Diagnosis of Pulmonary Embolism with <scp>d</scp>-Dimer Adjusted to Clinical Probability

Kearon, Clive; Wit, Kerstin de; Parpia, Sameer; Schulman, Sam; Afilalo, Marc; Hirsch, Andrew; Spencer, Frederick A.; Sharma, Sangita; D’Aragon, Frédérick; Deshaies, Jean-François; Gal, Grégoire Le; Lazo‐Langner, Alejandro; Wu, Cynthia; Rudd-Scott, Lisa; Bates, Shannon M.; Julian, Jim A.; Investigators, PEGeD Study

doi:10.1056/nejmoa1909159

Cited by 244 publications

(269 citation statements)

References 19 publications

Supporting

Mentioning

239

Contrasting

Unclassified

Order By: Relevance

“…For several reasons, diagnosing VTE in patients with COVID‐19 may be challenging; as described above, elevated D‐dimer levels is a common nonspecific finding in patients with COVID. However, clinical probability dependent D‐dimer levels could be used even in these patients 11‐13 . For critical patients with severe acute respiratory distress syndrome who require prone positioning, radiological imaging for PE may not be directly possible.…”

Section: Patients With Covid‐19mentioning

confidence: 99%

COVID‐19 associated coagulopathy and thromboembolic disease: Commentary on an interim expert guidance

Cannegieter

Klok

2020

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

Section: Patients With Covid‐19mentioning

confidence: 99%

COVID‐19 associated coagulopathy and thromboembolic disease: Commentary on an interim expert guidance

Cannegieter

Klok

2020

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

“…Especially, in these PEs are not associated with hemodynamic instability (i.e., shock or hypotension). Wells' score is often used to assess the risk of PE [24,25]. In patients with low, moderate, and high Wells' scores, the incidence rates of PE are 6%, 23%, and 49%, respectively [26].…”

Section: Resultsmentioning

confidence: 99%

Acute Pulmonary Embolism in Coronavirus Disease 2019

Guo

Sun

Liu

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Pulmonary embolism is a severe condition prone to misdiagnosis given its nonspecific signs and symptoms. Previous studies on the pneumonia outbreak caused by coronavirus disease 2019 (COVID-19) showed a number of patients with elevated d-dimer, whether those patients combined with pulmonary embolism got our attention. Methods Data on clinical manifestations, laboratory and radiological findings, treatment, and disease progression of 19 patients with laboratory-confirmed COVID-19 pneumonia,who completed computed tomographic pulmonary angiography (CTPA) during hospitalization in the Central Hospital of Wuhan from January 2 to March 26, 2020, were reviewed. Results Of the 19 suspected pulmonary embolism and subjected to CTPA patients, six were diagnosed with pulmonary embolism. The Wells’ score of the six patients with pulmonary embolism was 0–1, which suggested a low risk of pulmonary embolism. The median level of d-dimers collected at the day before or on the day of CTPA completion in the patients with pulmonary embolism was 18.36 (interquartile range [IQR]: 6.69–61.46) µg/mL, which was much higher than that in the patients without pulmonary embolism (median 9.47 [IQR: 4.22–28.02] µg/mL). Of the 6 patients diagnosed with pulmonary embolism, all patients received anticoagulant therapy, 5 of which survived and were discharged and 1 died. Conclusion A potential causal relationship exists between COVID-19 infection and pulmonary embolism, but whether this phenomenon is common remains uncertain. The clinical manifestations of COVID-19 patients who developed pulmonary embolism are similar to those of patients with increased d-dimer alone, prompting a significant challenge on differential diagnoses.

show abstract

“…A follow-up approach was used for pragmatic case adjudication based on 30-day outcomes. This method is routinely applied in diagnostic studies of cardiovascular emergencies in the ED such as pulmonary embolism and acute coronary syndromes and has been used in a previous multicenter study of AASs 12,[28][29][30][31][32] . As compared to our previous work, the timeline of the follow-up was extended from 14 to 30 days, in order to fully cover both the acute and subacute phases of AASs.…”

