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

Mouhat, Basile; Besutti, Matthieu; Bouiller, Kevin; Grillet, Franck; Monnin, Charles; Ecarnot, Fiona; Behr, Julien; Capellier, Gilles; Soumagne, Thibaud; Pili-Floury, Sébastien; Besch, Guillaume; Mourey, Guillaume; Lepiller, Quentin; Chirouze, Catherine; Schiele, François; Chopard, Romain; Meneveau, Nicolas

BACKGROUND: 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 (SpO2≤93% or breathing rate≥30/min); or rapid clinical worsening. Multivariable analysis was performed using Firth penalised maximum likelihood estimates. RESULTS: In total, 162 patients (46.4%) underwent CTPA (mean age 65.6±13.0; 67.3% males (95% confidence interval (CI) 59.5–75.5%)). PE was diagnosed in 44 patients (27.2%). Most PE 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 (odds ratio (OR) 4.0 (95%CI 2.4–6.7) per additional quartile, and OR 4.5 (95%CI 1.1–7.4) respectively). ROC curve analysis identified a D-dimer cut-off value of 2590 ng·mL(−1) to best predict occurrence of PE (AUC: 0.88, p<0.001, sensitivity 83.3%, specificity 83.8%). D-dimer level >2590 ng·mL(−1) was associated with a 17-fold increase in the adjusted risk of PE. CONCLUSION: Elevated D-dimers (>2590 ng·mL(−1)) and absence of anticoagulant therapy predict PE in hospitalised COVID-19 patients with clinical signs of severity. These data strengthen the evidence base in favour of systematic anticoagulation, and suggest wider use of D-dimer guided CTPA to screen for PE in acutely ill hospitalised patients with COVID-19.