D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients

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

D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients

2021

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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