Section: Discussionmentioning

confidence: 99%

Prospective diagnostic accuracy study of plasma soluble ST2 for diagnosis of acute aortic syndromes

Morello

Bartalucci

Bironzo

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Acute aortic syndromes (AASs) are difficult to diagnose emergencies. Plasma soluble ST2 (sST2), a prognostic biomarker for heart failure, has been proposed as a diagnostic biomarker of AASs outperforming D-dimer, the current diagnostic standard. We performed a prospective diagnostic accuracy study of sST2 for AASs in the Emergency Department (ED). In 2017-2018, patients were enrolled if they had ≥1 red-flag symptoms (chest/abdominal/back pain, syncope, perfusion deficit) and a clinical suspicion of AAS. sST2 was detected with the Presage ® assay. Adjudication was based on computed tomography angiography (CTA) or on diagnostic outcome inclusive of 30-day follow-up. 297 patients were enrolled, including 88 with AASs. The median age was 67 years. In 162 patients with CTA, the median sST2 level was 41.7 ng/mL (IQR 29.4-103.2) in AASs and 34.6 ng/mL (IQR 21.4-51.5) in alternative diagnoses (P = 0.005). In ROC analysis, the AUC of sST2 was 0.63, as compared to 0.82 of D-dimer (P < 0.001). Sensitivity and specificity values of sST2 associated with different cutoffs were: 95.5% and 10.8% (≥12 ng/mL), 84.1% and 29.7% (≥23.7 ng/mL), 35.2% and 85.1% (≥66.5 ng/mL). Results were similar in the full cohort. In conclusion, in patients from a European ED, plasma sST2 provided modest accuracy for diagnosis of AASs.Acute aortic syndromes (AASs), which include acute aortic dissection (AAD), intramural aortic hematoma (IMH), penetrating aortic ulcer (PAU) and spontaneous aortic rupture (SAR), are severe cardiovascular emergencies affecting 5-10 per 100.000 individuals a year 1 . A conclusive diagnosis of AASs requires advanced aortic imaging, typically computed tomography angiography (CTA), which uses ionizing radiations and may cause contrast-induced nephropathy and anaphylaxis. However, selection of the right patient to image with CTA is cumbersome, because AASs present with unspecific symptoms such as truncal pain, syncope, neurological deficits and hindlimb ischemia. These are leading causes of Emergency Department (ED) visits worldwide, and most patients with these symptoms are affected by more common conditions, such as acute coronary syndromes, gastrointestinal diseases and muscle-skeletal pain. Hence, the misdiagnosis rate of AASs is high, affecting clinical outcomes 2-4 . Increasing use of CTA in EDs has led to a high number of CTA exams requested for suspected AAS turning out negative, but has not substantially changed misdiagnosis rates, indicating that pre-test patient selection remains a key node 5-7 . Development of reliable diagnostic biomarkers discriminating AASs could positively impact on their diagnostic workup, as for other cardiovascular emergencies such as acute coronary syndromes and pulmonary embolism 8,9 . So far, potential biomarkers of AASs have been searched for within aortic layers (e.g. smooth muscle myosin, soluble elastin fragments, calponin, CD40 ligand), within inflammation/remodeling pathways (e.g. matrix metalloproteinases) and within coagulation processes mobilized by blood exposure to non-endo...

show abstract

Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability

Cited by 244 publications

References 19 publications

COVID‐19 associated coagulopathy and thromboembolic disease: Commentary on an interim expert guidance

COVID‐19 associated coagulopathy and thromboembolic disease: Commentary on an interim expert guidance

Acute Pulmonary Embolism in Coronavirus Disease 2019

Prospective diagnostic accuracy study of plasma soluble ST2 for diagnosis of acute aortic syndromes

Contact Info

Product

Resources

About