Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective study

Detalhes bibliográficos
Autor(a) principal: Vivan, Manoela Astolfi
Data de Publicação: 2022
Outros Autores: Rigatti, Brenda, Cunha, Sainan Voss da, Frison, Guilherme Cristianetti, Antoniazzi, Lucas Quadros, Oliveira, Paulo Henrique Kranz de, Oliveira, João Pedro Souza, Fontanari, Clara, Seligman, Beatriz Graeff Santos, Seligman, Renato
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UFRGS
Texto Completo: http://hdl.handle.net/10183/250470
Resumo: Background D-dimer levels are significantly higher in COVID-19 patients with Pulmonary Thromboembolism (PTE) as compared to those without PTE, but its clinical utility is still uncertain. Purpose To determine the D-dimer performance for ruling out PTE in patients with COVID-19. We also assessed clinical and laboratory factors associated with the presence of PTE on CT Pulmonary Angiogram (CTPA). Methods Retrospective study involving all patients who presented at a tertiary care hospital from March 2020 to May 2021 with severe acute respiratory syndrome from COVID-19, who underwent CTPA and had D-dimer collected within 48 hours from CTPA. The D-dimer ability to classify patients with or without PTE according to CTPA was evaluated. Results A total of 697 patients [382 (54.8%) men; mean (SD) age, 59 (20.5) years] were included, of which 71.5% required intensive care admission, 32.4% had PTE, and 35.6% died during hospitalization. PTE was independently associated with mortality [42.5% vs. 32.3%; p = 0.038]. D-dimer levels were higher in patients with PTE [9.1 (3.9; 20) vs. 2.3 (1.2; 5.1); p < 0.001]. Using the D-dimer cutoff of 0.5 μg/mL or above, sensitivity was 98.2% and specificity 5.7%. The 0.3 μg/mL threshold was associated with 100% of sensitivity for the presence of PTE, with which 99.1% of patients had increased values. ROC curve AUC was 0.77, demonstrating moderate discriminative power of D-dimers to detect PTE. Conclusions D-dimer levels are higher among COVID-19 hospitalized patients with PTE as compared to those without PTE and have moderate discriminative power to detect PTE, but its use to exclude PTE in this population may have limited clinical utility.
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spelling Vivan, Manoela AstolfiRigatti, BrendaCunha, Sainan Voss daFrison, Guilherme CristianettiAntoniazzi, Lucas QuadrosOliveira, Paulo Henrique Kranz deOliveira, João Pedro SouzaFontanari, ClaraSeligman, Beatriz Graeff SantosSeligman, Renato2022-10-27T04:52:15Z20221413-8670http://hdl.handle.net/10183/250470001151630Background D-dimer levels are significantly higher in COVID-19 patients with Pulmonary Thromboembolism (PTE) as compared to those without PTE, but its clinical utility is still uncertain. Purpose To determine the D-dimer performance for ruling out PTE in patients with COVID-19. We also assessed clinical and laboratory factors associated with the presence of PTE on CT Pulmonary Angiogram (CTPA). Methods Retrospective study involving all patients who presented at a tertiary care hospital from March 2020 to May 2021 with severe acute respiratory syndrome from COVID-19, who underwent CTPA and had D-dimer collected within 48 hours from CTPA. The D-dimer ability to classify patients with or without PTE according to CTPA was evaluated. Results A total of 697 patients [382 (54.8%) men; mean (SD) age, 59 (20.5) years] were included, of which 71.5% required intensive care admission, 32.4% had PTE, and 35.6% died during hospitalization. PTE was independently associated with mortality [42.5% vs. 32.3%; p = 0.038]. D-dimer levels were higher in patients with PTE [9.1 (3.9; 20) vs. 2.3 (1.2; 5.1); p < 0.001]. Using the D-dimer cutoff of 0.5 μg/mL or above, sensitivity was 98.2% and specificity 5.7%. The 0.3 μg/mL threshold was associated with 100% of sensitivity for the presence of PTE, with which 99.1% of patients had increased values. ROC curve AUC was 0.77, demonstrating moderate discriminative power of D-dimers to detect PTE. Conclusions D-dimer levels are higher among COVID-19 hospitalized patients with PTE as compared to those without PTE and have moderate discriminative power to detect PTE, but its use to exclude PTE in this population may have limited clinical utility.application/pdfengThe Brazilian journal of infectious diseases. Salvador. Vol. 26, no. 6 (2022), 102702, 9 p.COVID-19Embolia pulmonarDiagnósticoPulmonary embolismD-dimerPulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective studyinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/otherinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFRGSinstname:Universidade Federal do Rio Grande do Sul (UFRGS)instacron:UFRGSTEXT001151630.pdf.txt001151630.pdf.txtExtracted Texttext/plain37580http://www.lume.ufrgs.br/bitstream/10183/250470/2/001151630.pdf.txtc8c38f77ee529014d5c6df49d03babf2MD52ORIGINAL001151630.pdfTexto completo (inglês)application/pdf676345http://www.lume.ufrgs.br/bitstream/10183/250470/1/001151630.pdfd60d770ee1c25608a909004a94198250MD5110183/2504702022-10-28 04:48:14.159099oai:www.lume.ufrgs.br:10183/250470Repositório de PublicaçõesPUBhttps://lume.ufrgs.br/oai/requestopendoar:2022-10-28T07:48:14Repositório Institucional da UFRGS - Universidade Federal do Rio Grande do Sul (UFRGS)false
