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D-dimer value for predicting pulmonary embolism in COVID-19 patients: A retrospective study
S A A Maulana1, N Mat Hassan2, W Z Wan Ibrahim3
1Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia. aishahmaulana@unisza.edu.my.
Insights
A D-dimer cut-off of 2799 ng/ml helps predict pulmonary embolism (PE) in COVID-19 patients. This threshold aids clinical decisions, balancing sensitivity and specificity for diagnosing PE in this population.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Diagnostic Biomarkers
Background:
- Pulmonary embolism (PE) is a critical complication in COVID-19 patients, often linked to elevated D-dimer levels.
- The precise D-dimer threshold for PE prediction in COVID-19 remains unclear due to various disease factors.
- Understanding this relationship is crucial for timely diagnosis and management of PE in COVID-19.
Purpose of the Study:
- To determine the optimal D-dimer cut-off value for predicting PE in COVID-19 patients.
- To evaluate the sensitivity and specificity of this D-dimer cut-off.
- To identify factors associated with PE occurrence in COVID-19.
Main Methods:
- Retrospective analysis of 320 COVID-19 patients with suspected PE.
- Computed tomography pulmonary angiography (CTPA) was used for PE diagnosis.
- Analysis of clinical factors including age, sex, race, and D-dimer levels.
Main Results:
- An optimal D-dimer cut-off of 2799 ng/ml was identified (AUC 0.744).
- This cut-off demonstrated 81% sensitivity and 51% specificity for PE prediction.
- Higher D-dimer levels were significantly associated with PE in COVID-19 patients (p=0.001).
Conclusions:
- D-dimer is a valuable predictive biomarker for PE in COVID-19.
- The established D-dimer cut-off provides a practical tool for clinical decision-making.
- Further validation in diverse populations is recommended.
Introduction:
Pulmonary embolism (PE) is a significant complication in patients with COVID-19, often associated with elevated D-dimer levels. However, there remains uncertainty around the D-dimer threshold for predicting PE in COVID-19 patients as it is influenced by multiple disease factors. This study aimed to establish the D-dimer cut-off value for predicting pulmonary embolism (PE) in patients with COVID-19, evaluate the sensitivity and specificity of this cut-off value, and describe the occurrence of PE and its significant factors.
Materials And Methods:
A retrospective analysis was conducted on 320 patients with COVID-19 who underwent computed tomography pulmonary angiography (CTPA) due to clinical suspicion of PE between 2020 and 2021 at a single centre in Malaysia. Clinical and biological factors associated with PE were analyzed, including age, sex, race, and D-dimer levels.
Results:
Among the study population, 23.4% of males and 15.4% of females tested positive for PE, with no significant differences noted across racial groups. Age was significantly associated with PE development (p = 0.013). Ddimer levels in PE-positive patients were five times higher than in PE-negative patients (p = 0.001). An optimal D-dimer cut-off of 2799 ng/ml level was identified with an area under the curve (AUC) of 0.744 (95% CI: 0.676-0.813), and sensitivity of 81%, and specificity of 51%.
Conclusion:
This study highlights the role of D-dimer as a predictive biomarker for PE in COVID-19 patients. The identified cut-off value offers a practical threshold for clinical decision-making, balancing sensitivity and specificity. Further studies are needed to validate these findings in broader population.
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