Predictors Of Pulmonary Embolism Research Articles

Machine learning-based prediction of pulmonary embolism to reduce unnecessary computed tomography scans in gastrointestinal cancer patients: a retrospective multicenter study

This study aimed to develop a machine learning (ML) model for predicting pulmonary embolism (PE) in patients with gastrointestinal cancers, a group at increased risk for PE. We conducted a retrospective, multicenter study analyzing patients who underwent computed tomographic pulmonary angiography (CTPA) between 2010 and 2020. The study utilized demographic and clinical data, including the Wells score and D-dimer levels, to train a random forest ML model. The model’s effectiveness was assessed using the area under the receiver operating curve (AUROC). In total, 446 patients from hospital A and 139 from hospital B were included. The training set consisted of 356 patients from hospital A, with internal validation on 90 and external validation on 139 patients from hospital B. The model achieved an AUROC of 0.736 in hospital A and 0.669 in hospital B. The ML model significantly reduced the number of patients recommended for CTPA compared to the conventional diagnostic strategy (hospital A; 100.0% vs. 91.1%, P < 0.001, hospital B; 100.0% vs. 93.5%, P = 0.003). The results indicate that an ML-based prediction model can reduce unnecessary CTPA procedures in gastrointestinal cancer patients, highlighting its potential to enhance diagnostic efficiency and reduce patient burden.

Predictors of pulmonary embolism in chronic obstructive pulmonary diseases patients admitted for worsening respiratory symptoms: An individual participant data meta-analyses

BackgroundPulmonary embolism (PE) and acute exacerbation of chronic obstructive pulmonary disease (COPD) have similar clinical symptoms, making PE diagnosis challenging. Previous studies have shown that the prevalence of PE among COPD patients admitted with worsening respiratory symptoms was not negligible, but that systematic search for PE did not provide a clinical benefit. Predictive factors for PE remain unknown. Objectiveto identify predictive factors for PE among COPD patients with worsening respiratory symptoms. MethodsWe conducted an individual participant data meta-analysis which included the patients from the prospective PEP cohort and those randomized to the intervention arm in the SLICE trial which included a systematic search for PE in COPD patients admitted for worsening respiratory symptoms. Univariable and multivariable analysis were used to assess factors associated with the diagnosis of PE during the initial management. ResultsAmong 1110 COPD patients, PE was diagnosed in 61 (5.49 %; 95 %CI 4.15 %-6.84 %). In univariable analysis, BNP (Brain natriuretic peptide) (odds ratio [OR] 1.02 per 100 ng/L increase, 95 %CI 1.01–1.04), prothrombin time (OR 0.78, 95 %CI 0.65–0.94), fibrinogen (OR 0.80, 95 %CI 0.64–0.98), atrial fibrillation (OR 4.74, 95 %CI 1.84–10.80), respiratory rate ≥30 min (OR 2.34, 95 %CI 1.13–4.6) and recent medical immobilization (OR 1.79, 95 %CI 0.99–3.13]) were associated with the risk of PE diagnosed during the initial management. In multivariable analysis, respiratory rate ≥30 (OR 2.77, 95 %CI 1.08–6.71) was a predictive factor for PE, as well as BNP (OR 1.02, 95 %CI 1.00–1.05) with an area under the curve =0.64, negative predictive value =0.15 (95 %CI 0.09–0.23), sensitivity =0.78 (95 %CI 0.74–0.82) and specificity =0.46 (95 %CI 0.29–0.63). ConclusionAmong patients with COPD admitted for worsening respiratory symptoms, respiratory rate and BNP levels are predictor of PE, but with limited discriminatory power.

