Combined Use of Wells Scores and D-dimer Levels for the Diagnosis of Deep Vein Thrombosis and Pulmonary Embolism in COVID-19: A Retrospective Cohort Study.
Combined Use of Wells Scores and D-dimer Levels for the Diagnosis of Deep Vein Thrombosis and Pulmonary Embolism in COVID-19: A Retrospective Cohort Study.
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DOI：
10.7759/cureus.17687
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
Sankaramangalam K
中科院分区：
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作者：
Raj K;Chandna S;Doukas SG;Watts A;Jyotheeswara Pillai K;Anandam A;Singh D;Nagarakanti R;Sankaramangalam K
深静脉血栓形成（DVT）和肺栓塞（PE）是2019冠状病毒病（COVID-19）的主要并发症。该研究的主要结局是评估威尔斯DVT、威尔斯PE评分和D-二聚体在诊断DVT和PE中的效用。次要结局是COVID-19患者发生PE和DVT的风险因素。材料和方法我们比较了下肢（LE）双重阳性和阴性的COVID-19患者。对接受PE成像的患者采用了类似的方法。结果109例患者中PE的患病率为23.8%（26/109），DVT的患病率为33%（35/106），D-二聚体500 ng/mL诊断PE和DVT的敏感性分别为95.6%和93.7%。威尔斯深静脉血栓评分为3分，诊断COVID-19深静脉血栓的特异性为92.9%，敏感性为8.8%。威尔斯肺栓塞评分为4分诊断肺栓塞的特异性为100%，敏感性为20%。在疑似DVT中使用威尔斯DVT评分为3分，在疑似PE中使用威尔斯PE评分为4分，D-二聚体为500 ng/ml的组合方法的灵敏度分别为94.2%和96.1%。疑似DVT组，男性（OR 3.88，95% CI 1.55-9.7，P=0.004），较低的体重指数（BMI）（OR 0.92，95% CI 0.86-0.99，P=0.037），抗血小板药物使用（OR 0.19，95% CI 0.04-0.88，P=0.035），收缩压≤100 mmHg（OR 4.96，95%CI 1.37-17.86，P=0.014），绝对淋巴细胞≤1（OR 2.57，95% CI 1.07-6.12，P=0.033），D-二聚体≥500 ng/ml（OR 6.42，95%CI 1.40-29.38，P=0.016），血尿素氮（BUN）≥20 mg/dl（OR 2.33，95% CI 1.00-5.41，P=0.048）和插管（OR 3.32，95% CI 1.26-8.78，P=0.015）对DVT具有统计学意义。在疑似PE组中，癌症史（OR 10.69，95% CI 1.06-107.74，P=0.044），总WBC计数（OR 1.07，95%CI 0.95-1.21，P=0.032），血小板≥ 40万（OR 5.13，95% CI 1.79-14.68，P=0.002），D-二聚体水平≥ 500 ng/ml（OR 25.47，95% CI 3.27-197.97，P=0.002），威尔斯PE评分（OR 2.46，95%CI 1.50-4.06，P<0.001），肺栓塞排除标准（PERC）评分（OR 1.79，95%CI 1.05-3.05，P=0.054），序贯器官衰竭评估（SOFA）评分（OR 1.91，95%CI 1.16-3.12，P=0.002）有统计学意义。结论疑似DVT患者采用威尔斯DVT评分3分，疑似PE患者采用威尔斯PE评分4分，D-二聚体浓度500 ng/ml的联合方法可用于诊断COVID-19所致PE和DVT。COVID-19中静脉血栓栓塞（VTE）的发生与插管和全身炎症严重程度较高等非传统风险因素相关，这些患者可能会从更积极的VTE检测中受益。
Introduction Deep vein thrombosis (DVT) and pulmonary embolism (PE) are key complications of coronavirus disease 2019 (COVID-19). The study's primary outcome was assessing the utility of Wells DVT, Wells PE scores, and D-dimers in diagnosing DVT and PE. Secondary outcomes were the risk factors for the development of PE and DVT in COVID-19 patients. Materials and methods We compared COVID-19 patients with a positive and negative lower extremity (LE) duplex. A similar approach was made for patients who underwent imaging for PE. Results The prevalence of PE was 23.8% (26 out of 109 patients), and the prevalence of DVT was 33% (35 out of 106). A D-dimer of 500 ng/mL had a sensitivity of 95.6% and 93.7% for the diagnosis of PE and DVT, respectively. A Wells DVT score of 3 points had a specificity of 92.9% and sensitivity of 8.8% for DVT diagnosis in COVID-19. A Wells PE score of 4 had a specificity of 100% and a sensitivity of 20% for the diagnosis of PE. The combined approach of using a Wells DVT score of 3 in suspected DVT and a Wells PE score of 4 in suspected PE and D-dimers of 500 ng/ml has a sensitivity of 94.2% and 96.1%, respectively. In the suspected DVT group, male gender (OR 3.88, 95% CI 1.55-9.7, P=0.004), lower body mass index (BMI) (OR 0.92, 95% CI 0.86-0.99, P=0.037), antiplatelet use (OR 0.19, 95% CI 0.04-0.88, P=0.035), systolic blood pressure ≤100 mmhg (OR 4.96, 95% CI 1.37-17.86, P=0.014), absolute lymphocytes ≤1 (OR 2.57, 95% CI 1.07-6.12, P=0.033), D-dimer ≥500 ng/ml (OR 6.42, 95% CI 1.40-29.38, P=0.016), blood urea nitrogen (BUN) ≥20 mg/dl (OR 2.33, 95% CI 1.00-5.41, P=0.048), and intubation (OR 3.32, 95% CI 1.26-8.78, P=0.015) were found to be statistically significant for DVT. In the suspected PE group, history of cancer (OR 10.69, 95% CI 1.06-107.74, P=0.044), total WBC count (OR 1.07, 95% CI 0.95-1.21, P=0.032), platelets ≥ 400,000 (OR 5.13, 95% CI 1.79-14.68, P=0.002), D-dimer levels ≥ 500 ng/ml (OR 25.47, 95% CI 3.27-197.97, P=0.002), Wells PE score (OR 2.46, 95% CI 1.50-4.06, P<0.001), pulmonary embolism rule-out criteria (PERC) score (OR 1.79, 95% CI 1.05-3.05, P=0.054), and Sequential Organ Failure Assessment (SOFA) score (OR 1.91, 95% CI 1.16-3.12, P=0.002) were statistically significant. Conclusions The combined approach of using a Wells DVT score of 3 in suspected DVT and Wells PE score of 4 in suspected PE and D-dimers of 500 ng/ml may be used to diagnose PE and DVT in COVID-19. Venous thromboembolism (VTE) occurrence in COVID-19 is associated with non-traditional risk factors such as intubation and higher severity of systemic inflammation, and these patients may benefit from more aggressive testing for VTE.