D-dimer Thresholds to Exclude Pulmonary Embolism among COVID-19 Patients in the Emergency Department: Derivation with Independent Validation.
D-dimer Thresholds to Exclude Pulmonary Embolism among COVID-19 Patients in the Emergency Department: Derivation with Independent Validation.
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DOI：
10.1177/10760296221117997
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发表时间：
2022-01
影响因子：
2.9
通讯作者：
Kline, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Bledsoe, Joseph R.;Knox, Daniel;Peltan, Ithan D.;Woller, Scott C.;Lloyd, James F.;Snow, Gregory L.;Horne, Benjamin D.;Connors, Jean M.;Kline, Jeffrey A.
关键词：
推导并验证在急诊科（艾德）就诊的COVID-19患者中排除肺栓塞（PE）的D-二聚体临界值。在2020年3月1日至2021年1月31日期间，在包括22名成人艾德的综合医疗保健系统中进行了一项回顾性队列研究。在RECOVER登记研究中纳入的患者中验证了结果，代表了来自美国26个州的154例艾德的数据。将实验室确诊COVID-19的连续性艾德患者（在艾德到达后48小时内进行D-二聚体检查）和客观确诊PE的患者与无PE的患者进行比较。在确定衍生队列中PE阴性预测值的95%置信下限高于98%的D-二聚体阈值后，使用RECOVER登记研究数据进行验证。在3978例有D-二聚体结果的患者中，3583例确诊COVID-19感染的患者被纳入推导队列。总体而言，PE发生率为4.1%，D-二聚体临界值<2 μ/mL（2000 ng/mL）与NPV为98.5%（95% CI = 98.0%-98.9%）相关。 在13,091名D-二聚体患者的验证队列中，7748名患者确认了COVID-19感染，PE发生率为1.14%。D-二聚体临界值<2 μ/mL与NPV为99.5%（95% CI = 99.3%-99.7%）相关。 在COVID-19患者中，D-二聚体临界值<2 μ/ml与PE的高阴性预测值相关。 然而，在该阈值下的PE结果灵敏度（未进行预测试概率评估）将被视为临床上不安全。
To derive and validate a D-dimer cutoff for ruling out pulmonary embolism (PE) in COVID-19 patients presenting to the emergency department (ED). A retrospective cohort study was performed in an integrated healthcare system including 22 adult ED's between March 1, 2020, and January 31, 2021. Results were validated among patients enrolled in the RECOVER Registry, representing data from 154 ED's from 26 US states. Consecutive ED patients with laboratory confirmed COVID-19, a D-dimer performed within 48 h of ED arrival, and with objectively confirmed PE were compared to those without PE. After identifying a D-dimer threshold at which the 95% confidence lower bound of the negative predictive value for PE was higher than 98% in the derivation cohort, it was validated using RECOVER registry data. Among 3978 patients with a D-dimer result, 3583 with confirmed COVID-19 infection were included in the derivation cohort. Overall, PE incidence was 4.1% and a D-dimer cutoff of <2 μ/mL (2000 ng/mL) was associated with a NPV of 98.5% (95% CI = 98.0%−98.9%). In the validation cohort of 13,091 patients with a D-dimer, 7748 had confirmed COVID-19 infection, and the PE incidence was 1.14%. A D-dimer cutoff of <2 μ/mL was associated with a NPV of 99.5% (95% CI = 99.3%−99.7%). A D-dimer cutoff of <2 μ/ml was associated with a high negative predictive value for PE among patients with COVID-19. However, the resultant sensitivity for PE result at that threshold without pre-test probability assessment would be considered clinically unsafe.
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影响因子：
5.9
作者：
Kwee RM;Adams HJA;Kwee TC
通讯作者：
Kwee TC
影响因子：
2.2
作者：
Ventura-Díaz S;Quintana-Pérez JV;Gil-Boronat A;Herrero-Huertas M;Gorospe-Sarasúa L;Montilla J;Acosta-Batlle J;Blázquez-Sánchez J;Vicente-Bártulos A
通讯作者：
Vicente-Bártulos A
影响因子：
5.9
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
通讯作者：
AP-HP /Universities/Inserm COVID-19 research collaboration, AP-HP Covid CDR Initiative
影响因子：
4.4
作者：
Elberts, Samuel J.;Bateman, Ryan;Fields, J. Matthew
通讯作者：
Fields, J. Matthew
DOI：
10.1016/j.jinf.2021.01.003
发表时间：
2021-03
期刊：
The Journal of infection
影响因子：
--
作者：
García-Ortega A;Oscullo G;Calvillo P;López-Reyes R;Méndez R;Gómez-Olivas JD;Bekki A;Fonfría C;Trilles-Olaso L;Zaldívar E;Ferrando A;Anguera G;Briones-Gómez A;Reig-Mezquida JP;Feced L;González-Jiménez P;Reyes S;Muñoz-Núñez CF;Carreres A;Gil R;Morata C;Toledo-Pons N;Martí-Bonmati L;Menéndez R;Martínez-García MÁ
通讯作者：
Martínez-García MÁ