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

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: T...

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Autores principales: Quezada-Feijoo, Maribel, Ramos, Mónica, Lozano-Montoya, Isabel, Sarró, Mónica, Cabo Muiños, Verónica, Ayala, Rocío, Gómez-Pavón, Francisco J., Toro, Rocío
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619636/
https://www.ncbi.nlm.nih.gov/pubmed/34830715
http://dx.doi.org/10.3390/jcm10225433
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author Quezada-Feijoo, Maribel
Ramos, Mónica
Lozano-Montoya, Isabel
Sarró, Mónica
Cabo Muiños, Verónica
Ayala, Rocío
Gómez-Pavón, Francisco J.
Toro, Rocío
author_facet Quezada-Feijoo, Maribel
Ramos, Mónica
Lozano-Montoya, Isabel
Sarró, Mónica
Cabo Muiños, Verónica
Ayala, Rocío
Gómez-Pavón, Francisco J.
Toro, Rocío
author_sort Quezada-Feijoo, Maribel
collection PubMed
description 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.
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spelling pubmed-86196362021-11-27 Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study Quezada-Feijoo, Maribel Ramos, Mónica Lozano-Montoya, Isabel Sarró, Mónica Cabo Muiños, Verónica Ayala, Rocío Gómez-Pavón, Francisco J. Toro, Rocío J Clin Med Article 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. MDPI 2021-11-20 /pmc/articles/PMC8619636/ /pubmed/34830715 http://dx.doi.org/10.3390/jcm10225433 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Quezada-Feijoo, Maribel
Ramos, Mónica
Lozano-Montoya, Isabel
Sarró, Mónica
Cabo Muiños, Verónica
Ayala, Rocío
Gómez-Pavón, Francisco J.
Toro, Rocío
Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_full Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_fullStr Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_full_unstemmed Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_short Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_sort elderly population with covid-19 and the accuracy of clinical scales and d-dimer for pulmonary embolism: the octa-covid study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619636/
https://www.ncbi.nlm.nih.gov/pubmed/34830715
http://dx.doi.org/10.3390/jcm10225433
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