White blood count, D-dimers, and ferritin levels as predictive factors of pulmonary embolism suspected upon admission in noncritically ill COVID-19 patients: The French multicenter CLOTVID retrospective study

Eur J Haematol. 2021 Aug;107(2):190-201. doi: 10.1111/ejh.13638. Epub 2021 May 24.

Abstract

Background: A high prevalence of pulmonary embolism (PE) has been described during COVID-19. Our aim was to identify predictive factors of PE in non-ICU hospitalized COVID-19 patients.

Methods: Data and outcomes were collected upon admission during a French multicenter retrospective study, including patients hospitalized for COVID-19, with a CT pulmonary angiography (CTPA) performed in the emergency department for suspected PE. Predictive factors significantly associated with PE were identified through a multivariate regression model.

Results: A total of 88 patients (median [IQR] age of 68 years [60-78]) were analyzed. Based on CTPA, 47 (53.4%) patients were diagnosed with PE, and 41 were not. D-dimer ≥3000 ng/mL (OR 8.2 [95% CI] 1.3-74.2, sensitivity (Se) 0.84, specificity (Sp) 0.78, P = .03), white blood count (WBC) ≥12.0 G/L (29.5 [2.3-1221.2], Se 0.47, Sp 0.92, P = .02), and ferritin ≥480 µg/L (17.0 [1.7-553.3], Se 0.96, Sp 0.44, P = .03) were independently associated with the PE diagnosis. The presence of the double criterion D-dimer ≥3000 ng/mL and WBC ≥12.0 G/L was greatly associated with PE (OR 21.4 [4.0-397.9], P = .004).

Conclusion: The white blood count, the D-dimer and ferritin levels could be used as an indication for CTPA to confirm PE on admission in non-ICU COVID-19 patients.

Keywords: COVID‐19; D‐dimer; SARS‐CoV‐2; ferritin; predictive factor; pulmonary embolism; white blood count.

Publication types

  • Multicenter Study

MeSH terms

  • COVID-19 / complications*
  • COVID-19 / virology
  • Ferritins / metabolism*
  • Fibrin Fibrinogen Degradation Products / metabolism*
  • France
  • Humans
  • Leukocyte Count*
  • Patient Admission
  • Pulmonary Embolism / blood*
  • Pulmonary Embolism / complications*
  • Retrospective Studies
  • SARS-CoV-2 / isolation & purification

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Ferritins