Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients.

Aged Anticoagulants / administration & dosage Betacoronavirus COVID-19 Computed Tomography Angiography Coronavirus Infections / complications Female Fibrin Fibrinogen Degradation Products / metabolism France / epidemiology Humans Male Oximetry Pandemics Pneumonia, Viral / complications Predictive Value of Tests Pulmonary Embolism / diagnostic imaging Retrospective Studies SARS-CoV-2 Sensitivity and Specificity

Journal

The European respiratory journal
ISSN: 1399-3003
Titre abrégé: Eur Respir J
Pays: England
ID NLM: 8803460

Informations de publication

Date de publication:
10 2020
Historique:
received: 15 05 2020
accepted: 01 07 2020
pubmed: 11 9 2020
medline: 30 10 2020
entrez: 10 9 2020
Statut: epublish

Résumé

Coronavirus disease 2019 (COVID-19) may predispose to venous thromboembolism. We determined factors independently associated with computed tomography pulmonary angiography (CTPA)-confirmed pulmonary embolism (PE) in hospitalised severe COVID-19 patients. Among all (n=349) patients hospitalised for COVID-19 in a university hospital in a French region with a high rate of COVID-19, we analysed patients who underwent CTPA for clinical signs of severe disease (oxygen saturation measured by pulse oximetry ≤93% or breathing rate ≥30 breaths·min 162 (46.4%) patients underwent CTPA (mean±sd age 65.6±13.0 years; 67.3% male (95% CI 59.5-75.5%). PE was diagnosed in 44 (27.2%) patients. Most PEs were segmental and the rate of PE-related right ventricular dysfunction was 15.9%. By multivariable analysis, the only two significant predictors of CTPA-confirmed PE were D-dimer level and the lack of any anticoagulant therapy (OR 4.0 (95% CI 2.4-6.7) per additional quartile and OR 4.5 (95% CI 1.1-7.4), respectively). Receiver operating characteristic curve analysis identified a D-dimer cut-off value of 2590 ng·mL Elevated D-dimers (>2590 ng·mL

Sections du résumé

BACKGROUND
Coronavirus disease 2019 (COVID-19) may predispose to venous thromboembolism. We determined factors independently associated with computed tomography pulmonary angiography (CTPA)-confirmed pulmonary embolism (PE) in hospitalised severe COVID-19 patients.
METHODS
Among all (n=349) patients hospitalised for COVID-19 in a university hospital in a French region with a high rate of COVID-19, we analysed patients who underwent CTPA for clinical signs of severe disease (oxygen saturation measured by pulse oximetry ≤93% or breathing rate ≥30 breaths·min
RESULTS
162 (46.4%) patients underwent CTPA (mean±sd age 65.6±13.0 years; 67.3% male (95% CI 59.5-75.5%). PE was diagnosed in 44 (27.2%) patients. Most PEs were segmental and the rate of PE-related right ventricular dysfunction was 15.9%. By multivariable analysis, the only two significant predictors of CTPA-confirmed PE were D-dimer level and the lack of any anticoagulant therapy (OR 4.0 (95% CI 2.4-6.7) per additional quartile and OR 4.5 (95% CI 1.1-7.4), respectively). Receiver operating characteristic curve analysis identified a D-dimer cut-off value of 2590 ng·mL
CONCLUSION
Elevated D-dimers (>2590 ng·mL

Identifiants

DOI: 10.1183/13993003.01811-2020 PMID: 32907890 PMC: PMC7487272
pubmed: 32907890
pii: 13993003.01811-2020
doi: 10.1183/13993003.01811-2020
pmc: PMC7487272
pii:
doi:

Substances chimiques

Anticoagulants 0
Fibrin Fibrinogen Degradation Products 0
fibrin fragment D 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Informations de copyright

Copyright ©ERS 2020.

Déclaration de conflit d'intérêts

Conflict of interest: B. Mouhat has nothing to disclose. Conflict of interest: M. Besutti has nothing to disclose. Conflict of interest: K. Bouiller has nothing to disclose. Conflict of interest: F. Grillet has nothing to disclose. Conflict of interest: C. Monnin has nothing to disclose. Conflict of interest: F. Ecarnot has nothing to disclose. Conflict of interest: J. Behr has nothing to disclose. Conflict of interest: G. Capellier has nothing to disclose. Conflict of interest: T. Soumagne has nothing to disclose. Conflict of interest: S. Pili-Floury has nothing to disclose. Conflict of interest: G. Besch has nothing to disclose. Conflict of interest: G. Mourey has nothing to disclose. Conflict of interest: Q. Lepiller has nothing to disclose. Conflict of interest: C. Chirouze has nothing to disclose. Conflict of interest: F. Schiele has nothing to disclose. Conflict of interest: R. Chopard has nothing to disclose. Conflict of interest: N. Meneveau has nothing to disclose.