Comparison of Egg and Banana Sign, Carina Crossover Sign in Prediction of Pulmonary Embolism: A Cross-sectional Study

Introduction: Acute pulmonary embolism is a life-threatening condition that can lead to sudden death. Pulmonary Artery Hypertension (PAH) can be found in the setting of acute pulmonary embolism. The Egg and Banana sign and Carina Crossover (CCO) sign are seen in PAH, which are present on Computed Tomographic scans (CT scans). Aim: To determine the accuracy of CT scans, the Egg and Banana sign, and CCO sign seen in PAH in the evaluation of pulmonary embolism. Materials and Methods: This retrospective, cross-sectional study was conducted from May 2019 to May 2021 in the Department of Radiodiagnosis at Father Muller Medical College Hospital in Mangalore, Karnataka, India. The CT scans of 102 consecutive patients who underwent CT Pulmonary Angiography (CTPA) for suspected pulmonary embolism were evaluated for the presence of the CCO sign and Egg and Banana sign. The CCO sign was considered positive when the right pulmonary artery (PA) was seen crossing anterior to the carina at its bifurcation. The Egg and Banana sign was considered present when the PA was found lateral to the aortic arch, with the PA described as the Egg and the arch as the Banana. The results were statistically analysed using Statistical Package for Social Sciences version 3.0. Results: Pulmonary embolism was seen in 26 out of 102 cases, with a mean age of 60.2±16.27 years. Pulmonary embolism was absent in 76 cases with a mean age of 55.8±17.11. An equal gender distribution was seen in 26 cases of pulmonary embolism. The Egg and Banana sign was found in 8 out of 26 patients with pulmonary embolism and had a specificity of 78.9%, negative predictive value of 76.92%, and diagnostic accuracy of 66%. The CCO sign was seen in 14 out of 26 cases of pulmonary embolism and had a higher specificity of 81.58% and diagnostic accuracy of 74.51%. The CCO sign had a statistically significant value in detecting pulmonary embolism. Conclusion: According to the study, the CCO sign had a higher accuracy in detecting pulmonary embolism compared to the Egg and Banana sign. The accuracy was further improved when combined with other signs of pulmonary embolism.

Prediction of pulmonary embolism and its complication in diabetes mellitus type 2: a 5-year retrospective study

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;To investigate the association between type 2 diabetes mellitus (T2DM) and pulmonary embolism, as well as to determine the prognostic value of troponin, D-dimer, prothrombotic, and proinflammatory markers in patients with T2DM.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;The retrospective cohort study included 305 patients with pulmonary embolism, divided into two groups: the first group&amp;lt;br /&amp;gt;with type 2 diabetes mellitus (n=165) and the control group without type 2 diabetes mellitus (n=140). Data were collected from May 2018 to May 2023. In all patients the following parameters were analysed: anthropometric parameters, laboratory parameters (troponin, D-dimer, CRP, fibrinogen, uric acid, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), arterial blood pressure, antiphospholipid antibodies, HOMA-IR index, CT angiography of the pulmonary artery, rate of adverse clinical events in pulmonary embolism (need for inotropic catecholamine&amp;lt;br /&amp;gt;support, fibrinolysis, cardiopulmonary resuscitation) and the rate of intrahospital mortality from pulmonary embolism.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Patients with T2DM had elevated troponin, D-dimer, CRP, uric acid, fibrinogen, HOMA-IR and more severe clinical&amp;lt;br /&amp;gt;complications with higher mortality rates within 10 days of hospital admission. Significant predictors of PE in T2DM patients were found. Patients with pulmonary embolism in T2DM had a 4.38 times higher chance of death compared to patients with pulmonary embolism without T2DM.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusions&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Troponin, D-dimer, prothrombotic, and proinflammatory markers have good prognostic value for short-term&amp;lt;br /&amp;gt;outcomes in PE among patients with T2DM&amp;lt;/p&amp;gt;

319 Performance of the Khorana Score in the Prediction of Pulmonary Embolism in ED Patients With Cancer

319 Performance of the Khorana Score in the Prediction of Pulmonary Embolism in ED Patients With Cancer

Predictors of pulmonary embolism in hospitalized patients with COVID-19

BackgroundHigh venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE).MethodsWe performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE.Results92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03–1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01–1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04–1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24–154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01).ConclusionsIn 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19.

Obesity as a Predictor for Pulmonary Embolism and Performance of the Age-Adjusted D-Dimer Strategy in Obese Patients with Suspected Pulmonary Embolism.

