Engels, S.Y.H. (2022) A new D-dimer cut-off value to predict pulmonary embolism in patients with COVID-19. thesis, Medicine.
Full text available on request.Abstract
Background: Pulmonary embolism (PE) is a common complication in COVID-19 patients. Elevated D-dimer levels are observed even in the absence of PE, reducing its discriminative ability. This study aimed to determine the optimal D-dimer cut-off value for predicting PE in COVID-19 patients and to gain insight into the predictive value of dynamic changes of D-dimer levels during hospitalization. Methods: Confirmed COVID-19 patients with a Computed Tomography Pulmonary Angiography (CTPA) performed at Medisch Spectrum Twente were retrospectively analysed. Optimal D-dimer cut-off value was determined for patients with the initial CTPA ≤5 days after admission, using binary logistic regression and ROC curve analyses. GEE analyses were performed to analyse the predictive value of dynamic change variables for all CTPAs of patients with a D-dimer at admission and prior to CTPA. Results: In the cut-off value analyses, 142 patients were included. In the dynamic change analyses, 77 patients (107 CTPAs) were included. PE-prevalence was 20.6–36.4%. D-dimer prior to CTPA and white blood cell count were predictors for PE (OR 1.050; 95%-CI: 1.032–1.067; p<0.001 and OR 1.099; 95%-CI:0.998–1.221; p=0.081). The optimal D-dimer cut-off value was 751ng/ml (AUC 0.833; sensitivity 100%; specificity 19.5%; NPV 100%; PPV 24.2%). D-dimer multiplication factor (p=0.017) and average change per day (p=0.024) were significantly associated with PE. Conclusion: D-dimer cut-off value of 751ng/ml is higher than the YEARS cut-off value of 500ng/ml but has comparable sensitivity. Using higher cut-off values increases the number of missed PE. Dynamic changes of D-dimer levels may be a beneficial addition in the prediction of PE.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | van Veen, H.P.A.A. and Heuvelmans, M.A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 26 May 2023 11:49 |
| Last Modified: | 26 May 2023 11:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3540 |
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