tetano
Editor, Senior Moderator
J Thorac Dis
. 2023 Nov 30;15(11):6317-6322.
doi: 10.21037/jtd-23-870. Epub 2023 Nov 27. An optimized D-dimer cut-off value to predict pulmonary thromboembolism in COVID-19 patients
Sophie Y H Engels[SUP] 1 [/SUP], Ilonka H P A A van Veen[SUP] 1 [/SUP], Matthijs Oudkerk[SUP] 2 3 [/SUP], Job van der Palen[SUP] 4 5 [/SUP], Marjolein A Heuvelmans[SUP] 1 3 6 [/SUP]
Affiliations
Pulmonary thromboembolism (PTE) is a common complication in coronavirus disease 2019 (COVID-19) patients. Elevated D-dimer levels are observed even in the absence of PTE, reducing its discriminative ability as a screening test. It is unknown whether conventional D-dimer cut-off values, as used in the YEARS algorithm, apply to COVID-19 patients. This study aimed to determine the optimal D-dimer cut-off value to predict PTE in COVID-19 patients. All confirmed COVID-19 patients with a computed tomography pulmonary angiography (CTPA) performed ≤5 days after admission due to suspicion of PTE between March 2020 and February 2021, at Medisch Spectrum Twente, The Netherlands, were retrospectively analyzed. The association between PTE and D-dimer levels prior to CTPA, and other potential predictors, was analyzed using logistic regression analyses. The optimal cut-off value was identified using receiver operating characteristic (ROC) curve analyses. In 142 patients, PTE prevalence was 20.4%. The optimal cut-off value was 750 ng/mL (sensitivity 100%; specificity 19.5%; negative predictive value 100%; positive predictive value 24.2%). In total, 15 of 113 (13%) patients without PTE had a D-dimer level ≥500 and <750 ng/mL. In our population of patients hospitalized with COVID-19, a D-dimer level <750 ng/mL safely excluded PTE. Compared to the YEARS 500 ng/mL cut-off value, 13% fewer patients are in need of a CTPA, with similar sensitivity. Future research is required for external validation.
Keywords: Pulmonary thromboembolism (PTE); computed tomography pulmonary angiography (CTPA); coronavirus disease 2019 (COVID-19); fibrin fibrinogen degradation products; thrombosis.
. 2023 Nov 30;15(11):6317-6322.
doi: 10.21037/jtd-23-870. Epub 2023 Nov 27. An optimized D-dimer cut-off value to predict pulmonary thromboembolism in COVID-19 patients
Sophie Y H Engels[SUP] 1 [/SUP], Ilonka H P A A van Veen[SUP] 1 [/SUP], Matthijs Oudkerk[SUP] 2 3 [/SUP], Job van der Palen[SUP] 4 5 [/SUP], Marjolein A Heuvelmans[SUP] 1 3 6 [/SUP]
Affiliations
- PMID: 38090285
- PMCID: PMC10713327
- DOI: 10.21037/jtd-23-870
Pulmonary thromboembolism (PTE) is a common complication in coronavirus disease 2019 (COVID-19) patients. Elevated D-dimer levels are observed even in the absence of PTE, reducing its discriminative ability as a screening test. It is unknown whether conventional D-dimer cut-off values, as used in the YEARS algorithm, apply to COVID-19 patients. This study aimed to determine the optimal D-dimer cut-off value to predict PTE in COVID-19 patients. All confirmed COVID-19 patients with a computed tomography pulmonary angiography (CTPA) performed ≤5 days after admission due to suspicion of PTE between March 2020 and February 2021, at Medisch Spectrum Twente, The Netherlands, were retrospectively analyzed. The association between PTE and D-dimer levels prior to CTPA, and other potential predictors, was analyzed using logistic regression analyses. The optimal cut-off value was identified using receiver operating characteristic (ROC) curve analyses. In 142 patients, PTE prevalence was 20.4%. The optimal cut-off value was 750 ng/mL (sensitivity 100%; specificity 19.5%; negative predictive value 100%; positive predictive value 24.2%). In total, 15 of 113 (13%) patients without PTE had a D-dimer level ≥500 and <750 ng/mL. In our population of patients hospitalized with COVID-19, a D-dimer level <750 ng/mL safely excluded PTE. Compared to the YEARS 500 ng/mL cut-off value, 13% fewer patients are in need of a CTPA, with similar sensitivity. Future research is required for external validation.
Keywords: Pulmonary thromboembolism (PTE); computed tomography pulmonary angiography (CTPA); coronavirus disease 2019 (COVID-19); fibrin fibrinogen degradation products; thrombosis.