1
|
Siniscalchi C, Ticinesi A, Nouvenne A, Guerra A, Parise A, Finardi L, Cerundolo N, Prati B, Guida L, Meschi T. Non-Invasive Ventilation Support during Hospitalization for SARS-CoV-2 and the Risk of Venous Thromboembolism. J Clin Med 2024; 13:2737. [PMID: 38792278 PMCID: PMC11122199 DOI: 10.3390/jcm13102737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/19/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Although SARS-CoV-2 infection is a significant risk factor for venous thromboembolism (VTE), data on the impact of the use of non-invasive ventilation support (NIVS) to mitigate the risk of VTE during hospitalization are scarce. Methods: Data for 1471 SARS-CoV-2 patients, hospitalized in a single hub during the first pandemic wave, were collected from clinical records, including symptom duration and type, information on lung abnormalities on chest computed tomography (CT), laboratory parameters and the use of NIVS. Determining VTE occurrence during hospital stays was the main endpoint. Results: Patients with VTE (1.8%) had an increased prevalence of obesity (26% vs. 11%), diabetes (41% vs. 21%), higher CHA2DS2VASC score (4, IQR 2-5 vs. 3, IQR 1-4, age- and sex-adjusted, p = 0.021) and cough (65% vs. 44%) and experienced significantly higher rates of NIVS (44% vs. 8%). Using a stepwise multivariate logistic regression model, the prevalence of electrocardiogram abnormalities (odds ratio (OR) 2.722, 95% confidence interval (CI) 1.039-7.133, p = 0.042), cough (OR 3.019, 95% CI 1.265-7.202, p = 0.013), CHA2DS2-VASC score > 3 (OR 3.404, 95% CI 1.362-8.513, p = 0.009) and the use of NIVS (OR 15.530, 95% CI 6.244-38.627, p < 0.001) were independently associated with a risk of VTE during hospitalization. NIVS remained an independent risk factor for VTE even after adjustment for the period of admission within the pandemic wave. Conclusions: Our study suggests that NIVS is a risk factor for VTE during hospitalization in SARS-CoV-2 patients. Future studies should assess the optimal prophylactic strategy against VTE in patients with a SARS-CoV-2 infection candidate to non-invasive ventilatory support.
Collapse
Affiliation(s)
- Carmine Siniscalchi
- General and Specialistic Medicine Department, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Alberto Parise
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Lorenzo Finardi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Nicoletta Cerundolo
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Beatrice Prati
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Loredana Guida
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.T.); (A.N.); (A.G.); (A.P.); (L.F.); (N.C.); (B.P.); (L.G.); (T.M.)
| |
Collapse
|
2
|
Engels SYH, van Veen IHPAA, Oudkerk M, van der Palen J, Heuvelmans MA. An optimized D-dimer cut-off value to predict pulmonary thromboembolism in COVID-19 patients. J Thorac Dis 2023; 15:6317-6322. [PMID: 38090285 PMCID: PMC10713327 DOI: 10.21037/jtd-23-870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/14/2023] [Indexed: 05/14/2024]
Abstract
Pulmonary thromboembolism (PTE) is a common complication in coronavirus disease 2019 (COVID-19) patients. Elevated D-dimer levels are observed even in the absence of PTE, reducing its discriminative ability as a screening test. It is unknown whether conventional D-dimer cut-off values, as used in the YEARS algorithm, apply to COVID-19 patients. This study aimed to determine the optimal D-dimer cut-off value to predict PTE in COVID-19 patients. All confirmed COVID-19 patients with a computed tomography pulmonary angiography (CTPA) performed ≤5 days after admission due to suspicion of PTE between March 2020 and February 2021, at Medisch Spectrum Twente, The Netherlands, were retrospectively analyzed. The association between PTE and D-dimer levels prior to CTPA, and other potential predictors, was analyzed using logistic regression analyses. The optimal cut-off value was identified using receiver operating characteristic (ROC) curve analyses. In 142 patients, PTE prevalence was 20.4%. The optimal cut-off value was 750 ng/mL (sensitivity 100%; specificity 19.5%; negative predictive value 100%; positive predictive value 24.2%). In total, 15 of 113 (13%) patients without PTE had a D-dimer level ≥500 and <750 ng/mL. In our population of patients hospitalized with COVID-19, a D-dimer level <750 ng/mL safely excluded PTE. Compared to the YEARS 500 ng/mL cut-off value, 13% fewer patients are in need of a CTPA, with similar sensitivity. Future research is required for external validation.