Références

Thromb Haemost. 2020 Jul;120(7):1004-1024
pubmed: 32473596
J Am Coll Cardiol. 2020 Jul 7;76(1):122-124
pubmed: 32387623
JAMA. 2020 Mar 17;323(11):1061-1069
pubmed: 32031570
World J Nephrol. 2017 May 6;6(3):86-99
pubmed: 28540198
Eur Radiol. 2020 Sep;30(9):4903-4909
pubmed: 32314058
Radiology. 2020 Sep;296(3):E189-E191
pubmed: 32324102
Am J Hematol. 2020 Jun;95(6):E131-E134
pubmed: 32129508
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Thromb Res. 2020 Jul;191:145-147
pubmed: 32291094
J Am Coll Cardiol. 2020 Jun 16;75(23):2950-2973
pubmed: 32311448
J Thromb Haemost. 2020 May;18(5):1094-1099
pubmed: 32220112
Epidemiology. 2007 Nov;18(6):800-4
pubmed: 18049194
Circulation. 2020 Jul 14;142(2):184-186
pubmed: 32330083
Lancet. 2020 May 2;395(10234):e75
pubmed: 32330428
Lancet Gastroenterol Hepatol. 2020 May;5(5):428-430
pubmed: 32145190
Thromb Haemost. 2020 May;120(5):876-878
pubmed: 32246450
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
Eur Heart J. 2020 Jan 21;41(4):543-603
pubmed: 31504429
J Thromb Haemost. 2020 Jun;18(6):1421-1424
pubmed: 32271988
J Thromb Haemost. 2020 Jul;18(7):1743-1746
pubmed: 32320517
J Thorac Imaging. 2020 Jul;35(4):219-227
pubmed: 32324653
Thromb Res. 2020 Jul;191:148-150
pubmed: 32381264
J Thromb Haemost. 2020 Apr;18(4):844-847
pubmed: 32073213
Kidney Int. 2020 May;97(5):829-838
pubmed: 32247631
Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67
pubmed: 31573350
Radiology. 2020 Sep;296(3):E186-E188
pubmed: 32324103
JAMA. 2003 Jul 16;290(3):374-80
pubmed: 12865379
Eur Radiol. 2020 Aug;30(8):4407-4416
pubmed: 32215691
N Engl J Med. 2020 Apr 23;382(17):e38
pubmed: 32268022
Radiology. 1992 Nov;185(2):381-7
pubmed: 1410342
Stat Med. 2011 Feb 20;30(4):348-55
pubmed: 21225897
Chest. 2020 Jul;158(1):106-116
pubmed: 32275978

Auteurs

Basile Mouhat (B)

Dept of Cardiology, University Hospital, Besançon, France.
ORCID: 0000-0001-8459-8959

Matthieu Besutti (M)

Dept of Cardiology, University Hospital, Besançon, France.

Kevin Bouiller (K)

Infectious and Tropical Diseases Unit, University Hospital, Besançon, France.
UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon, France.

Franck Grillet (F)

Dept of Radiology, Besançon University Hospital, Besançon, France.
ORCID: 0000-0001-6594-8829

Charles Monnin (C)

Dept of Cardiology, University Hospital, Besançon, France.

Fiona Ecarnot (F)

Dept of Cardiology, University Hospital, Besançon, France.
Research Unit EA3920, University of Franche-Comte, Besancon, France.

Julien Behr (J)

Dept of Radiology, Besançon University Hospital, Besançon, France.

Gilles Capellier (G)

Research Unit EA3920, University of Franche-Comte, Besancon, France.
Medical Intensive Care Unit, University Hospital, Besançon, France.

Thibaud Soumagne (T)

Medical Intensive Care Unit, University Hospital, Besançon, France.

Sébastien Pili-Floury (S)

Research Unit EA3920, University of Franche-Comte, Besancon, France.
Anesthesia and Surgical Intensive Care Unit, University Hospital, Besançon, France.

Guillaume Besch (G)

Research Unit EA3920, University of Franche-Comte, Besancon, France.
Anesthesia and Surgical Intensive Care Unit, University Hospital, Besançon, France.

Guillaume Mourey (G)

Hematology Unit, University Hospital, Besançon, France.
INSERM UMR 1098, University of Franche-Comte, Besancon, France.

Quentin Lepiller (Q)

Virology Laboratory, University Hospital, Besançon, France.

Catherine Chirouze (C)

Infectious and Tropical Diseases Unit, University Hospital, Besançon, France.
UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon, France.
ORCID: 0000-0002-6150-2376

François Schiele (F)

Dept of Cardiology, University Hospital, Besançon, France.
Research Unit EA3920, University of Franche-Comte, Besancon, France.
ORCID: 0000-0003-4974-6551

Romain Chopard (R)

Dept of Cardiology, University Hospital, Besançon, France.
Research Unit EA3920, University of Franche-Comte, Besancon, France.
Both authors contributed equally.

Nicolas Meneveau (N)

Dept of Cardiology, University Hospital, Besançon, France.
Research Unit EA3920, University of Franche-Comte, Besancon, France.
Both authors contributed equally.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Virus › Virus à ARN › Virus à ARN à brin positif › Nidovirales › Coronaviridae › Coronavirus › Betacoronavirus › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › COVID-19 › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Tomographie à rayons X › Tomodensitométrie › Angiographie par tomodensitométrie › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Infection › Maladies virales › Infections à virus à ARN › Infections à Nidovirales › Infections à Coronaviridae › Infections à coronavirus › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Précurseurs de protéines › Produits de dégradation de la fibrine et du fibrinogène › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Régions géographiques › Europe › France › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Techniques d'investigation › Techniques de laboratoire clinique › Tests de chimie clinique › Analyse chimique du sang › Gazométrie sanguine › Oxymétrie › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Épidémies de maladies › Épidémies › Pandémies › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumopathie virale › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Valeur prédictive des tests › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Embolie et thrombose › Embolie › Embolie pulmonaire › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Virus › Virus à ARN › Virus à ARN à brin positif › Nidovirales › Coronaviridae › Coronavirus › Betacoronavirus › Virus du SRAS › SARS-CoV-2 › Elevated D-dimers and lack of anticoagulation...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Sensibilité et spécificité › Elevated D-dimers and lack of anticoagulation...