Adjusting D-dimer to Lung Disease Extent to Exclude Pulmonary Embolism in COVID-19 Patients (Co-LEAD)

Abstract Objective  D-dimer measurement is a safe tool to exclude pulmonary embolism (PE), but its specificity decreases in coronavirus disease 2019 (COVID-19) patients. Our aim was to derive a new algorithm with a specific D-dimer threshold for COVID-19 patients. Methods  We conducted a French mult...

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Published in:Thrombosis and haemostasis Vol. 122; no. 11; pp. 1888 - 1898
Main Authors: Planquette, Benjamin, Khider, Lina, Berre, Alice Le, Soudet, Simon, Pernod, Gilles, Mao, Raphaël Le, Besutti, Matthieu, Gendron, Nicolas, Yanoutsos, Alexandra, Smadja, David M., Goudot, Guillaume, Kahf, Salma Al, Mohamedi, Nassim, Hamoud, Antoine Al, Philippe, Aurélien, Fournier, Laure, Rance, Bastien, Diehl, Jean-Luc, Mirault, Tristan, Messas, Emmanuel, Emmerich, Joseph, Chocron, Richard, Couturaud, Francis, Ferretti, Gilbert, Sevestre, Marie Antoinette, Meneveau, Nicolas, Chatellier, Gilles, Sanchez, Olivier
Format: Journal Article
Language:English
Published: Rüdigerstraße 14, 70469 Stuttgart, Germany Georg Thieme Verlag KG 01.11.2022
Subjects:
Stroke, Systemic or Venous Thromboembolism
COVID-19
computed tomography
D-dimer
diagnosis
pulmonary embolism
ISSN:0340-6245, 2567-689X, 2567-689X
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Summary:Abstract Objective  D-dimer measurement is a safe tool to exclude pulmonary embolism (PE), but its specificity decreases in coronavirus disease 2019 (COVID-19) patients. Our aim was to derive a new algorithm with a specific D-dimer threshold for COVID-19 patients. Methods  We conducted a French multicenter, retrospective cohort study among 774 COVID-19 patients with suspected PE. D-dimer threshold adjusted to extent of lung damage found on computed tomography (CT) was derived in a patient set ( n  = 337), and its safety assessed in an independent validation set ( n  = 337). Results  According to receiver operating characteristic curves, in the derivation set, D-dimer safely excluded PE, with one false negative, when using a 900 ng/mL threshold when lung damage extent was <50% and 1,700 ng/mL when lung damage extent was ≥50%. In the derivation set, the algorithm sensitivity was 98.2% (95% confidence interval [CI]: 94.7–100.0) and its specificity 28.4% (95% CI: 24.1–32.3). The negative likelihood ratio (NLR) was 0.06 (95% CI: 0.01–0.44) and the area under the curve (AUC) was 0.63 (95% CI: 0.60–0.67). In the validation set, sensitivity and specificity were 96.7% (95% CI: 88.7–99.6) and 39.2% (95% CI: 32.2–46.1), respectively. The NLR was 0.08 (95% CI; 0.02–0.33), and the AUC did not differ from that of the derivation set (0.68, 95% CI: 0.64–0.72, p  = 0.097). Using the Co-LEAD algorithm, 76 among 250 (30.4%) COVID-19 patients with suspected PE could have been managed without CT pulmonary angiography (CTPA) and 88 patients would have required two CTs. Conclusion  The Co-LEAD algorithm could safely exclude PE, and could reduce the use of CTPA in COVID-19 patients. Further prospective studies need to validate this strategy.
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ISSN:0340-6245
2567-689X
2567-689X
DOI:10.1055/a-1768-4371