dc.title.pt_BR.fl_str_mv Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective study
title Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective study
spellingShingle Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective study
Vivan, Manoela Astolfi
COVID-19
Embolia pulmonar
Diagnóstico
Pulmonary embolism
D-dimer
title_short Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective study
title_full Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective study
title_fullStr Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective study
title_full_unstemmed Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective study
title_sort Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value : a retrospective study
author Vivan, Manoela Astolfi
author_facet Vivan, Manoela Astolfi
Rigatti, Brenda
Cunha, Sainan Voss da
Frison, Guilherme Cristianetti
Antoniazzi, Lucas Quadros
Oliveira, Paulo Henrique Kranz de
Oliveira, João Pedro Souza
Fontanari, Clara
Seligman, Beatriz Graeff Santos
Seligman, Renato
author_role author
author2 Rigatti, Brenda
Cunha, Sainan Voss da
Frison, Guilherme Cristianetti
Antoniazzi, Lucas Quadros
Oliveira, Paulo Henrique Kranz de
Oliveira, João Pedro Souza
Fontanari, Clara
Seligman, Beatriz Graeff Santos
Seligman, Renato
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Vivan, Manoela Astolfi
Rigatti, Brenda
Cunha, Sainan Voss da
Frison, Guilherme Cristianetti
Antoniazzi, Lucas Quadros
Oliveira, Paulo Henrique Kranz de
Oliveira, João Pedro Souza
Fontanari, Clara
Seligman, Beatriz Graeff Santos
Seligman, Renato
dc.subject.por.fl_str_mv COVID-19
Embolia pulmonar
Diagnóstico
topic COVID-19
Embolia pulmonar
Diagnóstico
Pulmonary embolism
D-dimer
dc.subject.eng.fl_str_mv Pulmonary embolism
D-dimer
description Background D-dimer levels are significantly higher in COVID-19 patients with Pulmonary Thromboembolism (PTE) as compared to those without PTE, but its clinical utility is still uncertain. Purpose To determine the D-dimer performance for ruling out PTE in patients with COVID-19. We also assessed clinical and laboratory factors associated with the presence of PTE on CT Pulmonary Angiogram (CTPA). Methods Retrospective study involving all patients who presented at a tertiary care hospital from March 2020 to May 2021 with severe acute respiratory syndrome from COVID-19, who underwent CTPA and had D-dimer collected within 48 hours from CTPA. The D-dimer ability to classify patients with or without PTE according to CTPA was evaluated. Results A total of 697 patients [382 (54.8%) men; mean (SD) age, 59 (20.5) years] were included, of which 71.5% required intensive care admission, 32.4% had PTE, and 35.6% died during hospitalization. PTE was independently associated with mortality [42.5% vs. 32.3%; p = 0.038]. D-dimer levels were higher in patients with PTE [9.1 (3.9; 20) vs. 2.3 (1.2; 5.1); p < 0.001]. Using the D-dimer cutoff of 0.5 μg/mL or above, sensitivity was 98.2% and specificity 5.7%. The 0.3 μg/mL threshold was associated with 100% of sensitivity for the presence of PTE, with which 99.1% of patients had increased values. ROC curve AUC was 0.77, demonstrating moderate discriminative power of D-dimers to detect PTE. Conclusions D-dimer levels are higher among COVID-19 hospitalized patients with PTE as compared to those without PTE and have moderate discriminative power to detect PTE, but its use to exclude PTE in this population may have limited clinical utility.
publishDate 2022
dc.date.accessioned.fl_str_mv 2022-10-27T04:52:15Z
dc.date.issued.fl_str_mv 2022
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dc.identifier.issn.pt_BR.fl_str_mv 1413-8670
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dc.language.iso.fl_str_mv eng
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dc.relation.ispartof.pt_BR.fl_str_mv The Brazilian journal of infectious diseases. Salvador. Vol. 26, no. 6 (2022), 102702, 9 p.
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