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

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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The Value of D-Dimer in Patients with Increased C-Reactive Protein Suspected of Pulmonary Embolism.

Blood ◽

10.1182/blood.v114.22.5056.5056 ◽

2009 ◽

Vol 114 (22) ◽

pp. 5056-5056

Author(s):

Claire Siemes ◽

Paul Berendes ◽

Frans van der Straaten ◽

Ton Cleophas ◽

Mark-David Levin

Keyword(s):

Pulmonary Embolism ◽

Conflicts Of Interest ◽

Area Under The Curve ◽

Roc Curves ◽

Serum Levels ◽

C Reactive Protein ◽

Reactive Protein ◽

Interaction Term ◽

Pulmonary Embolisms ◽

D Dimer

Abstract Abstract 5056 OBJECTIVE To investigate the relation between elevated levels of C-reactive protein (CRP) and D-dimer, and to study whether D-dimer levels can be interpreted in relation to elevated levels of CRP in the prediction of a pulmonary embolism in order to increase its specificity without decline in sensitivity. METHODS Between august 2004 and april 2007 (33 months) serum levels of C-reactive protein (mmol/L) and D-dimer (mmol/L) were cross-sectionally collected and pulmonary embolisms on CT-angiograms were scored within 48 hours. The study was devided into three parts. First, characteristics of excluded persons were studied. Second, the correlation between CRP and D-dimer level was considered in those with a defined (i.e. values with < and > symbols excluded) biomarker level. Finally, the effect of CRP level on the sensitivity of D-dimer for pulmonary embolisms was examined. RESULTS CRP and D-dimer levels were positively correlated ( r = 0.37; p < 0.001), and both were increased in persons with a pulmonary embolism (CRP: p = 0.02; D-dimer: p < 0.001). 14 % of variability in D-dimer level was explained by CRP level. Median D-dimer levels were increased in the pulmonary embolism (PE) group, however, the increase in D-dimer level by CRP quartile as was found in the non-PE was not seen in de PE-group. Adding the interaction term of CRP and D-dimer to the statistical model showed some influence on the area under the curve (AUC). Nevertheless, this was not significantly different from the model with only D-dimer levels. However, when stratified for CRP quartile, ROC-curves of the predictive effect of D-dimer on pulmonary embolisms showed a decrease in AUC by increment of CRP quartile. CONCLUSION CRP and D-dimer are positively correlated, and both predictive of PE. The predictive value of D-dimer for PE declines by increment of CRP, although this seems to be safely for a broader range of accompanied CRP levels. Disclosures No relevant conflicts of interest to declare.

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A 10-fold and greater increase in D-dimer at admission in COVID-19 patients is highly predictive of pulmonary embolism in a retrospective cohort study

Therapeutic Advances in Hematology ◽

10.1177/20406207211048364 ◽

2021 ◽

Vol 12 ◽

pp. 204062072110483

Author(s):

Adrian Perera ◽

Pratima Chowdary ◽

James Johnson ◽

Lucy Lamb ◽

Anja Drebes ◽

...

Keyword(s):

