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

Submitted: September 24, 2020
Accepted: January 21, 2021
Published: March 11, 2021
Abstract Views: 1585
PDF: 864
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

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.

Citations

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
Ignasi Garcia-Olivé, Department of Respiratory Medicine

CibeRes, Ciber de Enfermedades Respiratorias, Spain;
Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain;
Departament de Medicina, Universitat Autònoma de Barcelona, Spain

Helena Sintes, Department of Respiratory Medicine

Departament de Medicina, Universitat Autònoma de Barcelona, Spain

Joaquim Radua, Imaging of Mood- and Anxiety-Related Disorders (IMARD) group

CIBERSAM, Madrid, Spain;
Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;
Department of Clinical Neuroscience, Stockholm Health Care Services, Stockholm County Council, Karolinska Institutet, Stockholm, Sweden

Jorge Abad Capa, Department of Respiratory Medicine

CibeRes, Ciber de Enfermedades Respiratorias, Spain;
Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain;
Departament de Medicina, Universitat Autònoma de Barcelona, Spain

Antoni Rosell, Department of Respiratory Medicine

CibeRes, Ciber de Enfermedades Respiratorias, Spain;
Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain;
Departament de Medicina, Universitat Autònoma de Barcelona, Spain

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.