Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis.
Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis.
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DOI：
10.1007/s00330-021-08003-8
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发表时间：
2021-11
影响因子：
5.9
通讯作者：
Kwee TC
中科院分区：
文献类型：
--
作者：
Kwee RM;Adams HJA;Kwee TC
在荟萃分析中，研究新冠肺炎患者发生肺栓塞的频率，以及D-二聚体评估是否有助于选择接受CT肺血管造影的患者。对报道新冠肺炎患者CTPA上PE发生率的原始研究进行系统的文献检索。用随机效应模型合并PE的发生频率、PE的部位和D-二聚体水平的标化平均差(SMD)。共纳入71项研究。新冠肺炎患者在急诊科、普通病房和重症监护病房发生PE的合并频率分别为17.9%(95%CI：12.0~23.8%)、23.9%(95%CI：15.2~32.7%)和48.6%(95%CI：41.0~56.1%)。PE好发于外周动脉多于主肺动脉(合并发生率为65.3%[95%CI：60.0~70.1%]vs.32.9%[95%CI：26.7~39.0%]；OR=3.540[95%CI：2.308~5.431%])。PE患者的D-二聚体水平显著升高(合并SMD值为1.096[95%CI，0.844-1.349])。用于鉴别PE患者的D-二聚体水平在1000~4800μg/L之间变化。在ICU中，新冠肺炎患者出现PE的频率最高，其次是普通病房和急诊室。新冠肺炎的PE多位于外周动脉而不是中央动脉，提示局部血栓形成起主要作用。D-二聚体评估可能有助于选择新冠肺炎患者进行CTPA，使用至少1000μg/L的D-二聚体截止水平·新冠肺炎患者PE的频率在ICU最高，其次是普通病房和急诊室。·新冠肺炎的PE多位于外周动脉，而不是中央动脉。·新冠肺炎合并PE患者的D-二聚体水平显著升高。网上版载有补充材料，可在10.1007/s00330-021-08003-8查阅。
To investigate, in a meta-analysis, the frequency of pulmonary embolism (PE) in patients with COVID-19 and whether D-dimer assessment may be useful to select patients for computed tomography pulmonary angiography (CTPA). A systematic literature search was performed for original studies which reported the frequency of PE on CTPA in patients with COVID-19. The frequency of PE, the location of PE, and the standardized mean difference (SMD) of D-dimer levels between patients with and without PE were pooled by random effects models. Seventy-one studies were included. Pooled frequencies of PE in patients with COVID-19 at the emergency department (ED), general wards, and intensive care unit (ICU) were 17.9% (95% CI: 12.0–23.8%), 23.9% (95% CI: 15.2–32.7%), and 48.6% (95% CI: 41.0–56.1%), respectively. PE was more commonly located in peripheral than in main pulmonary arteries (pooled frequency of 65.3% [95% CI: 60.0–70.1%] vs. 32.9% [95% CI: 26.7–39.0%]; OR = 3.540 [95% CI: 2.308–5.431%]). Patients with PE had significantly higher D-dimer levels (pooled SMD of 1.096 [95% CI, 0.844–1.349]). D-dimer cutoff levels which have been used to identify patients with PE varied between 1000 and 4800 μg/L. The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries, which suggests local thrombosis to play a major role. D-dimer assessment may help to select patients with COVID-19 for CTPA, using D-dimer cutoff levels of at least 1000 μg/L. • The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. • PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries. • D-dimer levels are significantly higher in patients with COVID-19 who have PE. The online version contains supplementary material available at 10.1007/s00330-021-08003-8.
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