Cureus . Pulmonary Embolism in COVID-19 Patients: A Retrospective Case-Control Study

[tetano]

Cureus


. 2021 Oct 19;13(10):e18887.
doi: 10.7759/cureus.18887. eCollection 2021 Oct.
Pulmonary Embolism in COVID-19 Patients: A Retrospective Case-Control Study


Fatimah A Alaithan ¹ , Mahdi H Aljawad ² , Asia H Ghawas ³ , Abdulrahman S Althobaiti ⁴ , Qusai A Almuslem ⁵ , Mohammed H Bin Nasif ⁶ , Faisal F Algharbi ⁷ , Reem A Alshehri ⁸ , Yousef K Al Gethami ⁹ , Khaled W Altowayan ⁶ , Fahad K Alzahrani ⁶ , Amal A Suwaylih ¹⁰ , Abdullah S Alwadai ¹¹ , Abdulmajeed M Badawi ⁸ , Malak Alshammari ¹²



Affiliations

• PMID: 34820215
• PMCID: PMC8600393
• DOI: 10.7759/cureus.18887

Abstract

Background: Coagulopathy is a well-recognized complication in patients with coronavirus disease 2019 (COVID-19). Pulmonary embolism (PE) has substantial morbidity and mortality if the diagnosis is missed or the management is delayed. Computed tomography pulmonary angiography (CT-PA) is the imaging modality of choice for PE. Therefore, this study aimed to investigate the positive rate of CT-PA for PE among patients with COVID-19.
Methods: We conducted a retrospective study examining the diagnostic yield of CT-PA in patients with confirmed COVID-19 and compared it with that in patients without COVID-19. The study included all adult patients with confirmed COVID-19 who presented from June 2020 to June 2021.
Results: The study included 316 patients, including 158 patients with COVID-19, who underwent CT-PA for ruling out PE. Overall, 76 patients were found to have PE on the CT-PA scan, yielding a positive rate of 24.1%, with a significant difference between patients with COVID-19 (8.2%) and those without COVID-19 (39.9%). Further, 138 (87.3%) patients with COVID-19 had elevated D-dimer levels compared with 34 (21.5%) patients without COVID-19. A multivariable regression analysis model revealed that the smoking status (odds ratio [OR] = 1.94; 95% confidence interval [CI]: 1.4-3.8) and obesity (OR = 4.1; 95% CI: 1.5-8.9) were independent predictors of PE among patients with COVID-19. However, the elevated D-dimer level was not significantly associated with PE among patients with COVID-19 (OR = 0.7; 95% CI: 0.4-1.8).
Conclusion: The study found that the positive rate of CT-PA for PE was lower among patients with PE indicating probable overutilization of investigation in these patients. Additionally, patients with COVID-19 had a higher proportion of elevated D-dimer levels that may be a contributor to the increased investigation for PE. Lastly, patients with COVID-19 who were current smokers had a higher tendency of having PE.

Keywords: computed tomography; covid-19; hyper coagulopathy; pulmonary angiography; pulmonary embolism.