Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients.
Identifieur interne : 001054 ( Main/Exploration ); précédent : 001053; suivant : 001055Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients.
Auteurs : Basile Mouhat [France] ; Matthieu Besutti [France] ; Kevin Bouiller [France] ; Franck Grillet [France] ; Charles Monnin [France] ; Fiona Ecarnot [France] ; Julien Behr [France] ; Gilles Capellier [France] ; Thibaud Soumagne [France] ; Sébastien Pili-Floury [France] ; Guillaume Besch [France] ; Guillaume Mourey [France] ; Quentin Lepiller [France] ; Catherine Chirouze [France] ; François Schiele [France] ; Romain Chopard [France] ; Nicolas Meneveau [France]Source :
- The European respiratory journal [ 1399-3003 ] ; 2020.
Abstract
BACKGROUND
COVID-19 may predispose to venous thromboembolism. We determined factors independently associated with computed tomography pulmonary angiography (CTPA)-confirmed pulmonary embolism (PE) in hospitalised severe COVID-19 patients.
METHODS
Among all (N=349) patients hospitalised for COVID-19 in a university hospital in a French region with a high rate of COVID-19, we analysed patients who underwent CTPA for clinical signs of severe disease (SpO2≤93% or breathing rate≥30/min); or rapid clinical worsening. Multivariable analysis was performed using Firth penalised maximum likelihood estimates.
RESULTS
In total, 162 patients (46.4%) underwent CTPA (mean age 65.6±13.0; 67.3% males (95% confidence interval (CI) 59.5-75.5%)). PE was diagnosed in 44 patients (27.2%). Most PE were segmental and the rate of PE-related right ventricular dysfunction was 15.9%. By multivariable analysis, the only two significant predictors of CTPA-confirmed PE were D-dimer level and the lack of any anticoagulant therapy (odds ratio (OR) 4.0 (95%CI 2.4-6.7) per additional quartile, and OR 4.5 (95%CI 1.1-7.4) respectively). ROC curve analysis identified a D-dimer cut-off value of 2590 ng·mL
CONCLUSION
Elevated D-dimers (>2590 ng·mL
DOI: 10.1183/13993003.01811-2020
PubMed: 32907890
Affiliations:
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wicri:level="3"><nlm:affiliation>Medical Intensive Care Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Medical Intensive Care Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Soumagne, Thibaud" sort="Soumagne, Thibaud" uniqKey="Soumagne T" first="Thibaud" last="Soumagne">Thibaud Soumagne</name><affiliation wicri:level="3"><nlm:affiliation>Medical Intensive Care Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Medical Intensive Care Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement 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Care Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Mourey, Guillaume" sort="Mourey, Guillaume" uniqKey="Mourey G" first="Guillaume" last="Mourey">Guillaume Mourey</name><affiliation wicri:level="3"><nlm:affiliation>Hematology Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Hematology Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>INSERM UMR 1098, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>INSERM UMR 1098, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Lepiller, Quentin" sort="Lepiller, Quentin" uniqKey="Lepiller Q" first="Quentin" last="Lepiller">Quentin Lepiller</name><affiliation wicri:level="3"><nlm:affiliation>Virology Laboratory, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Virology Laboratory, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Chirouze, Catherine" sort="Chirouze, Catherine" uniqKey="Chirouze C" first="Catherine" last="Chirouze">Catherine Chirouze</name><affiliation wicri:level="3"><nlm:affiliation>UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Department of Radiology, Besançon University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Radiology, Besançon University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Schiele, Francois" sort="Schiele, Francois" uniqKey="Schiele F" first="François" last="Schiele">François Schiele</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Chopard, Romain" sort="Chopard, Romain" uniqKey="Chopard R" first="Romain" last="Chopard">Romain Chopard</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation><nlm:affiliation>Romain Chopard and Nicolas Meneveau contributed equally to this work.</nlm:affiliation><wicri:noCountry code="no comma">Romain Chopard and Nicolas Meneveau contributed equally to this work.</wicri:noCountry></affiliation></author><author><name sortKey="Meneveau, Nicolas" sort="Meneveau, Nicolas" uniqKey="Meneveau N" first="Nicolas" last="Meneveau">Nicolas Meneveau</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation><nlm:affiliation>Romain Chopard and Nicolas Meneveau contributed equally to this work.</nlm:affiliation><wicri:noCountry code="no comma">Romain Chopard and Nicolas Meneveau contributed equally to this work.