Blood test dynamics in hospitalized COVID-19 patients: Potential utility of D-dimer for pulmonary embolism diagnosis
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Abstract
A higher incidence of thrombotic events, mainly pulmonary embolism (PE), has been reported in hospitalized patients with COVID-19. The main objective was to assess clinical and laboratory differences in hospitalized COVID-19 patients according to occurrence of PE.
Methods
This retrospective study included all consecutive patients hospitalized with COVID-19 who underwent a computed tomography (CT) angiography for PE clinical suspicion. Clinical data and median blood test results distributed into weekly periods from COVID-19 symptoms onset, were compared between PE and non-PE patients.
Results
Ninety-two patients were included, 29 (32%) had PE. PE patients were younger (63.9 (SD 13.7) vs 69.9 (SD 12.5) years). Clinical symptoms and COVID-19 CT features were similar in both groups. PE was diagnosed after a mean of 20.0 (SD 8.6) days from the onset of COVID-19 symptoms. Corticosteroid boluses were more frequently used in PE patients (62% vs. 43%). No patients met ISTH DIC criteria. Any parameter was statistically significant or clinically relevant except for D-Dimer when comparing both groups. Median values [IQR] of D-dimer in PE vs non-PE patients were: week 2 (2010.7 [770.1–11208.9] vs 626.0 [374.0–2382.2]; p = 0.004); week 3 (3893.1 [1388.2–6694.0] vs 1184.4 [461.8–2447.8]; p = 0.003); and week 4 (2736.3 [1202.1–8514.1] vs 1129.1 [542.5–2834.6]; p = 0.01). Median fold-increase of D-dimer between week 1 and 2 differed between groups (6.64 [3.02–23.05] vs 1.57 [0.64–2.71], p = 0.003); ROC curve AUC was 0.879 ( p = 0.003) with a sensitivity and specificity for PE of 86% and 80%, respectively.
Conclusions
Among hospitalized COVID-19 patients, D-dimer levels are higher at weeks 2, 3 and 4 after COVID-19 symptom onset in patients who develop PE. This difference is more pronounced when the fold increase between weeks 1 and 2 is compared.
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SciScore for 10.1101/2020.09.21.20193953: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Informed consent was waived due to mandatory isolation measures in hospital care for these patients and because this was a retrospective study.
IRB: The protocol was approved by the Ethics Committee of the Hospital Universitari de Bellvitge (Randomization not detected. Blinding All chest CT scans with patterns consistent with COVID-19 and presence of PE were reviewed by 2 expert thoracic radiologists blinded to patient status and clinical and laboratory test results. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Analyses were performed using IBM SPSS Statistics, version 19.0 … SciScore for 10.1101/2020.09.21.20193953: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Informed consent was waived due to mandatory isolation measures in hospital care for these patients and because this was a retrospective study.
IRB: The protocol was approved by the Ethics Committee of the Hospital Universitari de Bellvitge (Randomization not detected. Blinding All chest CT scans with patterns consistent with COVID-19 and presence of PE were reviewed by 2 expert thoracic radiologists blinded to patient status and clinical and laboratory test results. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Analyses were performed using IBM SPSS Statistics, version 19.0 for the PC. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The present study has some limitations that should be mentioned. Firstly, the retrospective nature of the study, in which only patients with contrast-enhanced chest CT were considered, making the real PE incidence difficult to assess. Secondly, the relatively small size of the sample. However, we point out that this is the first study assessing all the commonly used blood test parameters in weekly intervals and that our results can be generalized to all COVID-19 patients, not only to ICU patients. Finally, external validation of our results is lacking. Despite that, our results could be helpful for the development of a new algorithm for PE diagnosis in hospitalized COVID-19 patients or to select those patients at higher risk of PE in randomized clinical trials aiming to assess the optimal dose of LMWH for thromboprophylaxis in this scenario. In conclusion, D-dimer levels are higher at weeks 2, 3 and 4 after onset of symptoms in COVID-19 patients who develop PE during hospitalization, compared to those who do not develop PE. This difference is more pronounced when the fold increase between weeks 1 and 2 from symptom onset is compared. New weekly D-dimer cut-offs should be determined for assessing the clinical probability of developing PE in COVID-19 patients.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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