Adjusting D-dimer to Lung Disease Extent to Exclude Pulmonary Embolism in COVID-19 Patients (Co-LEAD)

被引：6

作者：

Planquette, Benjamin ^{[1
,2
,3
,4
]}

Khider, Lina ^{[2
,5
,6
]}

Le Berre, Alice ^{[7
]}

Soudet, Simon ^{[8
,9
]}

Pernod, Gilles ^{[4
,10
]}

Le Mao, Raphael ^{[4
,11
]}

Besutti, Matthieu ^{[12
]}

Gendron, Nicolas ^{[1
,2
,4
,13
]}

Yanoutsos, Alexandra ^{[14
,15
]}

Smadja, David M. ^{[16
]}

Goudot, Guillaume ^{[2
,5
,6
]}

Al Kahf, Salma ^{[1
,2
,3
,4
]}

Mohamedi, Nassim ^{[2
,5
,6
]}

Al Hamoud, Antoine ^{[1
,2
,3
,4
]}

Philippe, Aurelien ^{[1
,2
,4
,13
]}

Fournier, Laure ^{[16
]}

Rance, Bastien ^{[17
]}

Diehl, Jean-Luc ^{[1
,2
,18
]}

Mirault, Tristan ^{[5
,20
]}

Messas, Emmanuel ^{[5
,7
,19
]}

Emmerich, Joseph ^{[14
,15
]}

Chocron, Richard ^{[20
]}

Couturaud, Francis ^{[4
,11
]}

Ferretti, Gilbert ^{[21
]}

Sevestre, Marie Antoinette ^{[8
,9
]}

Meneveau, Nicolas ^{[12
]}

Chatellier, Gilles ^{[22
]}

Sanchez, Olivier ^{[1
,2
,3
,4
]}

机构：

[1] Univ Paris, INSERM, Innovat Therapies Haemostasis, Paris, France

[2] Univ Paris, Biosurg Res Lab, Carpentier Fdn, Paris, France

[3] Ctr Univ Paris AP HP CUP, AP HP, Dept Resp Med, Paris, France

[4] F CRIN INNOVTE, St Etienne, France

[5] Ctr Univ Paris AP HP CUP, AP HP, Dept Vasc Med, Paris, France

[6] ESPCI Paris, INSERM U1273, Phys Med Paris, Paris, France

[7] Grp Hosp Paris St Joseph, Dept Radiol, Paris, France

[8] Univ Picardie Jules Verne, EA7516 CHIMERE, CHU Amiens Picardie, Amiens, France

[9] Univ Picardie Jules Verne, CHU Amiens Picardie, Serv Med Vasc, Amiens, France

[10] Univ Grenoble Alpes, Serv Univ Med Vasc, CRIN INNOVTE, CHU Grenoble Alpes,CNRS TIMC IMAG UMR 5525,Themas, F-38043 Grenoble, France

[11] Univ Bretagne Occidentale, CHU Brest, Dept Med Interne & Pneumol, EA 3878,CIC INSERM 1412, Brest, France

[12] Univ Burgundy Franche Comte, Univ Hosp, Dept Cardiol, EA3920, Besancon, France

[13] Ctr Univ Paris AP HP CUP, AP HP, Dept Haematol, Paris, France

[14] Grp Hosp Paris St Joseph, Dept Vasc Med, Paris, France

[15] INSERM CRESS UMR 1153, Dept Vasc Med, Paris, France

[16] Univ Paris, Ctr Univ Paris AP HP CUP, AP HP, Dept Radiol, Paris, France

[17] Univ Paris, Ctr Univ Paris AP HP Cup, AP HP, Dept Med Informat, Paris, France

[18] Ctr Univ Paris AP HP CUP, AP HP, Intens Care Unit, Paris, France

[19] INSERM UMR S 970, PARCC, Paris Res Cardiovasc Ctr, Dept Vasc Med, Paris, France

[20] Univ Paris, Ctr Univ Paris AP HP CUP, AP HP, PARCC,INSERM,Dept Emergency, Paris, France

[21] Univ Grenoble Alpes, Dept Radiol, CHU, St Etienne, France

[22] INSERM CIC 14 18, Dept Stat Bioinformat & Publ Hlth, Paris, France

来源：

THROMBOSIS AND HAEMOSTASIS | 2022年 / 122卷 / 11期

关键词：

pulmonary embolism; COVID-19; D-dimer; computed tomography; diagnosis; EMERGENCY-DEPARTMENT PATIENTS; RULE-OUT CRITERIA; VENOUS THROMBOEMBOLISM; DIAGNOSIS; COMPLICATIONS; MULTICENTER; PREVALENCE; MANAGEMENT; RISK;

D O I：

10.1055/a-1768-4371

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective D-dimer measurement is a safe tool to exclude pulmonary embolism (PE), but its specificity decreases in coronavirus disease 2019 (COVID-19) patients. Our aim was to derive a new algorithm with a specific D-dimer threshold for COVID-19 patients. Methods We conducted a French multicenter, retrospective cohort study among 774 COVID-19 patients with suspected PE. D-dimer threshold adjusted to extent of lung damage found on computed tomography (CT) was derived in a patient set (n = 337), and its safety assessed in an independent validation set (n = 337). Results According to receiver operating characteristic curves, in the derivation set, D-dimer safely excluded PE, with one false negative, when using a 900 ng/mL threshold when lung damage extent was <50% and 1,700 ng/mL when lung damage extent was >= 50%. In the derivation set, the algorithm sensitivity was 98.2% (95% confidence interval [CIJ: 94.7-100.0) and its specificity 28.4% (95% CI: 24.1-32.3). The negative likelihood ratio (NLR) was 0.06 (95% CI: 0.01-0.44) and the area under the curve (AUC) was 0.63 (95% CI: 0.60-0.67). In the validation set, sensitivity and specificity were 96.7% (95% CI: 88.7-99.6) and 39.2% (95% CI: 32.2-46.1), respectively. The NLR was 0.08 (95% CI; 0.02-0.33), and the AUC did not differ from that of the derivation set (0.68, 95% CI: 0.64-0.72, p = 0.097). Using the Co-LEAD algorithm, 76 among 250 (30.4%) COVID-19 patients with suspected PE could have been managed without CT pulmonary angiography (CTPA) and 88 patients would have required two CTs. Conclusion The Co-LEAD algorithm could safely exclude PE, and could reduce the use of CTPA in COVID-19 patients. Further prospective studies need to validate this strategy.

引用

页码：1888 / 1898

页数：11

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