Obesity is a risk factor for venous thromboembolism, but studies evaluating its association with pulmonary embolism (PE) in patients with suspected PE are lacking. To evaluate whether body mass index (BMI) and obesity (i.e., BMI ≥30 kg/m2) are associated with confirmed PE in patients with suspected PE and to assess the efficiency and safety of the age-adjusted D-dimer strategy in obese patients. We conducted a secondary analysis of a multinational, prospective study, in which patients with suspected PE were managed according to the age-adjusted D-dimer strategy and followed for 3 months. Outcomes were objectively confirmed PE at initial presentation, and efficiency and failure rate of the diagnostic strategy. Associations between BMI and obesity, and PE were examined using a log-binomial model that was adjusted for clinical probability and hypoxia. We included 1,593 patients (median age: 59 years; 56% women; 22% obese). BMI and obesity were not associated with confirmed PE. The use of the age-adjusted instead of the conventional D-dimer cut-off increased the proportion of obese patients in whom PE was considered ruled out without imaging from 28 to 38%. The 3-month failure rate in obese patients who were left untreated based on a negative age-adjusted D-dimer cut-off test was 0.0% (95% confidence interval: 0.0-2.9%). BMI on a continuous linear scale and obesity were not predictors of confirmed PE among patients presenting with a clinical suspicion of PE. The age-adjusted D-dimer strategy appeared safe in ruling out PE in obese patients with suspected PE.

Thrombus volume and Hounsfield unit density as a predictor of pulmonary embolism in patients with deep vein thrombosis.

There is a lack of studies evaluating the association between thrombus volume and density of deep vein thrombosis (DVT) and pulmonary embolism (PE). To assess the clinical value of thrombus volume and density for prediction of PE in patients with DVT. Among the patients with DVT, those without PE were classified as the "DVT-only group" and those with PE were classified as the "DVT-PE group." Thrombus volume and Hounsfield unit (HU) density of DVT was measured by drawing free-hand volume of interests within the thrombus. Multivariate regression and receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of thrombus volume and density for PE. Of the included 145 patients (mean age=41.7 ± 10.3 years), there were 87 patients in the DVT-only group and 58 patients in the DVT-PE group. The DVT-PE group showed a significantly higher DVT density (67.4 ± 8.6 HU vs. 57.3 ± 10.4 HU; P < 0.001) and larger DVT volume (16.4 ± 13.9 cm3 vs. 12.8 ± 10.1 cm3; P = 0.016) than the DVT-only group. On multivariate analysis, thrombus density was the only associated factor for PE. ROC analysis showed that thrombus density ≥61.8 HU was the optimal cutoff for predicting PE with an area under the curve (AUC) of 0.774 and thrombus volume ≥14.0 cm3 was the cutoff with an AUC of 0.638. Though the results of our study should be considered within the limitations, DVT density could be a predictor for acute PE. Further studies are needed to clarify the clinical value of quantitative features of DVT including thrombus volume as an imaging biomarker for PE.

Patient Characteristics and Predictors of Pulmonary Embolism in Patients Infected with COVID - 19 in Upper Egypt.

A little is known about the risk factors and predictors of pulmonary embolism (PE) in Coronavirus disease 2019 (Covid-19) infected patients. Therefore, we directed this study to investigate the predictors of PE in patients infected with Covid - 19 in Upper Egypt. We conducted a retrospective cohort study on 297 patients infected with COVID-19, aged ≥ 18years old. Suspicion of COVID-19 infection was based on the World Health Organization (WHO) criteria and confirmed by nasal and pharyngeal swab for real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. The patient was also determined to have COVID-19 when CT results that were thought to be typical for COVID-19 and clinical data that were compatible were present. PE was diagnosed in 18.2% of patients. We found that the incidence of PE was significantly higher in older patients, females, those with higher BMI, hypertensive patients, diabetics, and patients with co-morbidities. Also, PE was significantly higher in patients presented with dyspnea, chest pain, longer duration of symptoms at hospital admission, and lower oxygen concentration. The mean serum Hb level, platelet count, TLC and absolute lymphocytic count were markedly reduced in those who had PE. All the patients who developed PE had a CO-RADS scale five on their CT chest scan. Age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients' characteristics associated with the development of PE after the multivariate regression analysis. PE is a common complication of Covid 19 infection. PE is associated with a variety of clinical and laboratory parameters in univariate analysis, but age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients' characteristics associated with the development of PE in those infected with Covid-19.

