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

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 a...

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Autores principales: Machowski, Michał, Polańska, Anna, Gałecka-Nowak, Magdalena, Mamzer, Aleksandra, Skowrońska, Marta, Perzanowska-Brzeszkiewicz, Katarzyna, Zając, Barbara, Ou-Pokrzewińska, Aisha, Pruszczyk, Piotr, Kasprzak, Jarosław D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9224854/
https://www.ncbi.nlm.nih.gov/pubmed/35743369
http://dx.doi.org/10.3390/jcm11123298
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author Machowski, Michał
Polańska, Anna
Gałecka-Nowak, Magdalena
Mamzer, Aleksandra
Skowrońska, Marta
Perzanowska-Brzeszkiewicz, Katarzyna
Zając, Barbara
Ou-Pokrzewińska, Aisha
Pruszczyk, Piotr
Kasprzak, Jarosław D.
author_facet Machowski, Michał
Polańska, Anna
Gałecka-Nowak, Magdalena
Mamzer, Aleksandra
Skowrońska, Marta
Perzanowska-Brzeszkiewicz, Katarzyna
Zając, Barbara
Ou-Pokrzewińska, Aisha
Pruszczyk, Piotr
Kasprzak, Jarosław D.
author_sort Machowski, Michał
collection PubMed
description 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.
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spelling pubmed-92248542022-06-24 Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients Machowski, Michał Polańska, Anna Gałecka-Nowak, Magdalena Mamzer, Aleksandra Skowrońska, Marta Perzanowska-Brzeszkiewicz, Katarzyna Zając, Barbara Ou-Pokrzewińska, Aisha Pruszczyk, Piotr Kasprzak, Jarosław D. J Clin Med Article 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. MDPI 2022-06-09 /pmc/articles/PMC9224854/ /pubmed/35743369 http://dx.doi.org/10.3390/jcm11123298 Text en © 2022 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
Machowski, Michał
Polańska, Anna
Gałecka-Nowak, Magdalena
Mamzer, Aleksandra
Skowrońska, Marta
Perzanowska-Brzeszkiewicz, Katarzyna
Zając, Barbara
Ou-Pokrzewińska, Aisha
Pruszczyk, Piotr
Kasprzak, Jarosław D.
Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients
title Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients
title_full Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients
title_fullStr Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients
title_full_unstemmed Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients
title_short Age-Adjusted D-Dimer Levels May Improve Diagnostic Assessment for Pulmonary Embolism in COVID-19 Patients
title_sort age-adjusted d-dimer levels may improve diagnostic assessment for pulmonary embolism in covid-19 patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9224854/
https://www.ncbi.nlm.nih.gov/pubmed/35743369
http://dx.doi.org/10.3390/jcm11123298
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