Am J Med. 2020 Dec 11:S0002-9343(20)31108-6. doi: 10.1016/j.amjmed.2020.10.044. Online ahead of print.
ABSTRACT
BACKGROUND: The association of Coronavirus Disease 2019 (COVID-19) with hypercoagulability has been extensively described. Consequently, pulmonary embolism is a recognized complication of COVID-19. Currently, the need for Computed Tomography Pulmonary Angiogram (CTPA) relies on the Wells score and serum D-dimer levels. However, since COVID-19 patients have a different thrombotic and inflammatory milieu, the usefulness of the Wells score deserves further exploration for this patient population. We aimed to explore the ability of the Wells score to predict pulmonary embolism in patients with COVID-19.
METHODS: In this retrospective study, patients found to have a CTPA and a COVID-19 diagnosis during the same admission were selected for analysis. Patients' age and gender, CTPA results, and associated D-dimer levels were entered in a database. The Wells score sensitivity and specificity were calculated at different values, and an area under the curve of a receiver operating characteristic curve (AUC/ROC) measured.
RESULTS: Of 459 patients with COVID-19, 64 had a CTPA and 12 (19%) had evidence of pulmonary embolism. Previous or current evidence of deep vein thrombosis, a Wells score above four points, and serum D-dimer levels five times above age-adjusted upper normal values were associated with pulmonary embolism. However, only 33% of patients with PE had a Wells score of four points or higher. The AUC/ROC showed non-discriminating values (0.54) CONCLUSION: While a Wells score of four or more points predicted pulmonary embolism in our cohort, the outcome can be present even with lower scores.
PMID:33316254 | DOI:10.1016/j.amjmed.2020.10.044