基于 SEMI-COVID-19 登记研究的新冠肺炎住院患者入院 D-二聚体截断值预测静脉血栓栓塞事件的评估。
Estimation of Admission D-dimer Cut-off Value to Predict Venous Thrombotic Events in Hospitalized COVID-19 Patients: Analysis of the SEMI-COVID-19 Registry.
机构信息
General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
Department of Clinical Medicine, Faculty of Medicine, Miguel Hernández University, Elche, Alicante, Spain.
出版信息
J Gen Intern Med. 2021 Nov;36(11):3478-3486. doi: 10.1007/s11606-021-07017-8. Epub 2021 Jul 21.
BACKGROUND
Venous thrombotic events (VTE) are frequent in COVID-19, and elevated plasma D-dimer (pDd) and dyspnea are common in both entities.
OBJECTIVE
To determine the admission pDd cut-off value associated with in-hospital VTE in patients with COVID-19.
METHODS
Multicenter, retrospective study analyzing the at-admission pDd cut-off value to predict VTE and anticoagulation intensity along hospitalization due to COVID-19.
RESULTS
Among 9386 patients, 2.2% had VTE: 1.6% pulmonary embolism (PE), 0.4% deep vein thrombosis (DVT), and 0.2% both. Those with VTE had a higher prevalence of tachypnea (42.9% vs. 31.1%; p = 0.0005), basal O2 saturation <93% (45.4% vs. 33.1%; p = 0.0003), higher at admission pDd (median [IQR]: 1.4 [0.6-5.5] vs. 0.6 [0.4-1.2] μg/ml; p < 0.0001) and platelet count (median [IQR]: 208 [158-289] vs. 189 [148-245] platelets × 10/L; p = 0.0013). A pDd cut-off of 1.1 μg/ml showed specificity 72%, sensitivity 49%, positive predictive value (PPV) 4%, and negative predictive value (NPV) 99% for in-hospital VTE. A cut-off value of 4.7 μg/ml showed specificity of 95%, sensitivity of 27%, PPV of 9%, and NPV of 98%. Overall mortality was proportional to pDd value, with the lowest incidence for each pDd category depending on anticoagulation intensity: 26.3% for those with pDd >1.0 μg/ml treated with prophylactic dose (p < 0.0001), 28.8% for pDd for patients with pDd >2.0 μg/ml treated with intermediate dose (p = 0.0001), and 31.3% for those with pDd >3.0 μg/ml and full anticoagulation (p = 0.0183).
CONCLUSIONS
In hospitalized patients with COVID-19, a pDd value greater than 3.0 μg/ml can be considered to screen VTE and to consider full-dose anticoagulation.
背景
COVID-19 患者常发生静脉血栓栓塞事件（VTE），且血浆 D-二聚体（pDd）升高和呼吸困难在这两种情况下均很常见。
目的
确定与 COVID-19 患者住院期间 VTE 相关的入院时 pDd 截断值。
方法
这是一项多中心、回顾性研究，分析了入院时 pDd 截断值，以预测 COVID-19 患者因 VTE 而住院期间的 VTE 和抗凝强度。
结果
在 9386 例患者中，有 2.2%发生了 VTE：1.6%为肺栓塞（PE），0.4%为深静脉血栓形成（DVT），0.2%为两者兼有。有 VTE 的患者呼吸急促的发生率更高（42.9%比 31.1%；p = 0.0005），基础氧饱和度<93%（45.4%比 33.1%；p = 0.0003），入院时 pDd 更高（中位数[IQR]：1.4[0.6-5.5]比 0.6[0.4-1.2]μg/ml；p<0.0001）和血小板计数（中位数[IQR]：208[158-289]比 189[148-245]×10/L；p = 0.0013）。pDd 截断值为 1.1μg/ml 时，对住院 VTE 的特异性为 72%，灵敏度为 49%，阳性预测值（PPV）为 4%，阴性预测值（NPV）为 99%。截断值为 4.7μg/ml 时，特异性为 95%，灵敏度为 27%，PPV 为 9%，NPV 为 98%。总死亡率与 pDd 值成正比，根据抗凝强度，每个 pDd 类别中的发生率最低：pDd>1.0μg/ml 且接受预防性剂量治疗的患者为 26.3%（p<0.0001），pDd>2.0μg/ml 且接受中等剂量治疗的患者为 28.8%（p = 0.0001），pDd>3.0μg/ml 且接受全剂量抗凝治疗的患者为 31.3%（p = 0.0183）。
结论
在住院的 COVID-19 患者中，pDd 值大于 3.0μg/ml 可用于筛查 VTE 并考虑全剂量抗凝治疗。
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