Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study

Abstract

Background: Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in this population. Methods: This was a longitudinal, observational study that included patients ≥75 years old with COVID-19 and suspected PE. The performances of the Wells score, revised Geneva score and DD levels were assessed. The combinations of the DD level and the clinical scales were evaluated using positive rules for higher specificity. Results: Among 305 patients included in the OCTA-COVID study cohort, 50 had suspected PE based on computed tomography pulmonary arteriography (CTPA), and the prevalence was 5.6%. The frequencies of PE in the low-, intermediate- and high-probability categories were 5.9%, 88.2% and 5.9% for the Geneva model and 35.3%, 58.8% and 5.9% for the Wells model, respectively. The DD median was higher in the PE group (4.33 mg/L; interquartile range (IQR) 2.40–7.17) than in the no PE group (1.39 mg/L; IQR 1.01–2.75) (p < 0.001). The area under the curve (AUC) for DD was 0.789 (0.652–0.927). After changing the cutoff point for DD to 4.33 mg/L, the specificity increased from 42.5% to 93.9%. Conclusions: The cutoff point DD > 4.33 mg/L has an increased specificity, which can discriminate false positives. The addition of the DD and the clinical probability scales increases the specificity and negative predictive value, which helps to avoid unnecessary invasive tests in this population.

Coagulation parameters predict COVID-19-related thrombosis in a neural network with a positive predictive value of 98%

“…Interestingly, the mortality rate in subjects with COVID-19 related thrombosis is lower than the mortality rate in patients without thrombosis. This was proposed to be attributable to differences in age and treatment between the groups ( 20 , 31 ) as older individuals are known to be at risk for severe COVID-19 complications ( 32 ), including thrombosis ( 33 ).…”

A comparison of clinical characteristics between old and oldest-old patients hospitalised for SARS-COV2

“…This could be partially explained by doctors' lack of awareness of thromboembolic complications of COVID-19 during the first stage of the pandemic. Moreover, the critical situation of older patients may have reduced referrals for a thoracic CT angioscan [25].…”

SARS-CoV-2 infection induces the production of autoantibodies in severe COVID-19 patients in an age-dependent manner

“…The well-documented observation that anti-cardiolipin 81 and anti-platelet antibodies 82 increase the risk of thrombosis-related events such as pulmonary thromboembolism and deep vein thrombosis 83,84 is also true for COVID-19 patients 11,21,24,[85][86][87] . Thus, our findings could provide new insights into the complex pathophysiology of COVID-19, such as the thrombosisrelated pathological events occurring with increased frequency in elderly individuals with SARS-CoV-2 infection.…”