</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32907890</idno><idno type="pmid">32907890</idno><idno type="doi">10.1183/13993003.01811-2020</idno><idno type="wicri:Area/Main/Corpus">000179</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000179</idno><idno type="wicri:Area/Main/Curation">000179</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000179</idno><idno type="wicri:Area/Main/Exploration">000179</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients.</title><author><name sortKey="Mouhat, Basile" sort="Mouhat, Basile" uniqKey="Mouhat B" first="Basile" last="Mouhat">Basile Mouhat</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Besutti, Matthieu" sort="Besutti, Matthieu" uniqKey="Besutti M" first="Matthieu" last="Besutti">Matthieu Besutti</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Bouiller, Kevin" sort="Bouiller, Kevin" uniqKey="Bouiller K" first="Kevin" last="Bouiller">Kevin Bouiller</name><affiliation wicri:level="3"><nlm:affiliation>Infectious and Tropical Diseases Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Infectious and Tropical Diseases Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Grillet, Franck" sort="Grillet, Franck" uniqKey="Grillet F" first="Franck" last="Grillet">Franck Grillet</name><affiliation wicri:level="3"><nlm:affiliation>Department of Radiology, Besançon University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Radiology, Besançon University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Monnin, Charles" sort="Monnin, Charles" uniqKey="Monnin C" first="Charles" last="Monnin">Charles Monnin</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Ecarnot, Fiona" sort="Ecarnot, Fiona" uniqKey="Ecarnot F" first="Fiona" last="Ecarnot">Fiona Ecarnot</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Behr, Julien" sort="Behr, Julien" uniqKey="Behr J" first="Julien" last="Behr">Julien Behr</name><affiliation wicri:level="3"><nlm:affiliation>Infectious and Tropical Diseases Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Infectious and Tropical Diseases Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Capellier, Gilles" sort="Capellier, Gilles" uniqKey="Capellier G" first="Gilles" last="Capellier">Gilles Capellier</name><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Medical Intensive Care Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Medical Intensive Care Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Soumagne, Thibaud" sort="Soumagne, Thibaud" uniqKey="Soumagne T" first="Thibaud" last="Soumagne">Thibaud Soumagne</name><affiliation wicri:level="3"><nlm:affiliation>Medical Intensive Care Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Medical Intensive Care Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Pili Floury, Sebastien" sort="Pili Floury, Sebastien" uniqKey="Pili Floury S" first="Sébastien" last="Pili-Floury">Sébastien Pili-Floury</name><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Anesthesia and Surgical Intensive Care Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Anesthesia and Surgical Intensive Care Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Besch, Guillaume" sort="Besch, Guillaume" uniqKey="Besch G" first="Guillaume" last="Besch">Guillaume Besch</name><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Anesthesia and Surgical Intensive Care Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Anesthesia and Surgical Intensive Care Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Mourey, Guillaume" sort="Mourey, Guillaume" uniqKey="Mourey G" first="Guillaume" last="Mourey">Guillaume Mourey</name><affiliation wicri:level="3"><nlm:affiliation>Hematology Unit, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Hematology Unit, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>INSERM UMR 1098, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>INSERM UMR 1098, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Lepiller, Quentin" sort="Lepiller, Quentin" uniqKey="Lepiller Q" first="Quentin" last="Lepiller">Quentin Lepiller</name><affiliation wicri:level="3"><nlm:affiliation>Virology Laboratory, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Virology Laboratory, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Chirouze, Catherine" sort="Chirouze, Catherine" uniqKey="Chirouze C" first="Catherine" last="Chirouze">Catherine Chirouze</name><affiliation wicri:level="3"><nlm:affiliation>UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Department of Radiology, Besançon University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Radiology, Besançon University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Schiele, Francois" sort="Schiele, Francois" uniqKey="Schiele F" first="François" last="Schiele">François Schiele</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation></author><author><name sortKey="Chopard, Romain" sort="Chopard, Romain" uniqKey="Chopard R" first="Romain" last="Chopard">Romain Chopard</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation><nlm:affiliation>Romain Chopard and Nicolas Meneveau contributed equally to this work.