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: 1653
PDF: 901
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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.

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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.

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