Predicting pulmonary embolism in patients infected with COVID-19 based on D-dimer levels and days between diagnosis of the infection and D-dimer determination

https://doi.org/10.4081/monaldi.2021.1622

Authors

Abstract

Ruling out pulmonary embolism (PE) can be challenging in a situation of elevated D-dimer values such as in a case of COVID-19 infection. Our objective was to evaluate the difference in D-dimer values of subjects infected with COVID-19 in those with PE and those without and to analyze the predictive value of D-dimer for PE in these subjects based on the day of D-dimer determination. This was an observational, retrospective study, conducted at a tertiary hospital. All subjects with PCR-confirmed COVID-19 infection requiring hospital admission at our institution between the months of March and April 2020 were included in the study. We compared D-dimer levels in subjects who went on to develop a PE and those who did not. We then created a model to predict the subsequent development of a PE with the current D-dimer levels of the subject. D-dimer levels changed over time from COVID-19 diagnosis, but were always higher in subjects who went on to develop a PE. Regarding the predictive model created, the area under the curve of the ROC analyses of the cross-validation predictions was 0.72. The risk of pulmonary embolism for the same D-dimer levels varied depending on the number of days elapsed since COVID-19 diagnosis and D-dimer determination. To conclude, D-dimer levels were elevated in subjects with a COVID-19 infection, especially in those with PE. D-dimer levels increased during the first 10 days after the diagnosis of the infection and can be used to predict the risk of PE in COVID-19 subjects.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

References

Driggin E, Madhavan MV, Bikdeli B, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Cardiol. 2020;75:2352-71. DOI: https://doi.org/10.1016/j.jacc.2020.03.031

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020 28;395:1054-1062. DOI: https://doi.org/10.1016/S0140-6736(20)30566-3

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18:844-7. DOI: https://doi.org/10.1111/jth.14768

Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020;18:1094-9. DOI: https://doi.org/10.1111/jth.14817

Kline JA. Diagnosis and exclusion of pulmonary embolism. Thromb Res 2018;163:207-20. DOI: https://doi.org/10.1016/j.thromres.2017.06.002

Fan BE, Chong VCL, Chan SSW, et al. Hematologic parameters in patients with COVID-19 infection. Am Hematol 2020;95:e131-4. DOI: https://doi.org/10.1002/ajh.25847

Leonard-Lorant I, Delabranche X, Severac F, et al. Acute pulmonary embolism in COVID-19 patients on CT angiography and relationship to D-dimer levels. Radiology 2020;296:e189-91. DOI: https://doi.org/10.1148/radiol.2020201561

Garcia-Olive I, Sintes H, Radua J, et al. D-dimer in patients infected with COVID-19 and suspected pulmonary embolism. Respir Med 2020;169:106023. DOI: https://doi.org/10.1016/j.rmed.2020.106023

Tobin J. Estimation of relationships for limited dependent variables. Econometrica 1958;26:24–36. DOI: https://doi.org/10.2307/1907382

Cleveland WS. LOWESS: A program for smoothing scatterplots by robust locally weighted regression. American Statistician 1981;35:54. DOI: https://doi.org/10.2307/2683591

Yee TW. The VGAM Package for Categorical Data Analysis. J Stat Softw 2010;32:1-34. DOI: https://doi.org/10.18637/jss.v032.i10

Robin X, Turck N, Hainard A, et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 2011;12:77. DOI: https://doi.org/10.1186/1471-2105-12-77

Ranucci M, Ballotta A, Di Dedda U, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost 2020;18:1747-51. DOI: https://doi.org/10.1111/jth.14854

Artifoni M, Danic G, Gautier G, et al. Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors. J Thromb Thrombolysis 2020;1‐6. [Epub ahead of print] DOI: https://doi.org/10.1007/s11239-020-02146-z

Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020;191:9‐14. DOI: https://doi.org/10.1016/j.thromres.2020.04.024

Cui S, Chen S, Li X, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost 2020;18:1421-4. DOI: https://doi.org/10.1111/jth.14830

Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Throm Res 2020;191:145-7. DOI: https://doi.org/10.1016/j.thromres.2020.04.013

Llitjos JF, Leclerc M, Chocois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost 2020;18:1743-6. DOI: https://doi.org/10.1111/jth.14869

Klok FA, Kruip MJHA, van der Meer NJM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: And updated analysis. Throm Res 2020;191:148-50. DOI: https://doi.org/10.1016/j.thromres.2020.04.041

Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 2020;46:1089-98. DOI: https://doi.org/10.1007/s00134-020-06062-x

Stoneham SM, Milne KM, Nuttal E, et al. Thrombotic risk in COVID-19: a case series and case-control studies. Clin Med 2020;20:e76-81. DOI: https://doi.org/10.7861/clinmed.2020-0228

Downloads

Published
2021-03-11
Info
Issue
Section
COVID-19 - Collection of articles on the Coronavirus outbreak
Keywords:
Coronavirus, Covid-19 , D-dimer, pulmonary embolism, thromboembolic disease
Statistics
  • Abstract views: 295

  • PDF: 279
How to Cite
Garcia-Olivé, Ignasi, Helena Sintes, Joaquim Radua, Jordi Deportos, Isabel Nogueira, Cristian Morales-Indiano, Jorge Abad Capa, and Antoni Rosell. 2021. “Predicting Pulmonary Embolism in Patients Infected With COVID-19 Based on D-Dimer Levels and Days Between Diagnosis of the Infection and D-Dimer Determination”. Monaldi Archives for Chest Disease 91 (2). https://doi.org/10.4081/monaldi.2021.1622.