</nlm:affiliation><wicri:noCountry code="no comma">Romain Chopard and Nicolas Meneveau contributed equally to this work.</wicri:noCountry></affiliation></author><author><name sortKey="Meneveau, Nicolas" sort="Meneveau, Nicolas" uniqKey="Meneveau N" first="Nicolas" last="Meneveau">Nicolas Meneveau</name><affiliation wicri:level="3"><nlm:affiliation>Department of Cardiology, University Hospital, Besançon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Department of Cardiology, University Hospital, Besançon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Research Unit EA3920, University of Franche-Comte, Besancon</wicri:regionArea><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Franche-Comté</region><settlement type="city">Besançon</settlement></placeName></affiliation><affiliation><nlm:affiliation>Romain Chopard and Nicolas Meneveau contributed equally to this work.</nlm:affiliation><wicri:noCountry code="no comma">Romain Chopard and Nicolas Meneveau contributed equally to this work.</wicri:noCountry></affiliation></author></analytic><series><title level="j">The European respiratory journal</title><idno type="eISSN">1399-3003</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>COVID-19 may predispose to venous thromboembolism. We determined factors independently associated with computed tomography pulmonary angiography (CTPA)-confirmed pulmonary embolism (PE) in hospitalised severe COVID-19 patients.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Among all (N=349) patients hospitalised for COVID-19 in a university hospital in a French region with a high rate of COVID-19, we analysed patients who underwent CTPA for clinical signs of severe disease (SpO2≤93% or breathing rate≥30/min); or rapid clinical worsening. Multivariable analysis was performed using Firth penalised maximum likelihood estimates.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>In total, 162 patients (46.4%) underwent CTPA (mean age 65.6±13.0; 67.3% males (95% confidence interval (CI) 59.5-75.5%)). PE was diagnosed in 44 patients (27.2%). Most PE were segmental and the rate of PE-related right ventricular dysfunction was 15.9%. By multivariable analysis, the only two significant predictors of CTPA-confirmed PE were D-dimer level and the lack of any anticoagulant therapy (odds ratio (OR) 4.0 (95%CI 2.4-6.7) per additional quartile, and OR 4.5 (95%CI 1.1-7.4) respectively). ROC curve analysis identified a D-dimer cut-off value of 2590 ng·mL</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Elevated D-dimers (>2590 ng·mL</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32907890</PMID><DateRevised><Year>2020</Year><Month>09</Month><Day>10</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1399-3003</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Sep</Month><Day>09</Day></PubDate></JournalIssue><Title>The European respiratory journal</Title><ISOAbbreviation>Eur. Respir. J.</ISOAbbreviation></Journal><ArticleTitle>Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">2001811</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1183/13993003.01811-2020</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">COVID-19 may predispose to venous thromboembolism. We determined factors independently associated with computed tomography pulmonary angiography (CTPA)-confirmed pulmonary embolism (PE) in hospitalised severe COVID-19 patients.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Among all (N=349) patients hospitalised for COVID-19 in a university hospital in a French region with a high rate of COVID-19, we analysed patients who underwent CTPA for clinical signs of severe disease (SpO2≤93% or breathing rate≥30/min); or rapid clinical worsening. Multivariable analysis was performed using Firth penalised maximum likelihood estimates.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">In total, 162 patients (46.4%) underwent CTPA (mean age 65.6±13.0; 67.3% males (95% confidence interval (CI) 59.5-75.5%)). PE was diagnosed in 44 patients (27.2%). Most PE were segmental and the rate of PE-related right ventricular dysfunction was 15.9%. By multivariable analysis, the only two significant predictors of CTPA-confirmed PE were D-dimer level and the lack of any anticoagulant therapy (odds ratio (OR) 4.0 (95%CI 2.4-6.7) per additional quartile, and OR 4.5 (95%CI 1.1-7.4) respectively). ROC curve analysis identified a D-dimer cut-off value of 2590 ng·mL<sup>-1</sup> to best predict occurrence of PE (AUC: 0.88, p<0.001, sensitivity 83.3%, specificity 83.8%). D-dimer level >2590 ng·mL<sup>-1</sup> was associated with a 17-fold increase in the adjusted risk of PE.