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

Autor: Machowski M; Department of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, Poland., Polańska A; I Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Kniaziewicza 1/5 St., 91-347 Lodz, Poland., Gałecka-Nowak M; Department of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, Poland., Mamzer A; I Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Kniaziewicza 1/5 St., 91-347 Lodz, Poland., Skowrońska M; Department of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, Poland., Perzanowska-Brzeszkiewicz K; Department of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, Poland., Zając B; I Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Kniaziewicza 1/5 St., 91-347 Lodz, Poland., Ou-Pokrzewińska A; Department of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, Poland., Pruszczyk P; Department of Internal Medicine & Cardiology, Medical University of Warsaw, Lindleya 4 St., 02-005 Warsaw, Poland., Kasprzak JD; I Department of Cardiology, Bieganski Hospital, Medical University of Lodz, Kniaziewicza 1/5 St., 91-347 Lodz, Poland.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2022 Jun 09; Vol. 11 (12). Date of Electronic Publication: 2022 Jun 09.
DOI: 10.3390/jcm11123298
Abstrakt: 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.
Databáze: MEDLINE
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