Department of Respiratory Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
J Thromb Thrombolysis. 2021 Nov;52(4):1068-1073. doi: 10.1007/s11239-021-02508-1. Epub 2021 Jun 23.
COVID-19 patients have increased risk of pulmonary embolism (PE), but symptoms of both conditions overlap. Because screening algorithms for PE in COVID-19 patients are currently lacking, PE might be underdiagnosed. We evaluated a screening algorithm in which all patients presenting to the ED with suspected or confirmed COVID-19 routinely undergo D-dimer testing, followed by CT pulmonary angiography (CTPA) if D-dimer is ≥ 1.00 mg/L. Consecutive adult patients presenting to the ED of two university hospitals in Amsterdam, The Netherlands, between 01-10-2020 and 31-12-2020, who had a final diagnosis of COVID-19, were retrospectively included. D-dimer and CTPA results were obtained. Of 541 patients with a final diagnosis of COVID-19 presenting to the ED, 25 (4.6%) were excluded because D-dimer was missing, and 71 (13.1%) because they used anticoagulation therapy. Of 445 included patients, 185 (41.6%; 95%CI 37.0-46.3) had a D-dimer ≥ 1.00 mg/L. CTPA was performed in 169 of them, which showed PE in 26 (15.4%; 95%CI 10.3-21.7), resulting in an overall detection rate of 5.8% (95%CI 3.9-8.4) in the complete study group. In patients with and without PE at CTPA, median D-dimer was 9.84 (IQR 3.90-29.38) and 1.64 (IQR 1.17-3.01), respectively (p < 0.001). PE prevalence increased with increasing D-dimer, ranging from 1.2% (95%CI 0.0-6.4) if D-dimer was 1.00-1.99 mg/L, to 48.6% (95%CI 31.4-66.0) if D-dimer was ≥ 5.00 mg/L. In conclusion, by applying this screening algorithm, PE was identified in a considerable proportion of COVID-19 patients. Prospective management studies should assess if this algorithm safely rules-out PE if D-dimer is < 1.00 mg/L.
COVID-19 患者发生肺栓塞 (PE) 的风险增加，但这两种疾病的症状有重叠。由于目前 COVID-19 患者的 PE 筛查算法缺乏，PE 可能诊断不足。我们评估了一种筛查算法，所有因疑似或确诊 COVID-19 而到急诊就诊的患者常规进行 D-二聚体检测，如果 D-二聚体≥1.00mg/L，则进行 CT 肺动脉造影 (CTPA)。连续纳入 2020 年 10 月 1 日至 12 月 31 日期间在荷兰阿姆斯特丹两家大学医院急诊就诊的最终诊断为 COVID-19 的成年患者。回顾性获得 D-二聚体和 CTPA 结果。541 名最终诊断为 COVID-19 的患者中，25 名（4.6%）因 D-二聚体缺失而被排除，71 名（13.1%）因抗凝治疗而被排除。445 名纳入患者中，185 名（41.6%；95%CI 37.0-46.3）D-二聚体≥1.00mg/L。其中 169 例行 CTPA，26 例（15.4%；95%CI 10.3-21.7）显示 PE，总检出率为 5.8%（95%CI 3.9-8.4）。在 CTPA 有和无 PE 的患者中，D-二聚体中位数分别为 9.84（IQR 3.90-29.38）和 1.64（IQR 1.17-3.01）（p<0.001）。PE 的患病率随 D-二聚体的升高而增加，范围从 D-二聚体 1.00-1.99mg/L 时的 1.2%（95%CI 0.0-6.4）到 D-二聚体≥5.00mg/L 时的 48.6%（95%CI 31.4-66.0）。总之，通过应用该筛查算法，COVID-19 患者中有相当比例的患者发现了 PE。前瞻性管理研究应评估如果 D-二聚体<1.00mg/L，该算法是否能安全排除 PE。