Collapse
Affiliation(s)
- Sophie Y. H. Engels
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Matthijs Oudkerk
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
- Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Marjolein A. Heuvelmans
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
- Institute for Diagnostic Accuracy, Groningen, The Netherlands
- University of Groningen, University Medical Centre Groningen, Department of Epidemiology, Groningen, The Netherlands
| |
Collapse
|
3
|
Çınar C, Balaban Genç ZC, Kesim S, Çağlıyan Şen F, Karakurt S, Erdil TY, Öneş T, Eryuksel E. Effect of Anticoagulants in Pulmonary Thromboembolism in Post-COVID-19 Patients. Cureus 2023; 15:e39382. [PMID: 37362508 PMCID: PMC10286523 DOI: 10.7759/cureus.39382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background and objective COVID-19 may predispose to both venous and arterial thromboembolism (VTE and ATE) due to excessive inflammation, immobilization, and hypoxia. The purpose of this study is to evaluate clinical and laboratory risk factors, as well as related medications such as anticoagulants, to predict the risk of thromboembolic disease and/or death in COVID-19 patients. Methods Over a period of 14 months (from August 2020 to September 2021), a total of 145 consecutive patients with signs and symptoms suspicious of pulmonary embolism (PE) were referred for perfusion single-photon emission computed tomography/computed tomography (Q SPECT/CT). All patients had a history of SARS‑CoV‑2 infection, diagnosed with a positive real-time polymerase chain reaction (RT-PCR) test. Results Among the 145 patients included in the study, the risk of PE was found to be greater in elderly patients (odds ratio [OR] [95% CI]: 1.05 [1.02‑1.07]; p<0.001) and in patients with higher maximum d-dimer levels (OR [95% CI]: 1.14 [1.01‑1.3]; p=0.04). We also analyzed the utility of the maximum d-dimer level for predicting acute PE with receiver operating characteristic (ROC) curve analysis. For d‑dimer = 0.5 mg/dL, cut-off sensitivity is 91%, specificity is 23%, and for d-dimer = 1 mg/dL, cut-off sensitivity is 79%, specificity is 43% Conclusion D-dimer titers were higher in the PE group in our study. Another significant finding was that, possibly due to thromboinflammation, anticoagulants did not prevent the development of PE in COVID-19 patients.
Collapse
Affiliation(s)
- Caner Çınar
- Department of Pulmonology, Marmara University, Istanbul, TUR
| | | | - Selin Kesim
- Department of Nuclear Medicine, Marmara University, Istanbul, TUR
| | | | - Sait Karakurt
- Department of Pulmonology, Marmara University, Istanbul, TUR
| | | | - Tunç Öneş
- Department of Nuclear Medicine, Marmara University, Istanbul, TUR
| | - Emel Eryuksel
- Department of Pulmonology, Marmara University, Istanbul, TUR
| |
Collapse
|
4
|
Castro García JM, Arenas-Jiménez JJ, Ureña-Vacas A, García-Garrigós E, Sirera-Sirera P. Pulmonary CT angiography in the first wave of the COVID-19 pandemic: Comparison between patients with and without infection and with a pre-pandemic series. RADIOLOGIA 2023; 65:222-229. [PMID: 37268364 DOI: 10.1016/j.rxeng.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/28/2022] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIMS To analyze the diagnostic performance of pulmonary CT angiography and to compare different D-dimer cutoffs for the diagnosis of acute pulmonary embolism in patients with and without SARS-CoV-2 infections. MATERIALS AND METHODS We retrospectively analysed all consecutive pulmonary CT angiography studies done for suspected pulmonary embolism in a tertiary hospital during two time periods: the first December 2020 through February 2021 and the second December 2017 through February 2018. D-dimer levels were obtained less than 24 h before the pulmonary CT angiography studies. We analysed the sensitivity, specificity, positive and negative predictive values, area under the receiver operating curve (AUC), and pattern of pulmonary embolism for six different values of D-dimer and the extent of the embolism. During the pandemic period, we also analysed whether the patients had COVID-19. RESULTS After excluding 29 poor-quality studies, 492 studies were analysed; 352 of these were done during the pandemic, 180 in patients with COVID-19 and 172 in patients without COVID-19. The absolute frequency of pulmonary embolism diagnosed was higher during the pandemic period (34 cases during the prior period and 85 during the pandemic; 47 of these patients had COVID-19). No significant differences were found in comparing the AUCs for the D-dimer values. The optimum values calculated for the receiver operating characteristic curves differed between patients with COVID-19 (2200 mcg/l), without COVID-19 (4800 mcg/l), and diagnosed in the prepandemic period (3200 mcg/l). Peripheral distribution of the emboli was more common in patients with COVID-19 (72%) than in those without COVID-19 and than in those diagnosed before the pandemic [OR 6.6, 95% CI: 1.5-24.6, p < 0.05 when compared to central distribution]. CONCLUSIONS The number of CT angiography studies and the number of pulmonary embolisms diagnosed during the pandemic increased due to SARS-CoV-2 infection. The optimal d-dimer cutoffs and the distribution of the pulmonary embolisms differed between the groups of patients with and without COVID-19.
