The impact of COVID‐19 on the sensitivity of D‐dimer for pulmonary embolism

Abstract

Objective This study seeks to evaluate the test characteristics of D‐dimer for pulmonary embolism (PE) in patients with a concurrent diagnosis of COVID‐19. We hypothesized that the sensitivity of D‐dimer for PE at current institutional cut points would be similar to those without COVID‐19. Methods This is a multicenter retrospective observational cohort study across five urban and suburban EDs in the same health care system. The electronic health record was queried for all computed tomography pulmonary angiography (CTPA) studies from December 1, 2019, to October 22, 2020. All ED patients who underwent CTPA had D‐dimer and COVID‐19 testing completed in a single encounter were included in the study. Baseline demographics were obtained. Test characteristics of D‐dimer for PE were calculated for patients with and without COVID‐19. Additionally, receiver operator characteristics (ROC) curves were constructed for two different D‐dimer assays. Results There were 1158 patient encounters that met criteria for analysis. Performance of D‐dimer testing for PE was similar between COVID‐19–positive and –negative patients. In COVID‐19–positive patients, the sensitivity was 100% (95% confidence interval [CI] = 87.6%–100%), specificity was 11.9% (95% CI = 7.9%–17.1%), and negative predictive value (NPV) was 100%. In COVID‐19–negative patients the sensitivity was 97.6% (95% CI = 91.5%–99.7%), specificity was 14.4% (95% CI = 12.1%–17%), and NPV was 98.3% (95% CI = 93.8%–99.6%). For assay 1 the area under the curve (AUC) for COVID‐19–positive patients was 0.76 (95% CI = 0.68–0.83), and for COVID‐19–negative patients, 0.73 (95% CI = 0.69–0.77). For assay 2, AUC for COVID‐19–positive patients was 0.85 (95% CI = 0.77–0.92), and for COVID‐19–negative patients, 0.80 (95% CI = 0.77–0.84). Inspection of the ROC curve for assay 1 revealed that 100% sensitivity was maintained up to a threshold of 0.67 FEU (fibrinogen equivalent units; from 0.50 FEU) with an increase in specificity to 29% (from 18.7%), and for assay 2, 100% sensitivity was maintained up to a threshold of 662 D‐dimer units (DDU; from 230 DDU) with an increased specificity to 59% (from 6.1%). Conclusion Results from this multicenter retrospective study did not find a significant difference in sensitivity of D‐dimer for PE due to concomitant COVID‐19 infection. Further study is required to determine if PE can safely be excluded based on D‐dimer results alone in patients with suspected or proven COVID‐19 or if adjusted D‐dimer levels could have a role in management.

Identification of Parameters Representative of Immune Dysfunction in Patients with Severe and Fatal COVID-19 Infection: a Systematic Review and Meta-analysis

“…Beyond immunological and hematological cells, cytokines, antibodies and complements, there are some other laboratory parameters that are related to immune dysfunction and reflect the progression of COVID-19 which have been reported in previous studies [ 165 – 168 ]. In the current study, we simultaneously included coagulation parameters (including prothrombin time(PT), activated partial thromboplastin time(APTT), D-dimer and fibrinogen (FIB)), inflammatory parameters (containing C-reactive protein(CRP), procalcitonin(PCT), erythrocyte sedimentation rate(ESR), serum amyloid A(SAA)) and ferritin, biochemical parameters (including cardiac function related ones such as creatine kinase(CK), cardiac troponin I(cTnI), myoglobin (MYO), lactate dehydrogenase (LDH), liver function related ones such as aspartate aminotransferase(AST), alanine aminotransferase (ALT), total bilirubin(TBIL) and kidney function related ones such as creatinine(CRN), albumin(ALB), blood urea nitrogen(BUN).…”

[Retracted] Prediction of Changes in Tumor Regression during Radiotherapy for Nasopharyngeal Carcinoma by Using the Computed Tomography‐Based Radiomics

“…After the data were divided into the training set and the validation set, the AUC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the two groups were compared and analyzed, and the predictive effect of CT-based radiomics Contrast Media & Molecular Imaging characteristics in the degree of tumor regression in radiotherapy patients was used [14].…”

Correlations Between Covid 19 Symptoms and Risk of Pulmonary Embolism

“…According to the four-wave Covid treatment guide, all patients received at least one prophylactic anticoagulant treatment. The risk of PE has been suspected especially in the high values of d-dimers, although the specificity of the method is relatively low, considering a threshold value over 600 DDU, about 59% (17)(18).…”

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