What level of D-dimers can safely exclude pulmonary embolism in COVID-19 patients presenting to the emergency department?
What level of D-dimers can safely exclude pulmonary embolism in COVID-19 patients presenting to the emergency department?
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DOI：
10.1007/s00330-021-08377-9
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发表时间：
2022-04
影响因子：
5.9
通讯作者：
AP-HP /Universities/Inserm COVID-19 research collaboration, AP-HP Covid CDR Initiative
中科院分区：
文献类型：
--
作者：
Revel MP;Beeker N;Porcher R;Jilet L;Fournier L;Rance B;Chassagnon G;Fontenay M;Sanchez O;AP-HP /Universities/Inserm COVID-19 research collaboration, AP-HP Covid CDR Initiative
目的：确定在急诊科(ED)就诊的新冠肺炎患者中，哪种水平的D-二聚体可以安全地排除肺栓塞(PE)。这项回顾研究是在巴黎公共援助协会(AP-HP)的COVID数据库上进行的。纳入2020年3月1日至5月15日在AP-HP医院急诊科就诊的新冠肺炎患者，并在就诊后48h内服用D-二聚体。计算不同D-二聚体阈值下D-二聚体的敏感度、特异度、阳性预测值和阴性预测值，以及假阴性率、失败率和可能避免的CTPA数量。共纳入781例SARS-CoV-2 RT-PCR阳性患者(平均年龄62.0岁，男性53.8%)，其中60例(7.7%)患有CTPA确诊的PE。其D-二聚体水平中位数显著高于非PE组(4,013vs1,198 ng·mL−1，p <； 0.001)。用500ng.mL.−-1或以患者年龄调整的 >； 50年为界值，其敏感性和净现值均在90%以上。有了这些阈值，可以分别避免17.1%和31.5%的CTPA。在178名D-二聚体低于年龄调整临界值的患者中，有4名患者发生了PE，导致可接受的失败率为2.2%。使用更高的D-二聚体截止值可以避免更多的CTPA，但会降低敏感性并增加失败率。应使用与非COVID门诊患者相同的D-二聚体阈值安全地排除PE。新冠肺炎合并PE组血浆D-二聚体水平显著高于非PE组(分别为4,013 ng·m L−1和1,198 ng·m L−1，p <； 0.001)。以5 0 0 ng·m L−1或以年龄调整的D-二聚体为界值排除肺栓塞，敏感性和阴性预测值均在90%以上。·更高的截止日期将导致敏感度降低到85%以下，失败率上升，特别是对50岁以下的患者。网上版载有补充材料，可在10.1007/s00330-021-08377-9查阅。
To identify which level of D-dimer would allow the safe exclusion of pulmonary embolism (PE) in COVID-19 patients presenting to the emergency department (ED). This retrospective study was conducted on the COVID database of Assistance Publique – Hôpitaux de Paris (AP-HP). COVID-19 patients who presented at the ED of AP-HP hospitals between March 1 and May 15, 2020, and had CTPA following D-dimer dosage within 48h of presentation were included. The D-dimer sensitivity, specificity, and positive and negative predictive values were calculated for different D-dimer thresholds, as well as the false-negative and failure rates, and the number of CTPAs potentially avoided. A total of 781 patients (mean age 62.0 years, 53.8% men) with positive RT-PCR for SARS-Cov-2 were included and 60 of them (7.7%) had CTPA-confirmed PE. Their median D-dimer level was significantly higher than that of patients without PE (4,013 vs 1,198 ng·mL−1, p < 0.001). Using 500 ng·mL−1, or an age-adjusted cut-off for patients > 50 years, the sensitivity and the NPV were above 90%. With these thresholds, 17.1% and 31.5% of CTPAs could have been avoided, respectively. Four of the 178 patients who had a D-dimer below the age-adjusted cutoff had PE, leading to an acceptable failure rate of 2.2%. Using higher D-dimer cut-offs could have avoided more CTPAs, but would have lowered the sensitivity and increased the failure rate. The same D-Dimer thresholds as those validated in non-COVID outpatients should be used to safely rule out PE. • The median D-dimer level was significantly higher in COVID-19 patients with PE as compared to those without PE (4,013 ng·mL−1 vs 1,198 ng·mL−1 respectively, p < 0.001). • Using 500 ng·mL−1, or an age-adjusted D-dimer cut-off to exclude pulmonary embolism, the sensitivity and negative predictive value were above 90%. • Higher cut-offs would lead to a reduction in the sensitivity below 85% and an increase in the failure rate, especially for patients under 50 years. The online version contains supplementary material available at 10.1007/s00330-021-08377-9.
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DOI：
10.1164/rccm.202004-1412oc
发表时间：
2020-09-01
影响因子：
24.7
作者：
Patel, Brijesh, V;Arachchillage, Deepa J.;Desai, Sujal R.
通讯作者：
Desai, Sujal R.
影响因子：
9.6
作者：
Jiménez D;García-Sanchez A;Rali P;Muriel A;Bikdeli B;Ruiz-Artacho P;Le Mao R;Rodríguez C;Hunt BJ;Monreal M
通讯作者：
Monreal M
影响因子：
19.7
作者：
Poyiadji N;Cormier P;Patel PY;Hadied MO;Bhargava P;Khanna K;Nadig J;Keimig T;Spizarny D;Reeser N;Klochko C;Peterson EL;Song T
通讯作者：
Song T
影响因子：
3.7
作者：
Alonso-Fernandez, Alberto;Toledo-Pons, Nuria;Sala-LlinaS, Ernest
通讯作者：
Sala-LlinaS, Ernest
影响因子：
7.5
作者：
Klok, F. A.;Kruip, M. J. H. A.;Endeman, H.
通讯作者：
Endeman, H.