Vielhauer, Jakob; Benesch, Christopher; Pernpruner, Anna; Johlke, Anna-Lena; Hellmuth, Johannes Christian; Muenchhoff, Maximilian; Scherer, Clemens; Fink, Nicola; Sabel, Bastian; Schulz, Christian; Mayerle, Julia; Mahajan, Ujjwal Mukund; Stubbe, Hans Christian (2023): How to exclude pulmonary embolism in patients hospitalized with COVID-19: a comparison of predictive scores. Thrombosis Journal, 21 (1). ISSN 1477-9560
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Abstract
Background
Pulmonary embolism (PE) is an important complication of Coronavirus disease 2019 (COVID-19). COVID-19 is associated with respiratory impairment and a pro-coagulative state, rendering PE more likely and difficult to recognize. Several decision algorithms relying on clinical features and D-dimer have been established. High prevalence of PE and elevated Ddimer in patients with COVID-19 might impair the performance of common decision algorithms. Here, we aimed to validate and compare five common decision algorithms implementing age adjusted Ddimer, the GENEVA, and Wells scores as well as the PEGeD- and YEARS-algorithms in patients hospitalized with COVID-19.
Methods
In this single center study, we included patients who were admitted to our tertiary care hospital in the COVID-19 Registry of the LMU Munich. We retrospectively selected patients who received a computed tomography pulmonary angiogram (CTPA) or pulmonary ventilation/perfusion scintigraphy (V/Q) for suspected PE. The performances of five commonly used diagnostic algorithms (age-adjusted D-dimer, GENEVA score, PEGeD-algorithm, Wells score, and YEARS-algorithm) were compared.
Results
We identified 413 patients with suspected PE who received a CTPA or V/Q confirming 62 PEs (15%). Among them, 358 patients with 48 PEs (13%) could be evaluated for performance of all algorithms. Patients with PE were older and their overall outcome was worse compared to patients without PE. Of the above five diagnostic algorithms, the PEGeD- and YEARS-algorithms performed best, reducing diagnostic imaging by 14% and 15% respectively with a sensitivity of 95.7% and 95.6%. The GENEVA score was able to reduce CTPA or V/Q by 32.2% but suffered from a low sensitivity (78.6%). Age-adjusted D-dimer and Wells score could not significantly reduce diagnostic imaging.
Conclusion
The PEGeD- and YEARS-algorithms outperformed other tested decision algorithms and worked well in patients admitted with COVID-19. These findings need independent validation in a prospective study.
Doc-Type: | Article (LMU Hospital) |
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Organisational unit (Faculties): | 07 Medicine > Medical Center of the University of Munich > Medical Clinic and Outpatient Clinic II (Gastroenterology, Hepatology) |
DFG subject classification of scientific disciplines: | Life sciences |
Date Deposited: | 13. Oct 2023 12:12 |
Last Modified: | 07. Dec 2023 12:19 |
URI: | https://oa-fund.ub.uni-muenchen.de/id/eprint/939 |
DFG: | Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - 491502892 |