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Lung CT Segmentation to Identify Consolidations and Ground Glass Areas for Quantitative Assesment of SARS-CoV Pneumonia
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Adjusting D-dimer to Lung Disease Extent to Exclude Pulmonary Embolism in COVID-19 Patients (Co-LEAD)

Benjamin Planquette1,2,3,4, Lina Khider2,5,6, Alice Le Berre7

  • 1Innovative Therapies in Haemostasis, Université de Paris, INSERM, Paris, France.

Thrombosis and Haemostasis
|February 10, 2022
PubMed

Insights

A new algorithm (Co-LEAD) safely excludes pulmonary embolism (PE) in coronavirus disease 2019 (COVID-19) patients using adjusted D-dimer thresholds based on lung damage. This approach can reduce the need for CT pulmonary angiography (CTPA).

Area of Science:

  • Pulmonary Medicine
  • Infectious Diseases
  • Diagnostic Imaging

Background:

  • D-dimer testing is valuable for excluding pulmonary embolism (PE).
  • Its specificity is reduced in coronavirus disease 2019 (COVID-19) patients, leading to increased computed tomography pulmonary angiography (CTPA) use.
  • A need exists for improved diagnostic strategies in COVID-19 patients with suspected PE.

Purpose of the Study:

  • To develop and validate a new algorithm (Co-LEAD) to optimize D-dimer thresholds for PE exclusion in COVID-19 patients.
  • To assess the algorithm's safety and potential to reduce CTPA utilization.

Main Methods:

  • A retrospective, multicenter cohort study of 774 COVID-19 patients with suspected PE.
  • A D-dimer threshold adjusted for lung damage extent (<50% or ≥50%) was derived in a patient set (n=337).
  • The algorithm's safety and performance were validated in an independent set (n=337).

Main Results:

  • The Co-LEAD algorithm demonstrated high sensitivity (98.2% derivation, 96.7% validation) for PE exclusion.
  • Specific D-dimer thresholds (900 ng/mL or 1700 ng/mL) based on lung damage extent were established.
  • The algorithm could potentially allow 30.4% of patients to avoid CTPA, with a negative likelihood ratio of 0.06-0.08.

Conclusions:

  • The Co-LEAD algorithm provides a safe method for excluding PE in COVID-19 patients.
  • Implementation of this algorithm may significantly reduce the reliance on CTPA in this patient population.
  • Further prospective studies are recommended to confirm these findings.
Abstract

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