Pulmonary Embolism ◽

White Cell Count ◽

Area Under The Curve ◽

Pulmonary Vasculature ◽

Reactive Protein ◽

Pulmonary Angiogram ◽

Right Ventricular Strain ◽

Receiver Operator Curve Analysis ◽

D Dimer ◽

Operator Curve

Background: COVID-19 patients present with both elevated D-dimer and a higher incidence of pulmonary embolism (PE). This single-centre retrospective observational study investigated the prevalence of early PE in COVID-19 patients and its relation to D-dimer at presentation. Methods: The study included 1038 COVID-19-positive patients, with 1222 emergency department (ED) attendances over 11 weeks (16 March to 31 May 2020). Computed tomography pulmonary angiogram (CTPA) for PE was performed in 123 patients within 48 h of ED presentation, of whom 118 had D-dimer results. The remaining 875 attendances had D-dimer performed. Results: CTPA performed in 11.8% of patients within 48 h of ED presentation confirmed PE in 37.4% (46/123). Thrombosis was observed at all levels of pulmonary vasculature with and without right ventricular strain. In the CTPA cohort, patients with PE had significantly higher D-dimer, prothrombin time, C-reactive protein, troponin, total bilirubin, neutrophils, white cell count and lower albumin compared with non-PE patients. However, there was no difference in the median duration of inpatient stay or mortality. A receiver operator curve analysis demonstrated that D-dimer could discriminate between PE and non-PE COVID-19 patients (area under the curve of 0.79, p < 0.0001). Furthermore, 43% ( n = 62/145) of patients with D-dimer >5000 ng/ml had CTPA with PE confirmed in 61% ( n = 38/62), that is, 26% of >5000 ng/ml cohort. The sensitivity and specificity were related to D-dimer level; cutoffs of 2000, 3000, 4000, and 5000 ng/ml, respectively, had a sensitivity of 93%, 90%, 90% and 86%, and a specificity of 38%, 54%, 59% and 68%, and if implemented, an additional 229, 141, 106 and 83 CTPAs would be required. Conclusion: Our data suggested an increased PE prevalence in COVID-19 patients attending ED with an elevated D-dimer, and patients with levels >5000 ng/ml might benefit from CTPA to exclude concomitant PE.

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Effectiveness of mid-regional pro-adrenomedullin (MR-proADM) as prognostic marker in COVID-19 critically ill patients: An observational prospective study

PLoS ONE ◽

10.1371/journal.pone.0246771 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246771

Author(s):

Giorgia Montrucchio ◽

Gabriele Sales ◽

Francesca Rumbolo ◽

Filippo Palmesino ◽

Vito Fanelli ◽

...

Keyword(s):

Cardiovascular Disease ◽

Area Under The Curve ◽

Predictive Ability ◽

University Hospital ◽

Rank Test ◽

Operating Characteristics ◽

Icu Patients ◽

Dying Patients ◽

D Dimer ◽

Over Time

Objective To test the effectiveness of mid-regional pro-adrenomedullin (MR-proADM) in comparison to C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH) in predicting mortality in COVID-19-ICU-patients. Methods All consecutive COVID-19 adult patients admitted between March and June 2020 to the ICU of a referral, university hospital in Northern-Italy were enrolled. MR-proADM and routine laboratory test were measured within 48 hours from ICU admission, on day 3, 7 and 14. Survival curves difference with MR-proADM cut-off set to 1.8 nmol/L were tested using log-rank test. Predictive ability was compared using area under the curve and 95% confidence interval of different receiver-operating characteristics curves. Results 57 patients were enrolled. ICU and overall mortality were 54.4%. At admission, lymphocytopenia was present in 86% of patients; increased D-dimer and CRP levels were found in 84.2% and 87.7% of patients respectively, while PCT values > 0.5 μg/L were observed in 47.4% of patients. MR-proADM, CRP and LDH were significantly different between surviving and non-surviving patients and over time, while PCT, D-dimer and NT-pro-BNP did not show any difference between the groups and over time; lymphocytes were different between surviving and non-surviving patients only. MR-proADM was higher in dying patients (2.65±2.33vs1.18±0.47, p<0.001) and a higher mortality characterized patients with MR-proADM >1.8 nmol/L (p = 0.016). The logistic regression model adjusted for age, gender, cardiovascular disease, diabetes mellitus and PCT values confirmed an odds ratio = 10.3 [95%CI:1.9–53.6] (p = 0.006) for MR-proADM >1.8 nmol/L and = 22.2 [95%CI:1.6–316.9] (p = 0.022) for cardiovascular disease. Overall, MR-proADM had the best predictive ability (AUC = 0.85 [95%CI:0.78–0.90]). Conclusions In COVID-19 ICU-patients, MR-proADM seems to have constantly higher values in non-survivor patients and predict mortality more precisely than other biomarkers. Repeated MR-proADM measurement may support a rapid and effective decision-making. Further studies are needed to better explain the mechanisms responsible of the increase in MR-proADM in COVID-19 patients.

