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Article Dans Une Revue European Radiology Année : 2023

Strategies to safely rule out pulmonary embolism in COVID-19 outpatients: a multicenter retrospective study

Guillaume Chassagnon
Benoît Ghaye
  • Fonction : Auteur
Lucie Cassagnes
  • Fonction : Auteur
Mickael Ohana
  • Fonction : Auteur
Carole Jalaber
  • Fonction : Auteur
Gael Dournes
  • Fonction : Auteur
Nicolas Cazeneuve
  • Fonction : Auteur
Gilbert Ferretti
  • Fonction : Auteur
Pauline Talabard
  • Fonction : Auteur
Victoria Donciu
  • Fonction : Auteur
Emma Canniff
  • Fonction : Auteur
Marie-Pierre Debray
  • Fonction : Auteur
Bernard Crutzen
  • Fonction : Auteur
Valentin Rabeau
  • Fonction : Auteur
Philippe Khafagy
  • Fonction : Auteur
Richard Chocron
  • Fonction : Auteur
Ian Leonard Lorant
  • Fonction : Auteur
Loic Metairy
  • Fonction : Auteur
Lea Ruez-Lantuejoul
  • Fonction : Auteur
Sébastien Beaune
  • Fonction : Auteur
Jennifer Truchot
  • Fonction : Auteur
Antoine Khalil
  • Fonction : Auteur
Andrea Penaloza
  • Fonction : Auteur
Thibaut Affole
  • Fonction : Auteur
Catherine Roy
  • Fonction : Auteur
Julien Pucheux
  • Fonction : Auteur
Jordan Zbili
  • Fonction : Auteur
Olivier Sanchez
  • Fonction : Auteur
Raphael Porcher
  • Fonction : Auteur

Résumé

Objectives: The objective was to define a safe strategy to exclude pulmonary embolism (PE) in COVID-19 outpatients, without performing CT pulmonary angiogram (CTPA).Methods: COVID-19 outpatients from 15 university hospitals who underwent a CTPA were retrospectively evaluated. D-Dimers, variables of the revised Geneva and Wells scores, as well as laboratory findings and clinical characteristics related to COVID-19 pneumonia, were collected. CTPA reports were reviewed for the presence of PE and the extent of COVID-19 disease. PE rule-out strategies were based solely on D-Dimer tests using different thresholds, the revised Geneva and Wells scores, and a COVID-19 PE prediction model built on our dataset were compared. The area under the receiver operating characteristics curve (AUC), failure rate, and efficiency were calculated.Results: In total, 1369 patients were included of whom 124 were PE positive (9.1%). Failure rate and efficiency of D-Dimer > 500 µg/l were 0.9% (95%CI, 0.2–4.8%) and 10.1% (8.5–11.9%), respectively, increasing to 1.0% (0.2–5.3%) and 16.4% (14.4–18.7%), respectively, for an age-adjusted D-Dimer level. D-dimer > 1000 µg/l led to an unacceptable failure rate to 8.1% (4.4–14.5%). The best performances of the revised Geneva and Wells scores were obtained using the age-adjusted D-Dimer level. They had the same failure rate of 1.0% (0.2–5.3%) for efficiency of 16.8% (14.7–19.1%), and 16.9% (14.8–19.2%) respectively. The developed COVID-19 PE prediction model had an AUC of 0.609 (0.594–0.623) with an efficiency of 20.5% (18.4–22.8%) when its failure was set to 0.8%.Conclusions:The strategy to safely exclude PE in COVID-19 outpatients should not differ from that used in non-COVID-19 patients. The added value of the COVID-19 PE prediction model is minor.
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Dates et versions

hal-04249768 , version 1 (26-02-2023)
hal-04249768 , version 2 (05-02-2024)

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Guillaume Chassagnon, Mostafa El Hajjam, Samia Boussouar, Marie-Pierre Revel, Ralph Khoury, et al.. Strategies to safely rule out pulmonary embolism in COVID-19 outpatients: a multicenter retrospective study. European Radiology, inPress, ⟨10.1007/s00330-023-09475-6⟩. ⟨hal-04249768v1⟩
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