrombotic diagnosis was 40.0%— over twice that of COVID-19 patients without a thrombotic diagnosis (adjusted OR 2.50 [2.37 to 2.64], p-value < .001). When defining thrombosis as either a documented thrombotic diagnosis or a D-dimer level ≥ 3.0 μg/mL, 16.4% of the excess mortality in male patients could be explained by increased thrombotic risk. Conclusions and Relevance: Our findings suggest the higher COVID-19 mortality rate in males may be significantly accounted for by the elevated risk for thrombosis among males. Understanding the mechanisms that underlie increased male thrombotic risk may allow for the advancement of effective anticoagulation strategies that reduce COVID-19 mortality in males.

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D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19

Cited by 22 publications

References 7 publications

The Predictive Value of Cell Blood Count Parameters to Diagnose Pulmonary Embolism in Patients with SARS-CoV-2 Infection: A Case Control Study

The Predictive Value of Cell Blood Count Parameters to Diagnose Pulmonary Embolism in Patients with SARS-CoV-2 Infection: A Case Control Study

Contribution of the elevated thrombosis risk of males to the excess male mortality observed in COVID-19: an observational study

Contribution of the Elevated Thrombosis Risk of Males to the Excess Male Mortality Observed in COVID-19: An Observational Study

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