Improving risk prediction for pulmonary embolism in COVID‐19 patients using echocardiography

Pulmonary Circulation - Tập 12 Số 1 - 2022
Monika Satoskar1,2, Thomas S. Metkus1,3, Alborz Soleimani‐Fard3, Julie K. Shade4, Natalia A. Trayanova4, Erin D. Michos1,3, Monica Mukherjee3, Madeline Schiminger5, Wendy S. Post1,3, Allison G. Hays3
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
2Department of Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
3Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
4Department of Biomedical Engineering and Medicine, Johns Hopkins, Baltimore, Maryland, USA
5Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA

Tóm tắt

AbstractSARS‐CoV‐2 infection is associated with increased risk for pulmonary embolism (PE), a fatal complication that can cause right ventricular (RV) dysfunction. Serum D‐dimer levels are a sensitive test to suggest PE, however lacks specificity in COVID‐19 patients. The goal of this study was to identify a model that better predicts PE diagnosis in hospitalized COVID‐19 patients using clinical, laboratory, and echocardiographic imaging predictors. We performed a cross‐sectional study of 302 adult patients admitted to the Johns Hopkins Hospital (March 2020–February 2021) for COVID‐19 infection who underwent transthoracic echocardiography and D‐dimer testing; 204 patients had CT angiography. Clinical, laboratory and imaging predictors including, but not limited to, D‐dimer and RV dysfunction were used to build prediction models for PE using logistic regression. Model discrimination was assessed using area under the receiver operator curve (AUC) and calibration using Hosmer‐Lemeshow χ2 statistic. Internal validation was performed. The prevalence of PE was 7.6%. The model with positive D‐dimer above 5 mg/L, RV dysfunction on echocardiography, and troponin had an AUC of 0.77, and cross‐validated AUC of 0.74. D‐dimer (>5 mg/L) had a positive association with PE (adj odds ratio = 4.40; 95% confidence interval: [1.80, 10.78]). We identified a model including clinical, imaging and laboratory variables that predicted PE in hospitalized COVID‐19 patients. Positive D‐dimer >5, RV dysfunction on echocardiography, and troponin were important predictors for calculating likelihood of PE diagnosis. This approach may be useful to aid in clinical decision‐making related to diagnostic imaging and treatment. Prospective studies are needed to evaluate impact on patient outcomes.

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Pulmonary Circulation

Tập 12 Số 1

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