IMR Press / RCM / Volume 24 / Issue 1 / DOI: 10.31083/j.rcm2401018
Open Access Original Research
Revision of Clinical Pre-Test Probability Scores in Hospitalized Patients with Pulmonary Embolism and SARS-CoV-2 Infection
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1 Department of Cardiology, University Hospital of Split, 21000 Split, Croatia
2 Department of Surgery, University Hospital of Split, 21000 Split, Croatia
3 Department of Infectious Diseases, University Hospital of Split, 21000 Split, Croatia
4 Department of Pulmology, University Hospital of Split, 21000 Split, Croatia
5 Department of Radiology, University Hospital of Split, 21000 Split, Croatia
6 University Department of Health Studies, University of Split, 21000 Split, Croatia
7 School of Medicine, University of Split, 21000 Split, Croatia
*Correspondence: mijometer05@gmail.com (Mijo Meter)
Academic Editor: Jerome L. Fleg
Rev. Cardiovasc. Med. 2023, 24(1), 18; https://doi.org/10.31083/j.rcm2401018
Submitted: 29 September 2022 | Revised: 6 December 2022 | Accepted: 6 December 2022 | Published: 10 January 2023
(This article belongs to the Special Issue Risk Stratification in Cardiovascular Diseases)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: The need for computed tomography pulmonary angiography (CTPA) to rule out pulmonary embolism (PE) is based on clinical scores in association with D-dimer measurements. PE is a recognized complication in patients with SARS-CoV-2 infection due to a pro-thrombotic state which may reduce the usefulness of preexisting pre-test probability scores. Aim: The purpose was to analyze new clinical and laboratory parameters while comparing existing and newly proposed scoring system for PE detection in hospitalized COVID-19 patients (HCP). Methods: We conducted a retrospective study of 270 consecutive HCPs who underwent CTPA due to suspected PE. The Modified Wells, Revised Geneva, Simplified Geneva, YEARS, 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS), and PE rule-out criteria (PERC) scores were calculated and the area under the receiver operating characteristic curve (AuROC) was measured. Results: Overall incidence of PE among our study group of HCPs was 28.1%. The group of patients with PE had a significantly longer COVID-19 duration upon admission, at 10 vs 8 days, p = 0.006; higher D-dimer levels of 10.2 vs 5.3 μg/L, p < 0.001; and a larger proportion of underlying chronic kidney disease, at 16% vs 7%, p = 0.041. From already established scores, only 4PEPS and the modified Wells score reached statistical significance in detecting the difference between the HCP groups with or without PE. We proposed a new chronic kidney disease, D-dimers, 10 days of illness before admission (CDD-10) score consisting of the three aforementioned variables: C as chronic kidney disease (0.5 points if present), D as D-dimers (negative 1.5 points if normal, 2 points if over 10.0 μg/L), and D-10 as day-10 of illness carrying 2 points if lasting more than 10 days before admission or 1 point if longer than 8 days. The CDD-10 score ranged from –1.5 to 4.5 and had an AuROC of 0.672, p < 0.001 at cutoff value at 0.5 while 4PEPS score had an AuROC of 0.638 and Modified Wells score 0.611. The clinical probability of PE was low (0%) when the CDD-10 value was negative, moderate (24%) for CDD-10 ranging 0–2.5 and high (43%) when over 2.5. Conclusions: Better risk stratification is needed for HCPs who require CTPA for suspected PE. Our newly proposed CDD-10 score demonstrates the best accuracy in predicting PE in patients hospitalized for SARS-CoV-2 infection.

Keywords
pulmonary embolism
SARS-CoV-2 infection
pre-test probability scores
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