Diagnostic Accuracy of D-Dimers for Predicting Pulmonary Embolism in COVID-19-Patients

Abstract

Importance Proinflammatory and hypercoagulable states with marked elevation seen in D-Dimer levels have been accurately described in patients infected by the SARS- Cov2 even without pulmonary embolism (PE). Objectives To compare D-dimers values in patients infected by the novel Coronavirus 2019 (COVID-19) with and without PE and to establish an optimal D-dimer cut-off to predict the occurrence of PE, which guides pulmonary computed tomography angiography (CTPA) indication. Methods We retrospectively enrolled all COVID-19-patients admitted between October first and November 22th, 2020, at the University Hospital Center of Mohammed VI, Oujda (Morocco), suspected to have PE and underwent a CTPA. Demographic characteristics and blood test results were compared between PE-positive and PE-negative. The receiver operating characteristics (ROC) curve was constructed to establish an optimal D-Dimer cut-off to predict the occurrence of PE. Results The study population consisted of 84 confirmed COVID-19-patients. The mean age was 64.93 years (SD 14.19). PE was diagnosed on CTPA in 31 (36.9%) patients. Clinical symptoms and in-hospital outcomes were similar in both groups except that more men had PE ( p = .025). The median value of D-dimers in the group of patients with PE was significantly higher (14 680[IQR 33620-3450]ng/mL compared to the group of patients without PE 2980[IQR 6870-1600]ng/mL [P < .001]. A D-dimer at 2600 ng/mL was the optimal cut-off for predicting PE with a sensitivity of 90.3%, and AUC was .773[CI 95%, .667 −.876). Conclusion A D-dimer cut-off value of 2600 ng/mL is a significant predictor of PE in COVID-19-patients with a sensitivity of 90.3%.

Roles of spectral dual-layer CT, D-dimer concentration, and COVID-19 pneumonia in diagnosis of pulmonary embolism

“…Another metanalysis by Kwee et al [22] reports higher prevalence (23.9 %) in general wards versus in emergency departments (17.9 %) and intensive care units (48.6 %). Comparable monocentric study by Laounan Brem [23] shows slightly lower prevalence of PE (7.17 %).…”

Revision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 Infection

“…This contradicts the results of our study but can be explained by the fact that these were patients in the ICU where the inflammatory and hypercoagulable component is particularly emphasized independently of PE existence [ 30 ]. Although a significant number of studies have confirmed the association of elevated D-dimer levels with PE in COVID patients, increased D-dimer levels alone cannot be used to confirm PE diagnosis [ 31 , 32 , 33 , 34 ]. This is all the more the case because D-dimer values are increased even in COVID-19 individuals who do not have PE due to thromboinflammation or COVID-19-associated coagulopathy [ 35 , 36 ].…”

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

“…The value of an elevated D-dimer for ruling in concomitant PE in COVID-19 patients is more controversial. A number of studies have derived higher cut-off values [138][139][140][141][142][143][144], above which diagnostic imaging is recommended [138][139][140][141][142][143][144]. However, there is considerable variability in the proposed Ddimer cut-offs (ranging from 1000 to 2903 ng/mL) [138][139][140][141][142][143][144][145][146] with no published consensus on which value should be used clinically.…”

“…A number of studies have derived higher cut-off values [138][139][140][141][142][143][144], above which diagnostic imaging is recommended [138][139][140][141][142][143][144]. However, there is considerable variability in the proposed Ddimer cut-offs (ranging from 1000 to 2903 ng/mL) [138][139][140][141][142][143][144][145][146] with no published consensus on which value should be used clinically. These uncertainties are reflected in the British Thoracic Society guidelines [147], which do not recommend the routine use of high D-Dimer levels in isolation to guide decisions regarding investigation and anticoagulation for venous thromboembolic disease in COVID-19 patients [147].…”