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Journal Articles European Respiratory Journal Year : 2020

Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients

Matthieu Besutti
  • Function : Author
Charles Monnin
  • Function : Author
Guillaume Besch
  • Function : Author
Guillaume Mourey
  • Function : Author
François Schiele
Romain Chopard
  • Function : Author
Nicolas Meneveau
  • Function : Author


Background Coronavirus disease 2019 (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 (oxygen saturation measured by pulse oximetry ≤93% or breathing rate ≥30 breaths·min −1 ) or rapid clinical worsening. Multivariable analysis was performed using Firth penalised maximum likelihood estimates. Results 162 (46.4%) patients underwent CTPA (mean± sd age 65.6±13.0 years; 67.3% male (95% CI 59.5–75.5%). PE was diagnosed in 44 (27.2%) patients. Most PEs 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 (OR 4.0 (95% CI 2.4–6.7) per additional quartile and OR 4.5 (95% CI 1.1–7.4), respectively). Receiver operating characteristic curve analysis identified a D-dimer cut-off value of 2590 ng·mL −1 to best predict occurrence of PE (area under the curve 0.88, p<0.001, sensitivity 83.3%, specificity 83.8%). D-dimer level >2590 ng·mL −1 was associated with a 17-fold increase in the adjusted risk of PE. Conclusion Elevated D-dimers (>2590 ng·mL −1 ) 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.

Dates and versions

hal-03494876 , version 1 (20-12-2021)



Basile Mouhat, Matthieu Besutti, Kevin Bouiller, Franck Grillet, Charles Monnin, et al.. Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients. European Respiratory Journal, 2020, 56 (4), pp.2001811. ⟨10.1183/13993003.01811-2020⟩. ⟨hal-03494876⟩
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