Résumé
The COVID-19 infection seems to be associed with thrombo-embolic higher risk event. Inflammatory coagulopathy related to sepsis disrupts the non-invasive diagnosis of pulmonary embolism (EP) resulting in an increase in the realization of thoracic angioscan. Many attempts to adapt the D-dimer threshold have taken place without new thresholds being clearly identified. No studies have attempted to adjust the D-dimer threshold according to the inflammatory level of the patients. Objective: to adapt the D-dimer threshold for the non-invasive diagnosis of pulmonary embolism for COVID-19 patients consulting in the emergency department according to the inflammatory level assessed by CRP level and the quick SOFA.Methodology: realization of an ancillary study from the prospective and multicenter (30 centers) Cohort Revised Home COV composed of 1445 COVID-19 patients or strongly suspected of being, consulting in the emergency department, and not under a resuscitation care from the outset. Recruitment from December 2020 to March 2021. Results: 394 patients have been included of which 24 pulmonary embolisms. Three new D-dimer thresholds were identified based on CRP levels. For CRP levels <45 mg/L the D-dimer threshold with the best Youden index is 1033 ng/mL for a sensitivity of 77.78% (39.99%; 97.19%) and a specificity of 68.48% (61.77%; 75.19%), between 45 and 105 mg/L the threshold is 1221 ng/mL for a sensitivity of 75.00% (34 .91%; 69.81%) and a specificity of 71.00% (62.11%; 79.89%) and for CRP >105 mg/L the threshold is 3710 ng/mL for a sensitivity of 42.86% (9.90%; 81.59%) and a specificity of 90.70% (84.56%; 96.84%). The analysis for the quick SOFA could not be carried out in its entirety. The analysis for the quick SOFA could not be carried out in its entirety due, among other things, to a lack of power.Discussion: this study does not identify a new threshold of D-dimer adapted to inflammation with correct statistical performance due to a lack of power.