Mikhjian Gary, Elghoroury Ahmad, Cronovich Keith, Brody Kevin, Jarski Robert
Henry Ford Macomb.
Henry Ford.
Spartan Med Res J. 2021 Apr 13;6(1):18652. doi: 10.51894/001c.18652.
COVID-19 has been frequently cited as a condition causing a pro-inflammatory state leading to hypercoagulopathy and increased risk for venous thromboembolism. This condition has thus prompted prior studies and screening models that utilize D-dimer for pulmonary embolism (PE) into question. The limited research to date has failed to provide tools or guidance regarding what COVID-19 positive patients should receive pulmonary CT angiography screening. This knowledge gap has led to missed diagnoses, CT overutilization, and increased morbidity and mortality.
The purpose of this study was to examine the utility of the quantitative D-dimer lab marker in a convenience sample of 426 COVID-19 positive patients to assist providers in determining the utility of pulmonary CT angiography.
The authors conducted a retrospective analysis on all COVID-19 positive patients within the Henry Ford Medical System between March 1st, 2020 through April 30th, 2020 who received pulmonary CT angiography and had a quantitative D-dimer lab drawn within 24 hours of CT imaging.
Our sampling criteria yielded a total of n = 426 patients, of whom 347 (81.5%) were negative for PE and 79 (18.5%) were positive for PE. The average D-dimer in the negative PE group was 2.95 μg./mL. (SD 4.26), significantly different than the 9.15 μg./mL. (SD 6.80) positive PE group (P < 0.05; 95% CI -7.8, -4.6). Theoretically, applying the traditional ≤ 0.5 μg./mL. D-dimer cut-off to our data would yield a sensitivity of 100% and specificity of 7.49% for exclusion of PE. Based on these results, the authors would be able to increase the D-dimer threshold to < 0.89 μg./mL. to maintain their sensitivity to 100% and raise the specificity to 27.95%. Observing a D-dimer cut-off value of ≤ 1.28 μg./mL. would reduce sensitivity to 97.47% but increase the specificity to 57.93%.
These study results support the utilization of alternative D-dimer thresholds to exclude PE in COVID-19 patients. Based on these findings, providers may be able to observe increased D-dimer cut-off values to reduce unnecessary pulmonary CT angiography scans.
新型冠状病毒肺炎（COVID-19）常被认为是一种可导致促炎状态，进而引发高凝血症并增加静脉血栓栓塞风险的疾病。这种情况使得先前利用D-二聚体检测肺栓塞（PE）的研究和筛查模型受到质疑。迄今为止，有限的研究未能提供关于COVID-19阳性患者应接受肺部CT血管造影筛查的工具或指导。这种知识空白导致了漏诊、CT过度使用以及发病率和死亡率的增加。
本研究旨在探讨定量D-二聚体实验室指标在426例COVID-19阳性患者的便利样本中的效用，以帮助医疗人员确定肺部CT血管造影的效用。
作者对亨利福特医疗系统内2020年3月1日至2020年4月30日期间接受肺部CT血管造影且在CT成像后24小时内进行定量D-二聚体检测的所有COVID-19阳性患者进行了回顾性分析。
我们的抽样标准共纳入了n = 426例患者，其中347例（81.5%）PE检测为阴性，79例（18.5%）PE检测为阳性。PE阴性组的平均D-二聚体为2.95μg/mL（标准差4.26），与PE阳性组的9.15μg/mL（标准差6.80）有显著差异（P < 0.05；95%置信区间 -7.8，-4.6）。理论上，将传统的≤0.5μg/mL的D-二聚体临界值应用于我们的数据，排除PE的敏感性为100%，特异性为7.49%。基于这些结果，作者能够将D-二聚体阈值提高到<0.89μg/mL，以保持敏感性为100%，并将特异性提高到27.95%。观察到D-二聚体临界值≤1.28μg/mL将使敏感性降至97.47%，但特异性提高到57.93%。
这些研究结果支持采用替代的D-二聚体阈值来排除COVID-19患者的PE。基于这些发现，医疗人员或许能够提高D-二聚体临界值，以减少不必要的肺部CT血管造影扫描。