Predictors of acute pulmonary embolism-related hospitalizations – an artificial neural network analysis using a nationwide cohort in the United States

Abstract Background Considering a paucity of large-scale data on predictors of pulmonary embolism (PE) and its higher association with complications and worse outcomes, we aimed to determine the predictors of PE in this United States population-based analysis using Artificial Neural Network (ANN) Model in a nationally representative cohort. Methods We identified PE-related hospitalizations using 2018's National Inpatient Sample database. The relevant predictive factors for ANN were selected for this cohort. Of all admissions (unweighted n=7,105,498, weighted n=35,527,481), PE cohort (weighted n=387805) consisted of 1.1% of all admissions in 2018. The 2018 cohort was randomly split into training data (unweighted n=4716132, 70.0%) which were used to calibrate ANN and testing data (unweighted n=2019290, 30%) which were used to assess the accurateness of the algorithm. We equated the rate of incorrect prediction between training and testing data and measured the Area under Receiver Operator Curve (AUC) to determine ANN's efficacy in predicting PE hospitalizations. Results Patients hospitalized with PE often consisted of older (mean age 62.5±17.1 years), female (51.3%), white (70.5%) patients, and patients from lower-income quartile (0–25% income quartile: 28.8%%), often admitted non-electively (93.7%) with higher rates of cardiovascular disease risk factors. PE admissions revealed significantly higher (6.5% vs. 1.9%, p&amp;lt;0.001) in-hospital mortality, less frequent routine discharges (51.4% vs. 68.1%) and more frequent other facility transfers and requirement of home health care. Normalized Predictors of PE admissions are displayed in Fig. 1. Our ANN model had AUC 0.873 which correlates with an excellent prediction model. Our data demonstrated low levels (0.8%) error in both testing and training models. Conclusion Our ANN model showed high performance to predict risk factors for PE admissions in the US population. It will enable clinicians to screen patients at high-risk for PE admissions, curtail complication rate, improve survival and lower the healthcare cost. Funding Acknowledgement Type of funding sources: None.

A TALE OF TWO THROMBI

SESSION TITLE: Thrombosis Jamboree: Rare and Unique Cases SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Atrial Fibrillation is associated with an increased risk of stroke secondary to left atrial thromboembolism. Its association with venous thromboembolism from the right atria is not well established (1). We report a rare case of a patient with atrial fibrillation (AF) with concomitant pulmonary embolism (PE) and left atrial appendage (LAA) thrombus. CASE PRESENTATION: The patient is a 61-year-old female with a remote history of provoked venous thromboembolism (VTE) and essential tremor who presented with progressively worsening dyspnea and fatigue. Her blood pressure was 121/78 mm Hg, pulse was 155 beats/min, respiratory rate was 18 breaths/min, and oxygen saturation was 93% on room air. EKG showed new atrial fibrillation with a rapid ventricular rate of 130-150 beats/min. A computed tomographic scan per pulmonary embolism protocol showed multiple acute emboli within the right middle and lower lobe. RV/LV ratio was 1.0. Troponin 0.05 ng/ml and BNP was 462 pg/ml. Transthoracic echocardiogram found EF 50-55%, normal right ventricular systolic function, no wall motion abnormalities. Bilateral lower extremity dopplers were negative for DVT. The patient was started on a diltiazem drip, however, continued to remain in RVR after 48 hours. Cardioversion was planned with a transesophageal echocardiogram (TEE) however, TEE showed left atrial appendage thrombus suggestive of prolonged duration of atrial fibrillation. An agitated saline study was negative for patent foramen ovale. During her prolonged hospitalization patient was started on metoprolol and digoxin after which rate control was achieved. The patient was discharged home on anticoagulation with a plan for atrial fibrillation ablation after resolution of thrombus. DISCUSSION: The patient was found to have acute PE without any provoking cause. This could have contributed to the development of atrial fibrillation. The TEE findings including bilateral atrial enlargement and left atrial appendage thrombus suggest a longer duration of uncontrolled atrial fibrillation prior to admission, especially considering the agitated saline study was negative for an intra-atrial shunt. In essence, she had both pulmonary arterial and venous thrombus simultaneously. CONCLUSIONS: Our report suggests that management of atrial fibrillation in the setting of LAA thrombus and PE can be challenging and may require multiple AV nodal blocking agents. The significance of venous and arterial thrombi in atrial fibrillation remains unclear. Studies are needed to assess the safety and efficacy of thrombolytics and long-term outcomes in these patients. Reference #1: Friberg L, Svennberg E. A diagnosis of atrial fibrillation is not a predictor for pulmonary embolism. Thromb Res. 2020 Nov;195:238-242. doi: 10.1016/j.thromres.2020.08.019. Epub 2020 Aug 10. PMID: 32799131. DISCLOSURES: No relevant relationships by Mukul Bhattarai No relevant relationships by radhika deshpande No relevant relationships by Abhishek Kalidas Kulkarni No relevant relationships by Raj Patel No relevant relationships by Prashanth Singanallur

