Related Experiment Video
Updated: Aug 29, 2025
A Porcine Model of Acute Autologous Pulmonary Embolism
Published on: September 6, 2024
Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study
Manoela Astolfi Vivan1, Brenda Rigatti2, Sainan Voss da Cunha3
1Universidade Federal de Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Cardiologia, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Divisão de Medicina Interna, Porto Alegre, RS, Brazil.
Insights
Elevated D-dimer levels in COVID-19 patients indicate a higher risk of pulmonary thromboembolism (PTE). While D-dimer shows moderate ability to detect PTE, its clinical utility for ruling out PTE in this population is limited.
Area of Science:
- Pulmonology
- Hematology
- Infectious Diseases
Background:
- COVID-19 is associated with elevated D-dimer levels, a marker often linked to pulmonary thromboembolism (PTE).
- The precise clinical utility of D-dimer testing for diagnosing PTE in COVID-19 patients remains uncertain.
- Pulmonary thromboembolism (PTE) is a significant concern in hospitalized COVID-19 patients.
Purpose of the Study:
- To evaluate the diagnostic performance of D-dimer for ruling out PTE in COVID-19 patients.
- To identify clinical and laboratory factors associated with PTE in this patient cohort.
- To assess the association between PTE and mortality in severe acute respiratory syndrome due to COVID-19.
Main Methods:
- Retrospective analysis of 697 hospitalized COVID-19 patients who underwent CT Pulmonary Angiogram (CTPA).
- D-dimer levels were measured within 48 hours of CTPA.
- Statistical analysis was performed to evaluate D-dimer's ability to detect PTE and identify associated factors.
Main Results:
- 32.4% of patients had PTE, which was independently associated with increased mortality (42.5% vs. 32.3%).
- D-dimer levels were significantly higher in patients with PTE (9.1 μg/mL) compared to those without (2.3 μg/mL).
- A D-dimer cutoff of 0.3 μg/mL achieved 100% sensitivity for PTE detection, with an AUC of 0.77, indicating moderate discriminative power.
Conclusions:
- D-dimer levels are elevated in COVID-19 patients with PTE.
- D-dimer demonstrates moderate discriminative power for detecting PTE in this population.
- The clinical utility of D-dimer for excluding PTE in COVID-19 patients may be limited due to its moderate performance and high sensitivity thresholds.
Background:
D-dimer levels are significantly higher in COVID-19 patients with Pulmonary Thromboembolism (PTE) as compared to those without PTE, but its clinical utility is still uncertain.
Purpose:
To determine the D-dimer performance for ruling out PTE in patients with COVID-19. We also assessed clinical and laboratory factors associated with the presence of PTE on CT Pulmonary Angiogram (CTPA).
Methods:
Retrospective study involving all patients who presented at a tertiary care hospital from March 2020 to May 2021 with severe acute respiratory syndrome from COVID-19, who underwent CTPA and had D-dimer collected within 48 hours from CTPA. The D-dimer ability to classify patients with or without PTE according to CTPA was evaluated.
Results:
A total of 697 patients [382 (54.8%) men; mean (SD) age, 59 (20.5) years] were included, of which 71.5% required intensive care admission, 32.4% had PTE, and 35.6% died during hospitalization. PTE was independently associated with mortality [42.5% vs. 32.3%; p = 0.038]. D-dimer levels were higher in patients with PTE [9.1 (3.9; 20) vs. 2.3 (1.2; 5.1); p < 0.001]. Using the D-dimer cutoff of 0.5 μg/mL or above, sensitivity was 98.2% and specificity 5.7%. The 0.3 μg/mL threshold was associated with 100% of sensitivity for the presence of PTE, with which 99.1% of patients had increased values. ROC curve AUC was 0.77, demonstrating moderate discriminative power of D-dimers to detect PTE.
Conclusions:
D-dimer levels are higher among COVID-19 hospitalized patients with PTE as compared to those without PTE and have moderate discriminative power to detect PTE, but its use to exclude PTE in this population may have limited clinical utility.
More Related Videos
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:27Pulmonary Embolism III: Nursing Management
01:29Pulmonary Embolism I: Introduction
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:30Acute Coronary Syndrome III: Diagnostic Studies