D-dimer value for predicting pulmonary embolism in COVID-19 patients: A retrospective study

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.

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.

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%.

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.