D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients
2021
Benjamin Thoreau | Joris Galland | Maxime Delrue | Marie Neuwirth | Alain Stepanian | Anthony Chauvin | Azeddine Dellal | Olivier Nallet | Melanie Roriz | Mathilde Devaux | Jonathan London | Gonzague Martin-Lecamp | Antoine Froissart | Nouara Arab | Bertrand Ferron | Marie-Helene Groff | Viviane Queyrel | Christine Lorut | Lucile Regard | Emilie Berthoux | Guillaume Bayer | Chloe Comarmond | Bertrand Lioger | Arsène Mekinian | Tali-Anne Szwebel | Thomas Sené | Blanca Amador-Borrero | Olivier Mangin | Pierre O. Sellier | Virginie Siguret | Stéphane Mouly | Jean-Philippe Kevorkian | Lariboisière COVID Group | Dominique Vodovar | Damien Sene
The incidence of pulmonary embolism (PE) is high during severe Coronavirus Disease 2019 (COVID-19). We aimed to identify predictive and prognostic factors of PE in non-ICU hospitalized COVID-19 patients. In the retrospective multicenter observational CLOTVID cohort, we enrolled patients with confirmed RT-PCR COVID-19 who were hospitalized in a medicine ward and also underwent a CT pulmonary angiography for a PE suspicion. Baseline data, laboratory biomarkers, treatments, and outcomes were collected. Predictive and prognostics factors of PE were identified by using logistic multivariate and by Cox regression models, respectively. A total of 174 patients were enrolled, among whom 86 (median [IQR] age of 66 years [55–77]) had post-admission PE suspicion, with 30/86 (34.9%) PE being confirmed. PE occurrence was independently associated with the lack of long-term anticoagulation or thromboprophylaxis (OR [95%CI], 72.3 [3.6–4384.8]) D-dimers ≥ 2000 ng/mL (26.3 [4.1–537.8]) and neutrophils ≥ 7.0 G/L (5.8 [1.4–29.5]). The presence of these two biomarkers was associated with a higher risk of PE (p = 0.0002) and death or ICU transfer (HR [95%CI], 12.9 [2.5–67.8], p < 0.01). In hospitalized non-ICU severe COVID-19 patients with clinical PE suspicion, the lack of anticoagulation, D-dimers ≥ 2000 ng/mL, neutrophils ≥ 7.0 G/L, and these two biomarkers combined might be useful predictive markers of PE and prognosis, respectively.
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