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Assessment of the current D-dimer cutoff point in pulmonary embolism workup at a single institution: Retrospective study

Journal of Postgraduate Medicine ◽

10.4103/jpgm.jpgm_217_17 ◽

2018 ◽

Vol 64 (3) ◽

pp. 150

Author(s):

S Alhassan ◽

E Bihler ◽

K Patel ◽

S Lavudi ◽

M Young ◽

...

Keyword(s):

Pulmonary Embolism ◽

Retrospective Study ◽

Cutoff Point ◽

Single Institution ◽

D Dimer

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d-Dimer Assessment Improves the Simplified Pulmonary Embolism Severity Index for In-Hospital Risk Stratification in Acute Pulmonary Embolism

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618776799 ◽

2018 ◽

Vol 24 (8) ◽

pp. 1340-1346 ◽

Cited By ~ 2

Author(s):

Marta Kozlowska ◽

Magdalena Plywaczewska ◽

Marcin Koc ◽

Szymon Pacho ◽

Anna Wyzgal ◽

...

Keyword(s):

Pulmonary Embolism ◽

Adverse Event ◽

Risk Stratification ◽

Prognostic Value ◽

Acute Pulmonary Embolism ◽

Clinical Course ◽

Area Under The Curve ◽

Severity Index ◽

Net Reclassification Improvement ◽

D Dimer

d-dimer (DD) levels are used in the diagnostic workup of suspected acute pulmonary embolism (APE), but data on DD for early risk stratification in APE are limited. In this post hoc analysis of a prospective observational study of 270 consecutive patients, we aimed to optimize the discriminant capacity of the simplified pulmonary embolism severity index (sPESI), an APE risk assessment score currently used, by combining it with DD for in-hospital adverse event prediction. We found that DD levels were higher in patients with complicated versus benign clinical course 7.2 mg/L (25th-75th percentile: 4.5-27.7 mg/L) versus 5.1 mg/L (25th-75th percentile: 2.1-11.2 mg/L), P = .004. The area under the curve of DD for serious adverse event (SAE) was 0.672, P = .003. d-dimer =1.35 mg/L showed 100% negative predictive value for SAE and identified 11 sPESI ≥1 patients with a benign clinical course, detecting the 1 patient with SAE from sPESI = 0. d-dimer >15 mg/L showed heart rate for SAE 3.04 (95% confidence interval [CI]: 1-9). A stratification model which with sPESI + DD >1.35 mg/L demonstrated improved prognostic value when compared to sPESI alone (net reclassification improvement: 0.085, P = .04). d-dimer have prognostic value, values <1.35 mg/L identify patients with a favorable outcome, improving the prognostic potential of sPESI, while DD >15 mg/L is an independent predictor of SAE.

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The deceptive concept of hypoparathyroidism and recurrence after parathyroidectomy in dialysis patients: are we offering a Procrustean bed to some patients?

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912016005002 ◽

2016 ◽

Vol 43 (5) ◽

pp. 327-333 ◽

Cited By ~ 3

Author(s):

FABIO LUIZ DE MENEZES MONTENEGRO ◽

MARILIA D'ELBOUX GUIMARAES BRESCIA ◽

CLIMÉRIO PEREIRA NASCIMENTO JÚNIOR ◽

LEDO MAZZEI MASSONI NETO ◽

SÉRGIO SAMIR ARAP ◽

...

