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

Autor: Quezada-Feijoo M; Cardiology Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain.; Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain., Ramos M; Cardiology Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain.; Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain., Lozano-Montoya I; Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain.; Geriatric Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain., Sarró M; Radiology Departament, Hospital Central de La Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain., Cabo Muiños V; Biochemistry Laboratory, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain., Ayala R; Cardiology Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain.; Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain., Gómez-Pavón FJ; Facultad de Medicina, Universidad Alfonso X El Sabio, Avda. De la Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain.; Geriatric Departament, Hospital Central de la Cruz Roja, C/Reina Victoria, 24, 28003 Madrid, Spain., Toro R; Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Av/Ana de Viya 21, 11009 Cádiz, Spain.; Medicine Department, School of Medicine, Cádiz University, Edificio Andrés Segovia 30 Floor, C/Dr Marañón S/N, 21001 Cádiz, Spain.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2021 Nov 20; Vol. 10 (22). Date of Electronic Publication: 2021 Nov 20.
DOI: 10.3390/jcm10225433
Abstrakt: 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.
Databáze: MEDLINE
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