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Wells Score to Predict Pulmonary Embolism in Patients with Coronavirus Disease 2019
Brittany Kirsch1, Moez Aziz1, Sungita Kumar1
1Division of General Internal Medicine, Department of Internal Medicine, The University of Texas, John P. and Kathrine G. McGovern School of Medicine, Houston.
Insights
The Wells score may not reliably predict pulmonary embolism (PE) in COVID-19 patients. While a higher score indicated PE risk, many patients with PE had lower scores, suggesting limitations in this diagnostic tool for COVID-19 associated hypercoagulability.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Infectious Diseases
Background:
- COVID-19 is linked to hypercoagulability and increased risk of pulmonary embolism (PE).
- Current diagnostic strategies for PE in COVID-19 patients utilize the Wells score and D-dimer levels.
- The unique thrombotic and inflammatory state in COVID-19 may affect the accuracy of traditional PE diagnostic tools.
Purpose of the Study:
- To evaluate the predictive ability of the Wells score for diagnosing pulmonary embolism in patients with COVID-19.
- To determine if the Wells score is a reliable tool for identifying PE in the context of COVID-19 associated hypercoagulability.
Main Methods:
- Retrospective analysis of COVID-19 patients who underwent computed tomography pulmonary angiogram (CTPA).
- Data collected included patient demographics, CTPA findings, D-dimer levels, and Wells scores.
- Sensitivity, specificity, and receiver operating characteristic (ROC) curve analysis were used to assess the Wells score's performance.
Main Results:
- 19% of COVID-19 patients (12 out of 64) had evidence of pulmonary embolism on CTPA.
- Deep vein thrombosis, Wells score >4, and elevated D-dimer levels were associated with PE.
- Only 33% of patients with PE had a Wells score of 4 or higher; ROC analysis showed non-discriminating values (AUC=0.54).
Conclusions:
- A Wells score of 4 or more points showed some predictive value for PE in COVID-19 patients.
- However, pulmonary embolism can occur in COVID-19 patients with Wells scores below 4.
- The Wells score's utility in predicting PE in COVID-19 patients may be limited due to the altered thrombotic profile.
Background:
The association between coronavirus disease 2019 (COVID-19) and hypercoagulability has been extensively described, and pulmonary embolism is a recognized complication of COVID-19. Currently, the need for computed tomography pulmonary angiogram (CTPA) relies on the Wells score and serum D-dimer levels. However, because COVID-19 patients have a different thrombotic and inflammatory milieu, the usefulness of the Wells score deserves further exploration for this patient population. We aimed to explore the ability of the Wells score to predict pulmonary embolism in patients with COVID-19.
Methods:
In this retrospective study, patients found to have a CTPA and a COVID-19 diagnosis during the same admission were selected for analysis. Age and sex, CTPA results, and associated D-dimer levels were entered in a database. The Wells score sensitivity and specificity were calculated at different values, and the area under the curve of the receiver operating characteristic curve measured.
Results:
Of 459 patients with COVID-19, 64 had a CTPA and 12 (19%) had evidence of pulmonary embolism. Previous or current evidence of deep vein thrombosis, a Wells score above 4 points, and serum D-dimer levels 5 times above age-adjusted upper normal values were associated with pulmonary embolism. However, only 33% of patients with pulmonary embolism had a Wells score of 4 points or higher. The area under the curve of the receiver operating characteristic showed non-discriminating values (0.54) CONCLUSIONS: Although a Wells score of 4 or more points predicted pulmonary embolism in our cohort, the outcome can be present even with lower scores.
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