Keyword(s):

Retrospective Study ◽

Tertiary Hospital ◽

The Other ◽

Total Parathyroidectomy ◽

Target Level ◽

Dialysis Patients ◽

Sustained Reduction ◽

International Experts ◽

Recurrent Hyperparathyroidism ◽

Over Time

ABSTRACT Objective: to analyze the frequency of hypoparathyroidism and of its recurrence after parathyroidectomy in dialysis patients according to different existing classifications. Methods: we conducted a retrospective study of 107 consecutive dialysis patients undergoing total parathyroidectomy with immediate autograft in a tertiary hospital from 2006 to 2010. We studied the changes in PTH levels in the postoperative period over time. Were grouped patients according to different PTH levels targets recommended according to the dosage method and by the American and Japanese Nephrology Societies, and by an International Experts Consortium. Results: after parathyroidectomy, there was sustained reduction in serum calcium and phosphatemia. The median value of PTH decreased from 1904pg/ml to 55pg/ml in 12 months. Depending on the considered target level, the proportion of patients below the target ranged between 17% and 87%. On the other hand, the proportion of patients with levels above the target ranged from 3% to 37%. Conclusion: the application of different recommendations for PTH levels after parathyroidectomy in dialysis patients may lead to incorrect classifications of hypoparathyroidism or recurrent hyperparathyroidism and resultin discordant therapeutic conducts.

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Application value of D-dimer testing and Caprini risk assessment model (RAM) to predict venous thromboembolism (VTE) in Chinese non-oncological urological inpatients: a retrospective study from a tertiary hospital

Translational Andrology and Urology ◽

10.21037/tau-20-320 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1904-1911

Author(s):

Zi-Qiang Wu ◽

Kai-Xuan Li ◽

Quan Zhu ◽

Hao-Zhen Li ◽

Zheng-Yan Tang ◽

...

Keyword(s):

Risk Assessment ◽

Retrospective Study ◽

Venous Thromboembolism ◽

Tertiary Hospital ◽

Assessment Model ◽

Risk Assessment Model ◽

D Dimer

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Is there a diagnostic value for the platelet indices patients in pulmonary embolism?

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907917743489 ◽

2017 ◽

Vol 25 (2) ◽

pp. 91-94

Author(s):

İbrahim Çevik ◽

Hüseyin Narcı ◽

Güllü Akbaydoğan Dündar ◽

Cüneyt Ayrık ◽

Seyran B Babuş

Keyword(s):

Pulmonary Embolism ◽

Mean Platelet Volume ◽

Area Under The Curve ◽

Control Group ◽

Platelet Distribution Width ◽

Platelet Volume ◽

Distribution Width ◽

Platelet Indices ◽

Platelet Number ◽

D Dimer

Background: Pulmonary embolism is a common disease with a high mortality risk. It has recently been reported that platelet indices may be diagnostic in pulmonary embolism. Objective: In this study, we aimed to determine the diagnostic value of platelet indices in acute pulmonary embolism. Methods: The study group was composed of 61 patients diagnosed with pulmonary embolism and a control group of 67 subjects without pulmonary embolism. Patient age, sex, leukocyte and platelet number, hemoglobin concentration (Hb), mean platelet volume, platelet distribution width, red blood cell distribution width, C-reactive protein, D-Dimer, and troponin I levels were retrospectively analyzed and compared between the two groups. Results: There was no significant difference between age and platelet number of pulmonary embolism and control group. In pulmonary embolism group, platelet distribution width level was significantly high (p = 0.002), whereas mean platelet volume level was significantly lower (p = 0.038). Receiver operating characteristic curve analysis revealed that a mean platelet volume cut-off of 9 fL had a sensitivity of 35%, a specificity of 89.55%, and area under the curve of 0.589 for pulmonary embolism, while a platelet distribution width cut-off of 12.8 fL had a sensitivity of 61%, a specificity of 71.64%, and area under the curve of 0.661. Platelet distribution width and D-dimer levels had a significant positive correlation with each other, whereas there was no significant correlation between mean platelet volume and D-dimer. Conclusion: Platelet distribution width values of the pulmonary embolism group were higher than those of control group. Although the area under the curve of platelet distribution width is slightly better than for platelet number or mean platelet volume, it does not seem that this parameter has better diagnostic accuracy than the other two.

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