D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients

Thoreau, Benjamin; Galland, Joris; Delrue, Maxime; Neuwirth, Marie; Stepanian, Alain; Chauvin, Anthony; Dellal, Azeddine; Nallet, Olivier; Roriz, Melanie; Devaux, Mathilde; London, Jonathan; Martin-Lecamp, Gonzague; Froissart, Antoine; Arab, Nouara; Ferron, Bertrand; Groff, Marie-Helene; Queyrel, Viviane; Lorut, Christine; Regard, Lucile; Berthoux, Emilie; Bayer, Guillaume; Comarmond, Chloe; Lioger, Bertrand; Mekinian, Arsène; Szwebel, Tali-Anne; Sené, Thomas; Amador-Borrero, Blanca; Mangin, Olivier; Sellier, Pierre O.; Siguret, Virginie; Mouly, Stéphane; Kevorkian, Jean-Philippe; Vodovar, Dominique; Sene, Damien

The incidence of pulmonary embolism (PE) is high during severe Coronavirus Disease 2019 (COVID-19). We aimed to identify predictive and prognostic factors of PE in non-ICU hospitalized COVID-19 patients. In the retrospective multicenter observational CLOTVID cohort, we enrolled patients with confirmed RT-PCR COVID-19 who were hospitalized in a medicine ward and also underwent a CT pulmonary angiography for a PE suspicion. Baseline data, laboratory biomarkers, treatments, and outcomes were collected. Predictive and prognostics factors of PE were identified by using logistic multivariate and by Cox regression models, respectively. A total of 174 patients were enrolled, among whom 86 (median [IQR] age of 66 years [55–77]) had post-admission PE suspicion, with 30/86 (34.9%) PE being confirmed. PE occurrence was independently associated with the lack of long-term anticoagulation or thromboprophylaxis (OR [95%CI], 72.3 [3.6–4384.8]) D-dimers ≥ 2000 ng/mL (26.3 [4.1–537.8]) and neutrophils ≥ 7.0 G/L (5.8 [1.4–29.5]). The presence of these two biomarkers was associated with a higher risk of PE (p = 0.0002) and death or ICU transfer (HR [95%CI], 12.9 [2.5–67.8], p < 0.01). In hospitalized non-ICU severe COVID-19 patients with clinical PE suspicion, the lack of anticoagulation, D-dimers ≥ 2000 ng/mL, neutrophils ≥ 7.0 G/L, and these two biomarkers combined might be useful predictive markers of PE and prognosis, respectively.