Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study

Background: Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in this population. Methods: T...

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Autores principales:	Maribel Quezada-Feijoo, Mónica Ramos, Isabel Lozano-Montoya, Mónica Sarró, Verónica Cabo Muiños, Rocío Ayala, Francisco J. Gómez-Pavón, Rocío Toro
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	pulmonary embolism Wells scale Geneva scale COVID-19 older patients Medicine R
Acceso en línea:	https://doaj.org/article/9ba35a610aed40ee8776d8bc59b2534c
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spelling	oai:doaj.org-article:9ba35a610aed40ee8776d8bc59b2534c2021-11-25T18:02:47ZElderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study10.3390/jcm102254332077-0383https://doaj.org/article/9ba35a610aed40ee8776d8bc59b2534c2021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5433https://doaj.org/toc/2077-0383Background: Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in this population. Methods: This was a longitudinal, observational study that included patients ≥75 years old with COVID-19 and suspected PE. The performances of the Wells score, revised Geneva score and DD levels were assessed. The combinations of the DD level and the clinical scales were evaluated using positive rules for higher specificity. Results: Among 305 patients included in the OCTA-COVID study cohort, 50 had suspected PE based on computed tomography pulmonary arteriography (CTPA), and the prevalence was 5.6%. The frequencies of PE in the low-, intermediate- and high-probability categories were 5.9%, 88.2% and 5.9% for the Geneva model and 35.3%, 58.8% and 5.9% for the Wells model, respectively. The DD median was higher in the PE group (4.33 mg/L; interquartile range (IQR) 2.40–7.17) than in the no PE group (1.39 mg/L; IQR 1.01–2.75) (<i>p</i> < 0.001). The area under the curve (AUC) for DD was 0.789 (0.652–0.927). After changing the cutoff point for DD to 4.33 mg/L, the specificity increased from 42.5% to 93.9%. Conclusions: The cutoff point DD > 4.33 mg/L has an increased specificity, which can discriminate false positives. The addition of the DD and the clinical probability scales increases the specificity and negative predictive value, which helps to avoid unnecessary invasive tests in this population.Maribel Quezada-FeijooMónica RamosIsabel Lozano-MontoyaMónica SarróVerónica Cabo MuiñosRocío AyalaFrancisco J. Gómez-PavónRocío ToroMDPI AGarticlepulmonary embolismWells scaleGeneva scaleCOVID-19older patientsMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5433, p 5433 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	pulmonary embolism Wells scale Geneva scale COVID-19 older patients Medicine R
spellingShingle	pulmonary embolism Wells scale Geneva scale COVID-19 older patients Medicine R Maribel Quezada-Feijoo Mónica Ramos Isabel Lozano-Montoya Mónica Sarró Verónica Cabo Muiños Rocío Ayala Francisco J. Gómez-Pavón Rocío Toro Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
description	Background: Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in this population. Methods: This was a longitudinal, observational study that included patients ≥75 years old with COVID-19 and suspected PE. The performances of the Wells score, revised Geneva score and DD levels were assessed. The combinations of the DD level and the clinical scales were evaluated using positive rules for higher specificity. Results: Among 305 patients included in the OCTA-COVID study cohort, 50 had suspected PE based on computed tomography pulmonary arteriography (CTPA), and the prevalence was 5.6%. The frequencies of PE in the low-, intermediate- and high-probability categories were 5.9%, 88.2% and 5.9% for the Geneva model and 35.3%, 58.8% and 5.9% for the Wells model, respectively. The DD median was higher in the PE group (4.33 mg/L; interquartile range (IQR) 2.40–7.17) than in the no PE group (1.39 mg/L; IQR 1.01–2.75) (<i>p</i> < 0.001). The area under the curve (AUC) for DD was 0.789 (0.652–0.927). After changing the cutoff point for DD to 4.33 mg/L, the specificity increased from 42.5% to 93.9%. Conclusions: The cutoff point DD > 4.33 mg/L has an increased specificity, which can discriminate false positives. The addition of the DD and the clinical probability scales increases the specificity and negative predictive value, which helps to avoid unnecessary invasive tests in this population.
format	article
author	Maribel Quezada-Feijoo Mónica Ramos Isabel Lozano-Montoya Mónica Sarró Verónica Cabo Muiños Rocío Ayala Francisco J. Gómez-Pavón Rocío Toro
author_facet	Maribel Quezada-Feijoo Mónica Ramos Isabel Lozano-Montoya Mónica Sarró Verónica Cabo Muiños Rocío Ayala Francisco J. Gómez-Pavón Rocío Toro
author_sort	Maribel Quezada-Feijoo
title	Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_short	Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_full	Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_fullStr	Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_full_unstemmed	Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
title_sort	elderly population with covid-19 and the accuracy of clinical scales and d-dimer for pulmonary embolism: the octa-covid study
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/9ba35a610aed40ee8776d8bc59b2534c
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Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study

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