tetano
Editor, Senior Moderator
Thromb J
. 2023 Jul 3;21(1):73.
doi: 10.1186/s12959-023-00518-y. Predictors of pulmonary embolism in hospitalized patients with COVID-19
Jeeyune Bahk[SUP] 1 [/SUP], Abdul Rehman[SUP] 2 [/SUP], Kam Sing Ho[SUP] 1 [/SUP], Bharat Narasimhan[SUP] 1 [/SUP], Hafiza Noor Ul[SUP] 1 [/SUP], Ain Baloch[SUP] 3 [/SUP], Jiafang Zhang[SUP] 4 [/SUP], Rowena Yip[SUP] 4 [/SUP], Robert Lookstein[SUP] 5 [/SUP], David J Steiger[SUP] 6 [/SUP]
Affiliations
Background: High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE).
Methods: We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE.
Results: 92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03-1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01-1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04-1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24-154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01).
Conclusions: In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19.
Keywords: Coagulopathy; Coronavirus disease 2019; D-dimer; Pulmonary embolism; Venous Thromboembolism.
. 2023 Jul 3;21(1):73.
doi: 10.1186/s12959-023-00518-y. Predictors of pulmonary embolism in hospitalized patients with COVID-19
Jeeyune Bahk[SUP] 1 [/SUP], Abdul Rehman[SUP] 2 [/SUP], Kam Sing Ho[SUP] 1 [/SUP], Bharat Narasimhan[SUP] 1 [/SUP], Hafiza Noor Ul[SUP] 1 [/SUP], Ain Baloch[SUP] 3 [/SUP], Jiafang Zhang[SUP] 4 [/SUP], Rowena Yip[SUP] 4 [/SUP], Robert Lookstein[SUP] 5 [/SUP], David J Steiger[SUP] 6 [/SUP]
Affiliations
- PMID: 37400813
- DOI: 10.1186/s12959-023-00518-y
Background: High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE).
Methods: We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE.
Results: 92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03-1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01-1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04-1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24-154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01).
Conclusions: In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19.
Keywords: Coagulopathy; Coronavirus disease 2019; D-dimer; Pulmonary embolism; Venous Thromboembolism.