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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.
- Source :
- JGIM: Journal of General Internal Medicine; Nov2021, Vol. 36 Issue 11, p3478-3486, 9p, 2 Diagrams, 4 Charts, 1 Graph
- Publication Year :
- 2021
-
Abstract
- 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 × 10<superscript>9</superscript>/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. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 08848734
- Volume :
- 36
- Issue :
- 11
- Database :
- Complementary Index
- Journal :
- JGIM: Journal of General Internal Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 153682117
- Full Text :
- https://doi.org/10.1007/s11606-021-07017-8