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Multicenter Study
. 2023 Nov;24(6):1043-1048.
doi: 10.5811/westjem.58619.

Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients

Iltifat Husain  1 , James C O'Neill  1 , Jacob H Schoeneck  1 , K Alexander Soltany  1 , Hollins Clark  2 , Erika Weidman Rice  1 , Alex Gross  1 , Jonathan Redding  1 , David M Cline  1
Affiliations
Multicenter Study

Clinical Characteristics of SARS-CoV-2 Acute Pulmonary Embolism and Adjusted D-dimer for Emergency Department Patients

Iltifat Husain et al. West J Emerg Med. 2023 Nov.

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute pulmonary embolism (APE) present a diagnostic challenge in the emergency department (ED) setting. We aimed to identify key clinical characteristics and D-dimer thresholds associated with APE in SARS-CoV-2 positive ED patients.

Methods: We performed a multicenter, retrospective cohort study for adult patients who were diagnosed with coronavirus 2019 (COVID-19) and had computed tomography pulmonary angiogram (CTPA) performed between March 17, 2020-January 31, 2021. We performed univariate analysis to determine numeric medians, chi-square values for association between clinical characteristic and positive CTPA. Logistic regression was used to determine the odds of a clinical characteristic being associated with a diagnosis of APE.

Results: Of 408 patients who underwent CTPA, 29 (7.1%) were ultimately found to have APE. In multivariable analysis, patients with a body mass index greater than 32 (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.0 -19.3), a heart rate greater than 90 beats per minute (bpm) (OR 5.0, 95% CI 1.0-24.9), and a D-dimer greater than 1,500 micrograms per liter (μg/L) (OR 5.6, 95% CI 1.6-20.2) were significantly associated with pulmonary embolism. In our population that received a D-dimer and was SARS-CoV-2 positive, limiting CTPA to patients with a heart rate over 90 or a D-dimer value over 1500 μg/L would reduce testing 27.2% and not miss APE.

Conclusion: In patients with acute COVID-19 infections, D-dimer at standard cutoffs was not usable. Limiting CTPA using a combination of heart rate greater than 90 bpm or D-dimer greater than 1,500 μg/L would significantly decrease imaging in this population.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1.
Figure 1.
Flow diagram. COVID-19, coronavirus disease 2019; CTPE, computed tomography pulmonary embolus; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; APE, acute pulmonary embolism.
See this image and copyright information in PMC

References

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