Abstract Number: PB0168
Meeting: ISTH 2021 Congress
Background: D-dimer is a safe tool to exclude pulmonary embolism (PE) but its specificity is decreased in COVID-19.
Aims: Our aim was to derive a new algorithm with D-dimer threshold adjusted to CT extent of lung damage.
Methods: We conducted a multicenter, retrospective cohort study among 774 COVID-19 patients with suspected PE. D-dimer threshold adjusted to CT extent of lung damage was derived in a patient set (n=337), and its safety assessed in an independent validation set (n=337).
Results: According to ROC curves, D-dimer safely excluded PE, with one false negative when using a 900 ng/mL threshold when lung damage extent was <50% and 1700 ng/mL when lung damage extent was ≥50%. In the derivation set, the algorithm’s sensitivity was 98.2% (95% CI: 94.7–100.0), and its specificity 28.4% (95% CI: 24.1–32.3). The negative likelihood ratio (NLR) was 0.06 (95% CI: 0.01–0.44) and the AUC was 0.63 (95% CI: 0.60–0.67). In the validation set, sensitivity and specificity were 96.7% (95% CI: 88.7–99.6) and 39.2% (95% CI: 32.2–46.1), respectively. The NLR was 0.08 (95% CI: 0.02–0.33), and the AUC did not differ from that of the derivation set (0.68 (95% CI: 0.64–0.72), P = 0.097). Using the Co-LEAD algorithm, 76/250 (30.4%) COVID-19 patients with suspected PE could have been managed without CT pulmonary angiography (CTPA).
Conclusions: The Co-LEAD algorithm safely excludes PE, and allows reducing the use of CTPA in COVID-19 patients. Prospective management studies are necessary to validate this strategy.
To cite this abstract in AMA style:Khider L, Planquette B, Le Berre A, Soudet S, Pernod G, Le Mao R, Besutti M, Gendron N, Yannoutsos A, Smadja DM, Goudot G, Mirault T, Messas E, Emmerich J, Couturaud F, Ferretti G, Sevestre M-, Meneveau N, Chatellier G, Sanchez O. Adjusting D-dimer to Lung Disease Extent to Exclude Pulmonary Embolism in COVID-19 Patients (Co-LEAD) [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/adjusting-d-dimer-to-lung-disease-extent-to-exclude-pulmonary-embolism-in-covid-19-patients-co-lead/. Accessed December 8, 2021.
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