The impact of COVID-19 on the sensitivity of D-dimer for pulmonary embolism
The impact of COVID-19 on the sensitivity of D-dimer for pulmonary embolism
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DOI：
10.1111/acem.14348
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发表时间：
2021-08-23
影响因子：
4.4
通讯作者：
Fields, J. Matthew
中科院分区：
文献类型：
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作者：
Elberts, Samuel J.;Bateman, Ryan;Fields, J. Matthew
目的探讨d -二聚体在合并新冠肺炎（COVID-19）患者肺栓塞（PE）中的检测特点。我们假设d -二聚体在当前机构切割点对PE的敏感性与没有COVID-19的人相似。方法：本研究是一项多中心回顾性观察队列研究，涉及同一医疗保健系统的5个城市和郊区急诊科。查询2019年12月1日至2020年10月22日期间所有计算机断层扫描肺血管造影（CTPA）研究的电子健康记录。所有接受CTPA的ED患者都在一次就诊中完成了d -二聚体和COVID-19检测。获得基线人口统计数据。计算患有和不患有COVID-19的患者PE的d -二聚体的测试特征。此外，为两种不同的d -二聚体测定构建了受试者操作特征（ROC）曲线。结果有1158例患者符合分析标准。新冠肺炎阳性和阴性患者PE d -二聚体检测结果相似。在covid -19阳性患者中，敏感性为100%(95%可信区间[CI] = 87.6% ~ 100%)，特异性为11.9% (95% CI = 7.9% ~ 17.1%)，阴性预测值（NPV）为100%。在covid -19阴性患者中，敏感性为97.6% (95% CI = 91.5% ~ 99.7%)，特异性为14.4% (95% CI = 12.1% ~ 17%)， NPV为98.3% （95% CI = 93.8% ~ 99.6%）。对于检测1，covid -19阳性患者的曲线下面积（AUC）为0.76 (95% CI = 0.68-0.83)， covid -19阴性患者的曲线下面积（AUC）为0.73 （95% CI = 0.69-0.77）。试验2中，covid -19阳性患者的AUC为0.85 (95% CI = 0.77-0.92)， covid -19阴性患者的AUC为0.80 （95% CI = 0.77-0.84）。检测1的ROC曲线显示，100%的灵敏度维持在0.67 FEU（纤维蛋白原等效单位，从0.50 FEU）的阈值，特异性从18.7%增加到29%；检测2的灵敏度维持在662 d -二聚体单位（DDU，从230 DDU）的阈值，特异性从6.1%增加到59%。结论本多中心回顾性研究结果未发现d -二聚体对合并COVID-19感染的PE的敏感性有显著差异。需要进一步的研究来确定在疑似或确诊的COVID-19患者中，仅根据d -二聚体结果是否可以安全地排除PE，或者调整d -二聚体水平是否可以在管理中发挥作用。
Objective This study seeks to evaluate the test characteristics of D-dimer for pulmonary embolism (PE) in patients with a concurrent diagnosis of COVID-19. We hypothesized that the sensitivity of D-dimer for PE at current institutional cut points would be similar to those without COVID-19. Methods This is a multicenter retrospective observational cohort study across five urban and suburban EDs in the same health care system. The electronic health record was queried for all computed tomography pulmonary angiography (CTPA) studies from December 1, 2019, to October 22, 2020. All ED patients who underwent CTPA had D-dimer and COVID-19 testing completed in a single encounter were included in the study. Baseline demographics were obtained. Test characteristics of D-dimer for PE were calculated for patients with and without COVID-19. Additionally, receiver operator characteristics (ROC) curves were constructed for two different D-dimer assays. Results There were 1158 patient encounters that met criteria for analysis. Performance of D-dimer testing for PE was similar between COVID-19-positive and -negative patients. In COVID-19-positive patients, the sensitivity was 100% (95% confidence interval [CI] = 87.6%-100%), specificity was 11.9% (95% CI = 7.9%-17.1%), and negative predictive value (NPV) was 100%. In COVID-19-negative patients the sensitivity was 97.6% (95% CI = 91.5%-99.7%), specificity was 14.4% (95% CI = 12.1%-17%), and NPV was 98.3% (95% CI = 93.8%-99.6%). For assay 1 the area under the curve (AUC) for COVID-19-positive patients was 0.76 (95% CI = 0.68-0.83), and for COVID-19-negative patients, 0.73 (95% CI = 0.69-0.77). For assay 2, AUC for COVID-19-positive patients was 0.85 (95% CI = 0.77-0.92), and for COVID-19-negative patients, 0.80 (95% CI = 0.77-0.84). Inspection of the ROC curve for assay 1 revealed that 100% sensitivity was maintained up to a threshold of 0.67 FEU (fibrinogen equivalent units; from 0.50 FEU) with an increase in specificity to 29% (from 18.7%), and for assay 2, 100% sensitivity was maintained up to a threshold of 662 D-dimer units (DDU; from 230 DDU) with an increased specificity to 59% (from 6.1%). Conclusion Results from this multicenter retrospective study did not find a significant difference in sensitivity of D-dimer for PE due to concomitant COVID-19 infection. Further study is required to determine if PE can safely be excluded based on D-dimer results alone in patients with suspected or proven COVID-19 or if adjusted D-dimer levels could have a role in management.