Blood test dynamics in hospitalized COVID-19 patients: Potential utility of D-dimer for pulmonary embolism diagnosis.
Blood test dynamics in hospitalized COVID-19 patients: Potential utility of D-dimer for pulmonary embolism diagnosis.
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DOI：
10.1371/journal.pone.0243533
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Riera-Mestre A
中科院分区：
文献类型：
--
作者：
Cerdà P;Ribas J;Iriarte A;Mora-Luján JM;Torres R;Del Río B;Jofre HI;Ruiz Y;Huguet M;Fuset MP;Martínez-Yélamos S;Santos S;Llecha N;Corbella X;Riera-Mestre A
据报道，在COVID-19住院患者中，血栓形成事件（主要是肺栓塞（PE））的发生率较高。主要目的是根据PE的发生率评估住院COVID-19患者的临床和实验室差异。这项回顾性研究纳入了因临床疑似PE而接受计算机断层扫描（CT）血管造影的所有连续COVID-19住院患者。从COVID-19症状发作开始，将PE和非PE患者的临床数据和中位数血液检查结果分布到每周时段，进行比较。92例患者入选，29例（32%）患有PE。PE患者更年轻（63.9（SD 13.7）vs 69.9（SD 12.5）岁）。两组的临床症状和COVID-19 CT特征相似。PE在COVID-19症状发作后平均20.0（SD 8.6）天后被诊断。皮质类固醇推注更常用于PE患者（62% vs. 43%）。没有患者符合ISTH DIC标准。当比较两组时，除D-二聚体外，任何参数均具有统计学显著性或临床相关性。PE与非PE患者的D-二聚体中位数[IQR]为：第2周（2010.7 [770.1-11208.9] vs 626.0 [374.0-2382.2]; p = 0.004）;第3周（3893.1 [1388.2-6694.0] vs 1184.4 [461.8-2447.8]; p = 0.003）;第4周（2736.3 [1202.1-8514.1] vs 1129.1 [542.5-2834.6]; p = 0.01）。第1周和第2周之间D-二聚体的中位倍数增加在组间不同（6.64 [3.02-23.05] vs 1.57 [0.64-2.71]，p = 0.003）; ROC曲线AUC为0.879（p = 0.003），PE的灵敏度和特异性分别为86%和80%。在住院的COVID-19患者中，发生PE的患者在COVID-19症状发作后第2、3和4周的D-二聚体水平较高。当比较第1周和第2周之间的倍数增加时，这种差异更加明显。
A higher incidence of thrombotic events, mainly pulmonary embolism (PE), has been reported in hospitalized patients with COVID-19. The main objective was to assess clinical and laboratory differences in hospitalized COVID-19 patients according to occurrence of PE. This retrospective study included all consecutive patients hospitalized with COVID-19 who underwent a computed tomography (CT) angiography for PE clinical suspicion. Clinical data and median blood test results distributed into weekly periods from COVID-19 symptoms onset, were compared between PE and non-PE patients. Ninety-two patients were included, 29 (32%) had PE. PE patients were younger (63.9 (SD 13.7) vs 69.9 (SD 12.5) years). Clinical symptoms and COVID-19 CT features were similar in both groups. PE was diagnosed after a mean of 20.0 (SD 8.6) days from the onset of COVID-19 symptoms. Corticosteroid boluses were more frequently used in PE patients (62% vs. 43%). No patients met ISTH DIC criteria. Any parameter was statistically significant or clinically relevant except for D-Dimer when comparing both groups. Median values [IQR] of D-dimer in PE vs non-PE patients were: week 2 (2010.7 [770.1–11208.9] vs 626.0 [374.0–2382.2]; p = 0.004); week 3 (3893.1 [1388.2–6694.0] vs 1184.4 [461.8–2447.8]; p = 0.003); and week 4 (2736.3 [1202.1–8514.1] vs 1129.1 [542.5–2834.6]; p = 0.01). Median fold-increase of D-dimer between week 1 and 2 differed between groups (6.64 [3.02–23.05] vs 1.57 [0.64–2.71], p = 0.003); ROC curve AUC was 0.879 (p = 0.003) with a sensitivity and specificity for PE of 86% and 80%, respectively. Among hospitalized COVID-19 patients, D-dimer levels are higher at weeks 2, 3 and 4 after COVID-19 symptom onset in patients who develop PE. This difference is more pronounced when the fold increase between weeks 1 and 2 is compared.
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