Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients
Basile Mouhat, Matthieu Besutti, Kévin Bouiller, Franck Grillet, Charles Monnin, Fiona Ecarnot, Julien Behr, Gilles Capellier, Thibaud Soumagne, Sébastien Pili‐Floury, Guillaume Besch, Guillaume Mourey, Quentin Lepiller, Catherine Chirouze, François Schiele, Romain Chopard, Nicolas Méneveau
Abstract
Background Coronavirus disease 2019 (COVID-19) may predispose to venous thromboembolism. We determined factors independently associated with computed tomography pulmonary angiography (CTPA)-confirmed pulmonary embolism (PE) in hospitalised severe COVID-19 patients. Methods Among all (n=349) patients hospitalised for COVID-19 in a university hospital in a French region with a high rate of COVID-19, we analysed patients who underwent CTPA for clinical signs of severe disease (oxygen saturation measured by pulse oximetry ≤93% or breathing rate ≥30 breaths·min −1 ) or rapid clinical worsening. Multivariable analysis was performed using Firth penalised maximum likelihood estimates. Results 162 (46.4%) patients underwent CTPA (mean± sd age 65.6±13.0 years; 67.3% male (95% CI 59.5–75.5%). PE was diagnosed in 44 (27.2%) patients. Most PEs were segmental and the rate of PE-related right ventricular dysfunction was 15.9%. By multivariable analysis, the only two significant predictors of CTPA-confirmed PE were D-dimer level and the lack of any anticoagulant therapy (OR 4.0 (95% CI 2.4–6.7) per additional quartile and OR 4.5 (95% CI 1.1–7.4), respectively). Receiver operating characteristic curve analysis identified a D-dimer cut-off value of 2590 ng·mL −1 to best predict occurrence of PE (area under the curve 0.88, p<0.001, sensitivity 83.3%, specificity 83.8%). D-dimer level >2590 ng·mL −1 was associated with a 17-fold increase in the adjusted risk of PE. Conclusion Elevated D-dimers (>2590 ng·mL −1 ) and absence of anticoagulant therapy predict PE in hospitalised COVID-19 patients with clinical signs of severity. These data strengthen the evidence base in favour of systematic anticoagulation, and suggest wider use of D-dimer guided CTPA to screen for PE in acutely ill hospitalised patients with COVID-19.