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Elevated D-dimers (>2590 ng·mL<sup>-1</sup>) and absence of anticoagulant therapy predict PE in hospitalised COVID-19 patients with clinical signs of severity. These data strengthen the evidence base in favour of systematic anticoagulation, and suggest wider use of D-dimer guided CTPA to screen for PE in acutely ill hospitalised patients with COVID-19.</AbstractText><CopyrightInformation>Copyright ©ERS 2020.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Mouhat</LastName><ForeName>Basile</ForeName><Initials>B</Initials><Identifier Source="ORCID">https://orcid.org/0000-0001-8459-8959</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Besutti</LastName><ForeName>Matthieu</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bouiller</LastName><ForeName>Kevin</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Infectious and Tropical Diseases Unit, University Hospital, Besançon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Grillet</LastName><ForeName>Franck</ForeName><Initials>F</Initials><Identifier Source="ORCID">https://orcid.org/0000-0001-6594-8829</Identifier><AffiliationInfo><Affiliation>Department of Radiology, Besançon University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Monnin</LastName><ForeName>Charles</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ecarnot</LastName><ForeName>Fiona</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital, Besançon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Behr</LastName><ForeName>Julien</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Infectious and Tropical Diseases Unit, University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Capellier</LastName><ForeName>Gilles</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Medical Intensive Care Unit, University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Soumagne</LastName><ForeName>Thibaud</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Medical Intensive Care Unit, University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pili-Floury</LastName><ForeName>Sébastien</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Anesthesia and Surgical Intensive Care Unit, University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Besch</LastName><ForeName>Guillaume</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Anesthesia and Surgical Intensive Care Unit, University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mourey</LastName><ForeName>Guillaume</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Hematology Unit, University Hospital, Besançon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>INSERM UMR 1098, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lepiller</LastName><ForeName>Quentin</ForeName><Initials>Q</Initials><AffiliationInfo><Affiliation>Virology Laboratory, University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chirouze</LastName><ForeName>Catherine</ForeName><Initials>C</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-6150-2376</Identifier><AffiliationInfo><Affiliation>UMR CNRS 6249 Chrono-Environnement, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Radiology, Besançon University Hospital, Besançon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schiele</LastName><ForeName>François</ForeName><Initials>F</Initials><Identifier Source="ORCID">https://orcid.org/0000-0003-4974-6551</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital, Besançon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chopard</LastName><ForeName>Romain</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital, Besançon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Romain Chopard and Nicolas Meneveau contributed equally to this work.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Meneveau</LastName><ForeName>Nicolas</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Department of Cardiology, University Hospital, Besançon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Research Unit EA3920, University of Franche-Comte, Besancon, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Romain Chopard and Nicolas Meneveau contributed equally to this work.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>09</Month><Day>09</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Eur Respir J</MedlineTA><NlmUniqueID>8803460</NlmUniqueID><ISSNLinking>0903-1936</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><CoiStatement>Conflict of interest: Dr. Mouhat has nothing to disclose. Conflict of interest: Dr. Besutti has nothing to disclose. Conflict of interest: Dr. Bouiller has nothing to disclose. Conflict of interest: Dr. Grillet has nothing to disclose. Conflict of interest: Dr. Monnin has nothing to disclose. Conflict of interest: Dr. Ecarnot has nothing to disclose. Conflict of interest: Dr. Behr has nothing to disclose. Conflict of interest: Dr. Capellier has nothing to disclose. Conflict of interest: Dr. Soumagne has nothing to disclose. Conflict of interest: Dr. Pili-Floury has nothing to disclose. Conflict of interest: Dr. Besch has nothing to disclose. Conflict of interest: Dr. Mourey has nothing to disclose. Conflict of interest: Dr. Lepiller has nothing to disclose. Conflict of interest: Dr. Chirouze has nothing to disclose. Conflict of interest: Dr. Schiele has nothing to disclose. Conflict of interest: Dr. Chopard has nothing to disclose. Conflict of interest: Dr. Meneveau has nothing to disclose.