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Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis
Young Joo Suh1, Hyunsook Hong1, Mickaël Ohana1
1From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (Y.J.S.); Medical Research Collaborating Center (H.H.) and Department of Radiology (S.H.Y.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France (M.O.); Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Paris, France (F.B., M.P.R.); Department of Diagnostic Radiology, Papa Giovanni XXIII, Bergamo, Italy (C.V.); Department of Radiology, Military Hospital Begin, Saint Mande, France (A.G.); Resuscitation Center, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale U1285, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8576-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France (J.P.); Department of Hematology and Transfusion, Pôle de Biologie Pathologie Génétique, Institut Pasteur de Lille, Centre Hospitalier Universitaire de Lille, Université de Lille, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1011-European Genomic Institute for Diabetes, Lille, France (S.S.); Institute of Cardiometabolism and Nutrition, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition 1166, Paris, France; Intensive Medicine-Resuscitation Department, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France (G.H.); Department of Internal Medicine, Centre Hospitalier Universitaire de Nantes, Nantes, France (M.A.); Angiology Unit, Hôpital Fribourgeois-Hôpital Cantonal, Fribourg, Switzerland (D.P.); Multipurpose Resuscitation Service, Centre Hospitalier Victor Dupouy, Argenteuil, France (D.C.); Department of Intensive Care Medicine, Centre Hospitalier du Valais Romand de l'Hôpital du Valais (site de Sion), Sion, Switzerland (J.D., B.S.); and Department of Radiology, King's College Hospital National Health Service Foundation Trust, London, England (C.F., G.G., H.R.).
Abstract:
Background The association of pulmonary embolism (PE) with deep vein thrombosis (DVT) in patients with coronavirus disease 2019 (COVID-19) remains unclear, and the diagnostic accuracy of D-dimer tests for PE is unknown. Purpose To conduct meta-analysis of the study-level incidence of PE and DVT and to evaluate the diagnostic accuracy of D-dimer tests for PE from multicenter individual patient data. Materials and Methods A systematic literature search identified studies evaluating the incidence of PE or DVT in patients with COVID-19 from January 1, 2020, to June 15, 2020. These outcomes were pooled using a random-effects model and were further evaluated using metaregression analysis. The diagnostic accuracy of D-dimer tests for PE was estimated on the basis of individual patient data using the summary receiver operating characteristic curve. Results Twenty-seven studies with 3342 patients with COVID-19 were included in the analysis. The pooled incidence rates of PE and DVT were 16.5% (95% CI: 11.6, 22.9; I2 = 0.93) and 14.8% (95% CI: 8.5, 24.5; I2 = 0.94), respectively. PE was more frequently found in patients who were admitted to the intensive care unit (ICU) (24.7% [95% CI: 18.6, 32.1] vs 10.5% [95% CI: 5.1, 20.2] in those not admitted to the ICU) and in studies with universal screening using CT pulmonary angiography. DVT was present in 42.4% of patients with PE. D-dimer tests had an area under the receiver operating characteristic curve of 0.737 for PE, and D-dimer levels of 500 and 1000 μg/L showed high sensitivity (96% and 91%, respectively) but low specificity (10% and 24%, respectively). Conclusion Pulmonary embolism (PE) and deep vein thrombosis (DVT) occurred in 16.5% and 14.8% of patients with coronavirus disease 2019 (COVID-19), respectively, and more than half of patients with PE lacked DVT. The cutoffs of D-dimer levels used to exclude PE in preexisting guidelines seem applicable to patients with COVID-19. © RSNA, 2020 Supplemental material is available for this article. See also the editorial by Woodard in this issue.
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