RT Journal Article SR Electronic T1 Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 2001811 DO 10.1183/13993003.01811-2020 VO 56 IS 4 A1 Basile Mouhat A1 Matthieu Besutti A1 Kevin Bouiller A1 Franck Grillet A1 Charles Monnin A1 Fiona Ecarnot A1 Julien Behr A1 Gilles Capellier A1 Thibaud Soumagne A1 Sébastien Pili-Floury A1 Guillaume Besch A1 Guillaume Mourey A1 Quentin Lepiller A1 Catherine Chirouze A1 François Schiele A1 Romain Chopard A1 Nicolas Meneveau YR 2020 UL http://erj.ersjournals.com/content/56/4/2001811.abstract AB Background Coronavirus disease 2019 (COVID-19) may predispose to venous thromboembolism. We determined factors independently associated with computed tomography pulmonary angiography (CTPA)-confirmed pulmonary embolism (PE) in hospitalised severe COVID-19 patients.Methods Among all (n=349) patients hospitalised for COVID-19 in a university hospital in a French region with a high rate of COVID-19, we analysed patients who underwent CTPA for clinical signs of severe disease (oxygen saturation measured by pulse oximetry ≤93% or breathing rate ≥30 breaths·min−1) or rapid clinical worsening. Multivariable analysis was performed using Firth penalised maximum likelihood estimates.Results 162 (46.4%) patients underwent CTPA (mean±sd age 65.6±13.0 years; 67.3% male (95% CI 59.5–75.5%). PE was diagnosed in 44 (27.2%) patients. Most PEs were segmental and the rate of PE-related right ventricular dysfunction was 15.9%. By multivariable analysis, the only two significant predictors of CTPA-confirmed PE were D-dimer level and the lack of any anticoagulant therapy (OR 4.0 (95% CI 2.4–6.7) per additional quartile and OR 4.5 (95% CI 1.1–7.4), respectively). Receiver operating characteristic curve analysis identified a D-dimer cut-off value of 2590 ng·mL−1 to best predict occurrence of PE (area under the curve 0.88, p<0.001, sensitivity 83.3%, specificity 83.8%). D-dimer level >2590 ng·mL−1 was associated with a 17-fold increase in the adjusted risk of PE.Conclusion Elevated D-dimers (>2590 ng·mL−1) and absence of anticoagulant therapy predict PE in hospitalised COVID-19 patients with clinical signs of severity. These data strengthen the evidence base in favour of systematic anticoagulation, and suggest wider use of D-dimer guided CTPA to screen for PE in acutely ill hospitalised patients with COVID-19.We studied predictors of pulmonary embolism in severe COVID-19 and found that D-dimer level and lack of any anticoagulant therapy were associated with a 17-fold and four-fold increase in PE, respectively, in COVID-19 patients with clinical signs of severity https://bit.ly/2ETfAfo