VPB0138 - Diagnostic strategies for pulmonary embolism in patients hospitalized for COVID-19: role of clinical prediction rules

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: Virtual

Presenting Author(s)

Maria Cristina Vedovati, MD

Professor
Vascular and Emergency Medicine, University of Perugia
Perugia, Umbria, Italy

Co-Author(s)

FB

Francesco Balducci

Medical doctor
University of Perugia
Perugia, Umbria, Italy
CB

Cecilia Becattini, PhD

Professor
University of Perugia
Perugia, Umbria, Italy

Background: Diagnostic strategies for pulmonary embolism (PE) in patients already facing respiratory failure due to COVID-19 is challenging. The use of the conventional diagnostic algorithm and clinical prediction rules (CPR) for PE is controversial.

Aims: To evaluate the accuracy of currently available diagnostic algorithms for the diagnosis of PE and CPRs to assess the risk for venous thromboembolism (VTE) in medically ill patients affected by COVID-19.

Methods: Consecutive patients >18 years hospitalized for COVID-19 (confirmed by molecular testing) at Perugia Hospital (Italy) from March 2020 to September 2021 were included if underwent chest-CT angiography for suspicion of PE. The study outcome was the accuracy of currently available CPRs, for PE diagnosis (Wells and Geneva) and for VTE-risk stratification in medically ill patients (IMPROVE, IMPROVEDD and Padua score), to predict PE.

Results: 74 patients were included (mean age 68 years, male 64.9%), 13 (17.6%) had PE confirmed. No significant differences were observed for comorbidities, antithrombotic treatment and mortality between the two groups. D-dimer resulted significantly higher in patients with compared to patients without PE.
Poor discrimination was observed for Wells and Geneva scores (AUC 0.596, 95% CI 0.413-0.779, and AUC 0.603, 95% CI 0.439-0.767, respectively), without substantial differences adding D-dimer at conventional cut-off (Table). The IMPROVEDD score had the highest discriminative power among CPRs for VTE (AUC 0.699, 95% CI 0.539-0.860). Scores’ performance improved by increasing the D-dimer cut-off at level of 2000 ng/ml.

Conclusion(s): The accuracy of the currently used diagnostic and predictive scores for PE or VTE in COVID-19 patients is poor. D-dimer improves the diagnostic accuracy of these scores; most of all, it seems to allow a diagnostic strategy with a high negative predictive value, so we can rule out a consistent part of the patients with a low risk of PE.