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>05</Month><Day>15</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>07</Month><Day>01</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>9</Month><Day>10</Day><Hour>5</Hour><Minute>29</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>9</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>9</Month><Day>11</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32907890</ArticleId><ArticleId IdType="pii">13993003.01811-2020</ArticleId><ArticleId IdType="doi">10.1183/13993003.01811-2020</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>France</li></country><region><li>Bourgogne-Franche-Comté</li><li>Franche-Comté</li></region><settlement><li>Besançon</li></settlement></list><tree><country name="France"><region name="Bourgogne-Franche-Comté"><name sortKey="Mouhat, Basile" sort="Mouhat, Basile" uniqKey="Mouhat B" first="Basile" last="Mouhat">Basile Mouhat</name></region><name sortKey="Behr, Julien" sort="Behr, Julien" uniqKey="Behr J" first="Julien" last="Behr">Julien Behr</name><name sortKey="Besch, Guillaume" sort="Besch, Guillaume" uniqKey="Besch G" first="Guillaume" last="Besch">Guillaume Besch</name><name sortKey="Besch, Guillaume" sort="Besch, Guillaume" uniqKey="Besch G" first="Guillaume" last="Besch">Guillaume Besch</name><name sortKey="Besutti, Matthieu" sort="Besutti, Matthieu" uniqKey="Besutti M" first="Matthieu" last="Besutti">Matthieu Besutti</name><name sortKey="Bouiller, Kevin" sort="Bouiller, Kevin" uniqKey="Bouiller K" first="Kevin" last="Bouiller">Kevin Bouiller</name><name sortKey="Bouiller, Kevin" sort="Bouiller, Kevin" uniqKey="Bouiller K" first="Kevin" last="Bouiller">Kevin Bouiller</name><name sortKey="Capellier, Gilles" sort="Capellier, Gilles" uniqKey="Capellier G" first="Gilles" last="Capellier">Gilles Capellier</name><name sortKey="Capellier, Gilles" sort="Capellier, Gilles" uniqKey="Capellier G" first="Gilles" last="Capellier">Gilles Capellier</name><name sortKey="Chirouze, Catherine" sort="Chirouze, Catherine" uniqKey="Chirouze C" first="Catherine" last="Chirouze">Catherine Chirouze</name><name sortKey="Chirouze, Catherine" sort="Chirouze, Catherine" uniqKey="Chirouze C" first="Catherine" last="Chirouze">Catherine Chirouze</name><name sortKey="Chopard, Romain" sort="Chopard, Romain" uniqKey="Chopard R" first="Romain" last="Chopard">Romain Chopard</name><name sortKey="Chopard, Romain" sort="Chopard, Romain" uniqKey="Chopard R" first="Romain" last="Chopard">Romain Chopard</name><name sortKey="Ecarnot, Fiona" sort="Ecarnot, Fiona" uniqKey="Ecarnot F" first="Fiona" last="Ecarnot">Fiona Ecarnot</name><name sortKey="Ecarnot, Fiona" sort="Ecarnot, Fiona" uniqKey="Ecarnot F" first="Fiona" last="Ecarnot">Fiona Ecarnot</name><name sortKey="Grillet, Franck" sort="Grillet, Franck" uniqKey="Grillet F" first="Franck" last="Grillet">Franck Grillet</name><name sortKey="Lepiller, Quentin" sort="Lepiller, Quentin" uniqKey="Lepiller Q" first="Quentin" last="Lepiller">Quentin Lepiller</name><name sortKey="Meneveau, Nicolas" sort="Meneveau, Nicolas" uniqKey="Meneveau N" first="Nicolas" last="Meneveau">Nicolas Meneveau</name><name sortKey="Meneveau, Nicolas" sort="Meneveau, Nicolas" uniqKey="Meneveau N" first="Nicolas" last="Meneveau">Nicolas Meneveau</name><name sortKey="Monnin, Charles" sort="Monnin, Charles" uniqKey="Monnin C" first="Charles" last="Monnin">Charles Monnin</name><name sortKey="Mourey, Guillaume" sort="Mourey, Guillaume" uniqKey="Mourey G" first="Guillaume" last="Mourey">Guillaume Mourey</name><name sortKey="Mourey, Guillaume" sort="Mourey, Guillaume" uniqKey="Mourey G" first="Guillaume" last="Mourey">Guillaume Mourey</name><name sortKey="Pili Floury, Sebastien" sort="Pili Floury, Sebastien" uniqKey="Pili Floury S" first="Sébastien" last="Pili-Floury">Sébastien Pili-Floury</name><name sortKey="Pili Floury, Sebastien" sort="Pili Floury, Sebastien" uniqKey="Pili Floury S" first="Sébastien" last="Pili-Floury">Sébastien Pili-Floury</name><name sortKey="Schiele, Francois" sort="Schiele, Francois" uniqKey="Schiele F" first="François" last="Schiele">François Schiele</name><name sortKey="Schiele, Francois" sort="Schiele, Francois" uniqKey="Schiele F" first="François" last="Schiele">François Schiele</name><name sortKey="Soumagne, Thibaud" sort="Soumagne, Thibaud" uniqKey="Soumagne T" first="Thibaud" last="Soumagne">Thibaud Soumagne</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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