Characteristics and predictors of pulmonary embolism in patients admitted for COVID-19 with respiratory failure.

Characteristics and predictors of pulmonary embolism in patients admitted for COVID-19 with respiratory failure.

Prediction of pulmonary embolism in patients with SARS-CoV-2 infection

ObjectiveTo determine the predictive factors of pulmonary thromboembolic (PTE) in patients with SARS-CoV-2 infection (COVID-19) assessed in the emergency department at a tertiary hospital during the first pandemic wave. MethodsObservational single-center study conducted in a retrospective cohort of patients with confirmed SARS-CoV-2 infection (or high clinical-radiological suspicion) who underwent PTE screening by computed tomography pulmonary angiography (CTPA). Predictive factors of PTE were explored using logistic regression, creating two predictive models (without or with D-dimer values). ResultsOut of a total of 274 CTPA performed, 70 procedures presented diagnostic findings of PTE, representing a cumulative incidence of 25.54% (95% confidence interval [CI]: 20.49–31.14). In the non-D-dimer based model, respiratory rate >22 bpm (odds ratio [OR]: 3.162; 95% CI: 1.627–6.148; p = 0.001) and the absence of findings suggestive of COVID-19 in plain chest X-ray (OR: 3.869; 95% CI: 0.869–17.225; p = 0.076) were predictors of PTE. In the D-dimer-based model, tachypnea remained as a predictive factor (OR: 4.967; 95% CI: 2.053–12.018; p < 0.001), as well as D-dimers > 3000 ng/mL (OR: 7.494; 95% CI: 3.038–18.485; p < 0.001). ConclusionsThe presence of tachypnea (>22 bpm) and the absence of radiological findings suggestive of SARS-CoV-2 infection in the chest X-ray, in addition to D-dimer values >3000 ng/mL, were identified as predictive factors of PTE in patients with COVID-19.

Wells score and prediction of pulmonary embolism in patients with coronavirus disease 2019 in Morocco

Wells score and prediction of pulmonary embolism in patients with coronavirus disease 2019 in Morocco

Value of platelet indices in prediction of pulmonary embolism

Value of platelet indices in prediction of pulmonary embolism

Prevalence and predictors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease.

Background:The prevalence of pulmonary embolism (PE) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) varies over a wide range. Early detection and treatment of PE in AECOPD is a key to improve patient outcome. The purpose of the study was to investigate the prevalence and predictors of PE in patients of AECOPD in a high burden region of North India.Materials and Methods:This prospective study included patients of AECOPD with no obvious cause of exacerbation on initial evaluation. Apart from routine workup, the participants underwent assessment of D-dimer, compression ultrasound and venous Doppler ultrasound of the lower limbs and pelvic veins, and a multidetector computed tomography pulmonary angiography.Results:A total of 100 patients of AECOPD with unknown etiology were included. PE as a possible cause of AE-COPD was observed in 14% of patients. Among the participants with PE, 63% (n = 9) had a concomitant presence of lower extremity deep venous thrombosis. Hemoptysis and chest pain were significantly higher in patients of AECOPD with PE ([35.7% vs. 7%, P = 0.002] and [92.9% vs. 38.4%, P = 0.001]). Likelihood of PE was significantly higher in patients who presented with tachycardia, tachypnea, respiratory alkalosis (PaCO2 <45 mmHg and pH >7.45), and hypotension. No difference was observed between the two groups in terms of in-hospital mortality, age, sex distribution, and risk factors for embolism except for the previous history of venous thromboembolism (35.7% vs. 12.8% P = 0.03).Conclusion:PE was probably responsible for AECOPD in 14% of patients with no obvious cause on initial assessment. Patients who present with chest pain, hemoptysis, tachypnea, tachycardia, and respiratory alkalosis should be particularly screened for PE.

