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Article Dans Une Revue Thrombosis and Haemostasis Année : 2022

Adjusting D-dimer to lung disease extent to exclude Pulmonary Embolism in COVID-19 patients (Co-LEAD)

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Benjamin Planquette
  • Fonction : Auteur
Lina Khider
  • Fonction : Auteur
Alice Le Berre
  • Fonction : Auteur
Simon Soudet
Gilles Pernod
  • Fonction : Auteur
Raphael Le Mao
  • Fonction : Auteur
Matthieu Besutti
Nicolas Gendron
Alexandra Yannoutsos
  • Fonction : Auteur
David Smadja
Guillaume Goudot
  • Fonction : Auteur
Salma Al Kahf
  • Fonction : Auteur
Nassim Mohammedi
  • Fonction : Auteur
Antoine Al Hamoud
  • Fonction : Auteur
Aurélien Philippe
  • Fonction : Auteur
Laure Fournier
  • Fonction : Auteur
Bastien Rance
  • Fonction : Auteur
Jean-Luc Diehl
  • Fonction : Auteur
Tristan Mirault
Emmanuel Messas
  • Fonction : Auteur
Joseph Emmerich
  • Fonction : Auteur
Richard Chocron
  • Fonction : Auteur
Francis Couturaud
  • Fonction : Auteur
Gilbert Ferreti
  • Fonction : Auteur
Nicolas Meneveau
  • Fonction : Auteur
Gilles Chatellier
  • Fonction : Auteur
Olivier Sanchez
  • Fonction : Auteur

Résumé

Introduction: D-dimer measurement is a safe tool to exclude pulmonary embolism (PE) but its specificity decreases in COVID-19. Our aim was to derive a new algorithm with specific D-dimer threshold in COVID-19 patients. Methods: We conducted a French multicenter, retrospective cohort study among 774 COVID-19 patients with suspected PE. D-dimer threshold adjusted to computed tomography (CT) extent of lung damage was derived in a patient set (n=337), and its safety assessed in an independent validation set (n=337). Results: According to ROC curves, in the derivation set D-dimer safely excluded PE, with one false negative when using a 900 ng/mL threshold when lung damage extent was <50% and 1700 ng/mL when lung damage extent was ≥50%. In the derivation set, the algorithm sensitivity was 98.2% (95% CI: 94.7–100.0) and its specificity 28.4% (95% CI: 24.1–32.3). The negative likelihood ratio (NLR) was 0.06 (95% CI: 0.01–0.44) and the area under the curve (AUC) was 0.63 (95% CI: 0.60–0.67). In the validation set, sensitivity and specificity were 96.7% (95% CI: 88.7–99.6) and 39.2% (95% CI: 32.2–46.1), respectively. The NLR was 0.08 (95% CI; 0.02–0.33) and the AUC did not differed from that of the derivation set (0.68 ,95% CI: 0.64–0.72, P = 0.097). Using the Co-LEAD algorithm, 76/250 (30.4%) COVID-19 patients with suspected PE could have been managed without CT pulmonary angiography (CTPA). Conclusion: The Co-LEAD algorithm safely excludes PE, and allows reducing the use of CTPA among COVID-19 patients. Further prospective studies are necessary to validate this strategy.
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Dates et versions

hal-03722805 , version 1 (13-07-2022)

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Benjamin Planquette, Lina Khider, Alice Le Berre, Simon Soudet, Gilles Pernod, et al.. Adjusting D-dimer to lung disease extent to exclude Pulmonary Embolism in COVID-19 patients (Co-LEAD). Thrombosis and Haemostasis, 2022, ⟨10.1055/a-1768-4371⟩. ⟨hal-03722805⟩
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