tetano
Editor, Senior Moderator
Eur Radiol
. 2021 May 9.
doi: 10.1007/s00330-021-08003-8. Online ahead of print.
Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis
Robert M Kwee[SUP] 1 [/SUP], Hugo J A Adams[SUP] 2 [/SUP], Thomas C Kwee[SUP] 3 [/SUP]
Affiliations
Abstract
Purpose: To investigate, in a meta-analysis, the frequency of pulmonary embolism (PE) in patients with COVID-19 and whether D-dimer assessment may be useful to select patients for computed tomography pulmonary angiography (CTPA).
Methods: A systematic literature search was performed for original studies which reported the frequency of PE on CTPA in patients with COVID-19. The frequency of PE, the location of PE, and the standardized mean difference (SMD) of D-dimer levels between patients with and without PE were pooled by random effects models.
Results: Seventy-one studies were included. Pooled frequencies of PE in patients with COVID-19 at the emergency department (ED), general wards, and intensive care unit (ICU) were 17.9% (95% CI: 12.0-23.8%), 23.9% (95% CI: 15.2-32.7%), and 48.6% (95% CI: 41.0-56.1%), respectively. PE was more commonly located in peripheral than in main pulmonary arteries (pooled frequency of 65.3% [95% CI: 60.0-70.1%] vs. 32.9% [95% CI: 26.7-39.0%]; OR = 3.540 [95% CI: 2.308-5.431%]). Patients with PE had significantly higher D-dimer levels (pooled SMD of 1.096 [95% CI, 0.844-1.349]). D-dimer cutoff levels which have been used to identify patients with PE varied between 1000 and 4800 ?g/L.
Conclusion: The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries, which suggests local thrombosis to play a major role. D-dimer assessment may help to select patients with COVID-19 for CTPA, using D-dimer cutoff levels of at least 1000 ?g/L.
Key points: ? The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. ? PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries. ? D-dimer levels are significantly higher in patients with COVID-19 who have PE.
Keywords: Coagulation; Coronavirus; Diagnosis; Pulmonary embolism; Tomography.
. 2021 May 9.
doi: 10.1007/s00330-021-08003-8. Online ahead of print.
Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis
Robert M Kwee[SUP] 1 [/SUP], Hugo J A Adams[SUP] 2 [/SUP], Thomas C Kwee[SUP] 3 [/SUP]
Affiliations
- PMID: 33966132
- DOI: 10.1007/s00330-021-08003-8
Abstract
Purpose: To investigate, in a meta-analysis, the frequency of pulmonary embolism (PE) in patients with COVID-19 and whether D-dimer assessment may be useful to select patients for computed tomography pulmonary angiography (CTPA).
Methods: A systematic literature search was performed for original studies which reported the frequency of PE on CTPA in patients with COVID-19. The frequency of PE, the location of PE, and the standardized mean difference (SMD) of D-dimer levels between patients with and without PE were pooled by random effects models.
Results: Seventy-one studies were included. Pooled frequencies of PE in patients with COVID-19 at the emergency department (ED), general wards, and intensive care unit (ICU) were 17.9% (95% CI: 12.0-23.8%), 23.9% (95% CI: 15.2-32.7%), and 48.6% (95% CI: 41.0-56.1%), respectively. PE was more commonly located in peripheral than in main pulmonary arteries (pooled frequency of 65.3% [95% CI: 60.0-70.1%] vs. 32.9% [95% CI: 26.7-39.0%]; OR = 3.540 [95% CI: 2.308-5.431%]). Patients with PE had significantly higher D-dimer levels (pooled SMD of 1.096 [95% CI, 0.844-1.349]). D-dimer cutoff levels which have been used to identify patients with PE varied between 1000 and 4800 ?g/L.
Conclusion: The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries, which suggests local thrombosis to play a major role. D-dimer assessment may help to select patients with COVID-19 for CTPA, using D-dimer cutoff levels of at least 1000 ?g/L.
Key points: ? The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. ? PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries. ? D-dimer levels are significantly higher in patients with COVID-19 who have PE.
Keywords: Coagulation; Coronavirus; Diagnosis; Pulmonary embolism; Tomography.