Modified CHA2DS2-VASc can predict mortality in COVID-19 patients admitted to the emergency department

IntroductionCHA2DS2-VASc score is used to determine the thromboembolic risk, but its prognostic value has been demonstrated in several cardiovascular (CV) diseases. Except for female gender, many CV risk factors comprising this score are recognized as risk factors for mortality in COVID-19. Cetinak G. et al demonstrated the ability of modified CHA2DS2-VASc (M-CHA2DS2-VASc) to predict mortality in COVID-19, which is based on changing gender criteria from female to male.PurposeTo evaluate the prognostic value of a M-CHA2DS2-VASc score to predict pulmonary embolism (PE) and mortality in pts with COVID-19 admitted at the emergency department (ED).MethodsRetrospective study of pts admitted to the ED between June 2020-January 2021, who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. Pts were stratified into 3 M-CHA2DS2-VASc risk groups: lower (0–1), intermediate (2–3) and high risk (≥4). Kruskal-Wallis and X-square test were used to compare score risk groups. Logistic regression was used to determine predictors of PE and mortality. ROC curve was performed to evaluate the discriminative power of the score.ResultsWe included 300 pts: median age 71 years, 59% male. Hypertension (59%) chronic kidney disease (CKD, 33%), dyslipidemia (32%) and diabetes (28%) were the most common comorbidities. PE was diagnosed in 46 pts (15%). We found no difference in PE incidence according to M-CHA2DS2-VASc groups (p=0.531) and it showed no predictive value for PE (OR: 1.050, p=0.596). The AUC of M-CHA2DS2-VASc was 0.52, suggesting no discriminative power to predict PE.Regarding mortality, M-CHA2DS2-VASc score was higher in non-survivors COVID-19 pts than in survivors [4 (IQR 3–5) vs 2 (1–4), respectively, p<0.001]. A multivariate logistic regression analysis was performed for mortality based on M-CHA2DS2-VASC, troponin, CKD and smoking history, and only M-CHA2DS2-VASc was identified as an independent predictor of mortality (OR: 1.406, p=0.007). Kaplan-Meier showed that M-CHA2DS2-VASc score was associated with mortality: the survival rate was 92%, 80% and 63% in the lower, intermediate and higher M-CHA2DS2VASc score risk group (logrank test p<0.001; Fig. A).Most of the pts in the cohort were hospitalized (83%), but 21 pts (17%) discharged from the ED. Among these pts, 33% (n=17) had low risk, 37% (n=19) intermediate risk and 29% (n=15) high risk for mortality according to the M-CHA2DS2VASc score. The Kaplan-Meier individual survival analysis for hospitalized patients (Fig. B) and for those discharged from the ED (Fig. C) showed that M-CHA2DS2-VASc score had a good discriminative ability to predict short-term mortality for both groups (logrank test p<0.001 and p=0.007, respectively).ConclusionConsidering the lack of validated scores to predict mortality in COVID-19 pts, the M-CHA2DS2-VASc might be a simple tool to predict short-term mortality in these pts, irrespectively of the need for hospitalization or not.Funding AcknowledgementType of funding sources: None.

Relationship of D-dimer and prediction of pulmonary embolism in hospitalized COVID-19 patients: a multicenter study.

Aim: COVID-19 is a known risk factor for pulmonary embolism (PE). In this retrospective, multicenter study, we aimed to determine an optimal D-dimer cutoff to predict PE in hospitalized patients with COVID-19. Materials & methods: A total of 193 patients underwent computerized tomographic pulmonary angiography imaging and were classified into PE positive and negative groups. Physiological, radiological and biochemical parameters were compared and receiver operator curve analysis was conducted to determine a predictive D-dimer threshold. Results: An optimal D-dimer cutoff of 2494 ng/ml was selected (Youden index: 0.906), giving a sensitivity of 100% (95% CI: 100–100) and specificity of 90.62% (95% CI: 90.5–90.8) for predicting PE. Conclusion: We propose that in the absence of other clinical signs, a D-dimer threshold of 2495 ng/ml could be used with high sensitivity and specificity to predict PE in hospitalized patients with COVID-19.

