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

García-Cervera, Carles ; Giner-Galvañ, Vicente ; Wikman-Jorgensen, Philip ; Laureiro, Jaime ; Rubio-Rivas, Manuel ; Gurjian Arena, Anthony ; Arnalich-Fernandez, Francisco ; Beato Pérez, José Luis ; Vargas Núñez, Juan Antonio ; González Igual, Jesús Javier (Universidad de Zaragoza) ; Díez-Manglano, Jesús (Universidad de Zaragoza) ; Méndez Bailón, Manuel ; García Blanco, María José ; Freire Castro, Santiago J. ; Aranda Lobo, Judit ; Manzano, Luis ; Magallanes Gamboa, Jeffrey Oskar ; Arribas Pérez, Luis ; González Moraleja, Julio ; Calderón Hernaiz, Ruth ; García Alegría, Javier ; González Noya, Amara ; Gómez Huelgas, Ricardo ; Lumbreras Bermejo, Carlos ; Antón Santos, Juan Miguel

Resumen: 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 × 109/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. © 2021, Society of General Internal Medicine.

Idioma: Inglés

DOI: 10.1007/s11606-021-07017-8

Año: 2021

Publicado en: JOURNAL OF GENERAL INTERNAL MEDICINE 36, 11 (2021), 3478-3486
ISSN: 0884-8734

Factor impacto JCR: 6.473 (2021)

Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 31 / 172 = 0.18 (2021) - Q1 - T1
Categ. JCR: HEALTH CARE SCIENCES & SERVICES rank: 11 / 109 = 0.101 (2021) - Q1 - T1

Factor impacto CITESCORE: 5.7 - Medicine (Q1)

Factor impacto SCIMAGO: 1.537 - Internal Medicine (Q1)

Tipo y forma: Article (Published version)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)