To scan or not to scan – D-dimers and computed tomography pulmonary angiography in the era of COVID-19

Tuck, Alexander; White, H.; Abdalla, Badr; Cartwright, G.; Figg, K.; Murphy, Emily; Pyrke, B.; Reynolds, Mark A.; Taha, Rana; Haboubi, Hasan

doi:10.7861/clinmed.2020-0664

Cited by 11 publications

(9 citation statements)

References 25 publications

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“…It is found that the D-dimer level in those patients was lower in males as compared with females in the settings of the absence of pulmonary embolism. 34 However, in COVID-19 patients, the level of D-dimer was found to be higher in males, 35 although the proportion of abnormally high D-dimer level was not significantly different.…”

Section: Discussionmentioning

confidence: 87%

D-Dimer as a Sensitive Biomarker of Survival Rate in Patients with COVID-19

Hilda¹,

Liana²,

Nurtjahyo³

et al. 2022

Eurasian J Med

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Objective: The global case fatality rate of coronavirus disease 2019 is 2.16% as announced by the World Health Organization. In Indonesia, according to the Ministry of Health, the number is even higher, reaching a 2.8% case fatality rate. D-dimer levels were found to affect coronavirus disease 2019 patient’s survival in several studies. The study aimed to determine whether the amount of D-dimer predicted survival in coronavirus disease 2019 patients. Materials and Methods: This research was performed in a retrospective cohort design and used survival analysis. From March 1, 2020, to August 31, 2020, the samples were collected from polymerase chain reaction-confirmed coronavirus disease 2019 patients at Mohammad Hoesin General Hospital in Palembang, South Sumatera, Indonesia. We used electronic medical records to obtain demographic (age and gender), coexisting condition, laboratory (coagulation and hematologic test), and outcome (non-survivors or survivors) data. The chi-square and Mann–Whitney tests were used to evaluate the results. The Kaplan–Meier method and the Mantel–Haenszel log-rank test were used to examine D-dimer levels and patient outcomes. Youden index was calculated to determine the optimal cut-off value of D-dimer. Results: There were 52 non-survivors and 235 survivors among the 287 patients who met the inclusion criterion. Non-survivors had D-dimer levels of more than 1.49 mg/L in 82.69% of cases. Males had lower cut-off compared to females (>1.49 mg/L vs. >2.2 mg/L). The researchers discovered a highly significant correlation between D-dimer levels and coronavirus disease 2019 mortality ( P = .001). The c-index analysis showed that D-dimer (0.79, 95% CI: 0.73-0.83) ability for mortality prediction was the second-best compared with other laboratory markers. Conclusion: D-dimer can be used as a predictor of coronavirus disease 2019 in-hospital mortality for early identification of coagulopathy.

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Section: Discussionmentioning

confidence: 87%

D-Dimer as a Sensitive Biomarker of Survival Rate in Patients with COVID-19

Hilda¹,

Liana²,

Nurtjahyo³

et al. 2022

Eurasian J Med

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“…The value of an elevated D-dimer for ruling in concomitant PE in COVID-19 patients is more controversial. A number of studies have derived higher cut-off values [138][139][140][141][142][143][144], above which diagnostic imaging is recommended [138][139][140][141][142][143][144]. However, there is considerable variability in the proposed Ddimer cut-offs (ranging from 1000 to 2903 ng/mL) [138][139][140][141][142][143][144][145][146] with no published consensus on which value should be used clinically.…”