Diagnostic performance of D-dimer in predicting pulmonary embolism in tuberculous pleural effusion patients

BackgroundTuberculous pleural effusion (TPE) patients usually have elevated D-dimer levels. The diagnostic performance of D-dimer in predicting pulmonary embolism (PE) in the TPE population is unclear. This study aimed to assess the diagnostic performance of D-dimer for PE in the TPE population and explore its potential mechanism.MethodsWe retrospectively analysed patients who were admitted to Xinhua Hospital and Weifang Respiratory Disease Hospital with confirmed TPE between March 2014 and January 2020. D-dimer levels were compared between patients with and without PE. To test the diagnostic performance of D-dimer in predicting PE, receiver operating characteristic curve analysis was performed. Positive predictive value (PPV) and negative predictive value (NPV) were also reported. To explore the potential mechanism of PE in TPE, inflammatory biomarkers were compared between PE and non-PE patients.ResultsThis study included 248 patients (170 males and 78 females) aged 43 ± 20.6 years. Elevated D-dimer levels (≥ 0.5 mg/L) were detected in 186/248 (75%) patients. Of the 150 patients who underwent computed tomography pulmonary angiography, 29 were diagnosed with PE. Among the TPE population, the PE patients had significantly higher D-dimer levels than the non-PE patients (median, 1.06 mg/L vs. 0.84 mg/L, P < 0.05). The optimal cut-off value for D-dimer in predicting PE in TPE was 1.18 mg/L, with a sensitivity of 89.7% and a specificity of 77.8% (area under curve, 0.893; 95% confidence interval 0.839–0.947; P < 0.01). The PPV was 49.1%, while the NPV was 96.9% at a D-dimer cut-off of 1.18 mg/L for PE. PE patients had lower median WBC and interleukin (IL)-8 values (5.14 × 109/L vs. 6.1 × 109/L, P < 0.05; 30.2 pg/ml vs. 89.7 pg/ml, P < 0.05) but a higher median IL-2 receptor value (1964.8 pg/ml vs. 961.2 pg/ml, P < 0.01) than those in the non-PE patients.ConclusionsD-dimer is an objective biomarker for predicting PE in patients with TPE. A D-dimer cut-off of 1.18 mg/L in the TPE population may reduce unnecessary radiological tests due to its excellent sensitivity, specificity, and NPV for PE. The imbalance of prothrombotic and antithrombotic cytokines may partly be attributed to the formation of pulmonary emboli in patients with TPE.

Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Systematic Review and Meta-analysis.

Background:Pulmonary embolism (PE), depending on the severity, carries a high mortality and morbidity. Proper evaluation, especially in patients with low probability for PE, is important to avoid unnecessary diagnostic testing.Objective:To review the diagnostic utility of conventional versus age-adjusted D-dimer cutoff values in patients 50 years and older with suspected pulmonary embolism.Methods:Systematic review with univariant and bivariant meta-analysis.Data sources:We searched PubMed, MEDLINE, and EBSCO for studies published before September 20th, 2020. We cross checked the reference list of relevant studies that compares conventional versus age-adjusted D-dimer cutoff values in patients with suspected pulmonary embolism.Study selection:We included primary published studies that compared both conventional (500 µg/L) and age-adjusted (age × 10 µg/L) cutoff values in patients with non-high clinical probability for pulmonary embolism.Results:Nine cohorts that included 47 720 patients with non-high clinical probability were included in the meta-analysis. Both Age-adjusted D-dimer and conventional D-dimer have high sensitivity. However, conventional D-dimer has higher false positive rate than age-adjusted D-dimer.Conclusion:Age-adjusted D-dimer cutoffs combined with low risk clinical probability assessment ruled out PE diagnosis in suspected patients with a decreased rate of false positive tests.