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

• Published in: Viruses 2021-04, Vol.13 (5), p.758
• Main Authors: 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, Lariboisière Covid Group, Vodovar, Dominique, Sene, Damien
• Format: Article
• Language: English
• Subjects: Aged; Angiography; Anticoagulants; anticoagulation; Biomarkers; Blood tests; Computed Tomography Angiography; Coronaviruses; COVID-19; D-dimer; Drug dosages; Embolism; Female; Fibrin Fibrinogen Degradation Products; Hospitalization; Humans; Infections; Laboratories; Leukocytes (neutrophilic); Life Sciences; Logistic Models; Male; Medical prognosis; Medicine; Middle Aged; neutrophil; Neutrophils; Polymerase chain reaction; predictive factor; Prognosis; Pulmonary Embolism; Pulmonary embolisms; Regression analysis; Retrospective Studies; Risk Factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Venous Thromboembolism
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v13050758

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 ( = 0.0002) and death or ICU transfer (HR [95%CI], 12.9 [2.5-67.8], < 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.