Section: D-dimermentioning

confidence: 99%

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

et al. 2023

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In acute coronavirus disease 19 (COVID‐19) patients, effective clinical risk stratification has important implications on treatment and therapeutic resource distribution. This article reviews the evidence behind a wide range of biomarkers with prognostic value in COVID‐19. Patient characteristics and co‐morbidities, such as cardiovascular and respiratory diseases, are associated with increased mortality risk. Peripheral oxygen saturation and arterial oxygenation are predictive of severe respiratory compromise, whereas risk scores such as the 4C‐score enable multi‐factorial prognostic risk estimation. Blood tests such as markers of inflammation, cardiac injury and d‐dimer and abnormalities on electrocardiogram are linked to inpatient prognosis. Of the imaging modalities, lung ultrasound and echocardiography enable the bedside assessment of prognostic abnormalities in COVID‐19. Chest radiograph (CXR) and computed tomography (CT) can inform about prognostic pulmonary pathologies, whereas cardiovascular CT detects high‐risk features such as coronary artery and aortic calcification. Dynamic changes in biomarkers, such as blood tests, CXR, CT and electrocardiogram findings, can further inform about disease severity and prognosis. Despite the vast volumes of existing evidence, several gaps exist in our understanding of COVID‐19 biomarkers. First, the pathophysiological basis on which these markers can foretell prognosis in COVID‐19 remains poorly understood. Second, certain under‐explored tests such as thoracic impedance assessment and cardiovascular magnetic resonance imaging deserve further investigation. Lastly, the prognostic values of most biomarkers in COVID‐19 are derived from retrospective analyses. Prospective studies are required to validate these markers for guiding clinical decision‐making and to facilitate their translation into clinical management pathways.

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“…48 The positive and negative predictive values for PE at a D-dimer level of 8.460 µg/mL has been determined to be 77 and 86%, respectively. 48 D-dimer level can predict the presence of PE 23,[49][50][51] and VTE. 32,52 In a recent review of 11 studies, 22 they calculated the sensitivity and specificity for D-dimer to detect PE with cut-off values of 1.0 and 3.0 μg/mL as 91 and 24%, and 72 and 63%, respectively.…”

Section: D-dimermentioning

confidence: 99%

“…D-dimer level can predict the presence of PE 23 49 50 51 and VTE. 32 52 In a recent review of 11 studies, 22 they calculated the sensitivity and specificity for D-dimer to detect PE with cut-off values of 1.0 and 3.0 μg/mL as 91 and 24%, and 72 and 63%, respectively.…”

Section: D-dimermentioning

confidence: 99%

Assessment and Monitoring of Coagulation in Patients with COVID-19: A Review of Current Literature

Uzun¹,

Althaus²,

Hammer³

et al. 2022

Hamostaseologie

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Coagulation abnormalities are common in patients with COVID-19 and associated with high morbidity and mortality. It became a daily challenge to navigate through these abnormal laboratory findings and deliver the best possible treatment to the patients. The unique character of COVID-19-induced coagulopathy necessitates not only a dynamic follow-up of the patients in terms of hemostatic findings but also the introduction of new diagnostic methods to determine the overall function of the coagulation system in real time. After the recognition of the high risk of thromboembolism in COVID-19, several professional societies published their recommendations regarding anticoagulation in patients with COVID-19. This review summarizes common hemostatic findings in COVID-19 patients and presents the societal recommendations regarding the use of coagulation laboratory findings in clinical decision-making. Although several studies have investigated coagulation parameters in patients with COVID-19, the methodological shortcomings of published studies as well as the differences in employed anticoagulation regimens that have changed over time, depending on national and international guidelines, limit the applicability of these findings in other clinical settings. Accordingly, evidence-based recommendations for diagnostics during acute COVID-19 infection are still lacking. Future studies should verify the role of coagulation parameters as well as viscoelastic methods in the management of patients with COVID-19.

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To scan or not to scan – D-dimers and computed tomography pulmonary angiography in the era of COVID-19

Cited by 11 publications

References 25 publications

D-Dimer as a Sensitive Biomarker of Survival Rate in Patients with COVID-19

D-Dimer as a Sensitive Biomarker of Survival Rate in Patients with COVID-19

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

Assessment and Monitoring of Coagulation in Patients with COVID-19: A Review of Current Literature

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