D-Dimer Levels as a Predictive Marker of Pulmonary Embolism in COVID-19 Patients

oleh: Namirah Iftikhar, Osama Rehman Khalid, Asif Husain Osmani, Uzma Ghori, Ashar Ekhlaq Ahmed

Format: Article
Diterbitkan: ziauddin University 2024-08-01

Deskripsi

Background: COVID-19 infections have a higher risk of thrombotic complications due to a pro-inflammatory environment. This study aimed to find the association of D-dimer levels with pulmonary embolism (PE) and assess D-dimer levels as a predictive marker of PE in COVID-19 patients. Methods: This prospective cross-sectional study was conducted from June to December 2021, at a private tertiary care teaching hospital in Karachi. Hospitalized COVID-19 patients with CTPA for PE, aged ≥18 years were selected through purposive sampling. With SPSS v.21, the association of co-morbidities and D-dimer levels for pulmonary embolism was analyzed using a t-test, chi-square test, and regression analysis while the predictive value of D-dimer levels for pulmonary embolism was analyzed using ROC analysis. Results: Participants (337), median age:50yrs, IQR:48-70(52.2% males, 47.8% females). The majority (96.7%) were receiving prophylactic anticoagulant therapy, Median D-dimer levels were 1380(IQR:800-2100). Pulmonary Embolism was found in 46(13.6%), had a significant association with disease duration >5days (p=0.01), D-dimer levels >2200(p<0.001), smoking status (p<0.001), heart disease history (p=0.007), functional status (p=0.009), and chronic kidney disease (p=0.007). ROC curve analysis showed the 2285ng/ml D-dimers and maximum Youden Index,0.636. The D-dimer value had 80%sensitivity, 80%specificity, 38.6%PPV,  96.21%NPV, and 80%diagnostic accuracy. The average cumulative D-dimer value of 2300ng/ml, during admission had a 0.824 Youlden index with 97%sensitivity and 84%specificity. This cutoff was 48.83%PPV,  99.4%NPV, and 85.7%diagnostic accuracy. Conclusion: Pulmonary Embolism was found in 13.6%(46/337). D-dimer levels  >2285ng/ml have 80% diagnostic accuracy for pulmonary embolism. Larger multicentre studies are warranted to explore thrombo-prophylaxis indications, drug choice, and dosing based on D-dimer levels. Keywords: COVID-19, Thromboembolism, Pulmonary, D-dimer