HealthDay News — Use of D-dimer levels to exclude pulmonary embolism (PE) has limited clinical utility and may be inappropriate in patients hospitalized with COVID-19, many of whom have increased plasma D-dimer values, according to a research letter published online October 8 in JAMA Network Open.
Constantine N. Logothetis, MD, from the University of South Florida in Tampa, and colleagues conducted a diagnostic accuracy study to characterize the performance of D-dimer to exclude PE among patients hospitalized with COVID-19. Among 287 patients with suspected PE, plasma D-dimer concentrations from an automated, standardized assay were compared to the criterion standard of computed tomographic pulmonary angiography. The ability of plasma D-dimer concentrations to correctly classify patients with PE was examined.
Of the 287 patients with COVID-19 and suspected PE, 118 required intensive care unit levels of care and 27 died during hospitalization (41.1 and 9.4%, respectively). The researchers found that 37 patients (12.9%) had radiographic evidence of PE and 87.1% did not. Overall, 92.3% of patients had plasma D-dimer levels of 0.05µg/mL and greater, including all patients with PE and 225 of 250 without PE (91.2%). For patients without and with PE, the median D-dimer values were 1.0 and 6.1µg/mL, respectively; D-dimer values ranged from 0.2 to 128µg/mL and from 0.5 to more than 10,000µg/mL, respectively. Mean D-dimer values were significantly lower for patients without PE.
“These results suggest that the use of D-dimer levels to exclude PE among patients hospitalized with COVID-19 may be inappropriate and have limited clinical utility,” the authors write.