Collapse
Affiliation(s)
- J M Castro García
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Elche, Spain
| | - A Ureña-Vacas
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain
| | - E García-Garrigós
- Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - P Sirera-Sirera
- Servicio de Análisis Clínicos, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain
| |
Collapse
|
5
|
Kalyanasundaram S, Sudarsanam H, Dhas D, Shankar A, Varadan B, Ethiraj D, Rajakumar A, A.C S, Devarajan V, Hakeem AR. Role of Combined CT Pulmonary Angiography and Indirect CT Venography in Diagnosing Venous Thromboembolism in COVID-19 Patients - Experience From an Indian Quaternary Centre. Vasc Endovascular Surg 2023; 57:129-136. [PMID: 36179371 PMCID: PMC9527151 DOI: 10.1177/15385744221131424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To study the role of combined CTPA and indirect CT venogram to diagnose venous thromboembolism (VTE) in patients with COVID-19 pneumonia and to compare the clinical characteristics, laboratory parameters, CT findings and clinical outcomes between the VTE positive and negative groups. METHODS In this retrospective study, 131 patients with COVID-19 pneumonia who underwent CTPA and venogram between August 2020 and January 2021 were included. Relevant demographical, clinical and laboratory data and CT images were collected. Two thoracic radiologists independently reviewed the CTPA and venogram images. RESULTS VTE was identified in 29 patients (22% of the study population). CT venogram identified DVT in 9 patients. No statistical difference was observed between the two groups with respect to age, gender, BMI and presence of comorbidities. There was a significant difference in the hospital stay duration, which is increased in the VTE positive group. The number of patients who were dependent on oxygen and mortality were also high in the positive group. There was statistically significant difference in the mean D-dimer value and the mean Neutrophil/lymphocyte ratio, which were higher in the VTE positive group. CONCLUSION Combined CTPA and venogram can be used as a one-stop investigation for diagnosing PE and DVT of lower limbs in patients with COVID-19 pneumonia. CTPA with venogram should be performed in patients with D-dimer value in the range of 1000 - 1200 μg/L and above to rule out VTE as the hospital stay duration and final outcomes vary between the positive and negative groups.
Collapse
Affiliation(s)
- Srinivasan Kalyanasundaram
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India,Srinivasan Kalyanasundaram, Department of
Radiology, Dr. Rela Institute and Medical Centre, 7, CLC Works street, 600045,
Chromepet, Chennai, India.
| | - Hemanth Sudarsanam
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Daspin Dhas
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Abhinaya Shankar
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Baskaran Varadan
- Department of Radiology, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Dillibabu Ethiraj
- Department of Radio-diagnosis, Vardhman Mahavir Medical College
and Safdarjung Hospital, New Delhi, India
| | - Akila Rajakumar
- Department of Liver Intensive Care
and Anaesthesia, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Sathya A.C
- Department of Anaesthesia and ICU, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Vidya Devarajan
- Department of Infectious Diseases, Dr. Rela Institute and Medical
Centre, Chennai, India
| | - Abdul Rahman Hakeem
- Department of HB & Liver
Transplant Surgery, St James’s University
Hospital, Leeds, UK
| |
Collapse
|
6
|
Bagırtan B, Altuntas E, Yasar S, Karabay KO. Changing face of pulmonary embolism with COVID-19. Cardiovasc J Afr 2023; 34:4-8. [PMID: 35244670 PMCID: PMC10392801 DOI: 10.5830/cvja-2022-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/09/2022] [Indexed: 06/07/2023] Open
Abstract
AIM This study aimed to describe the baseline characteristics of coronavirus disease 2019 (COVID-19) patients with pulmonary embolism, and to examine the Geneva score, pulmonary embolism severity index (PESI), radiological and biochemical findings. METHODS From March 2020 to June 2021, the files of 41 COVID-19 patients with pulmonary embolism were accessed. RESULTS Mean D-dimer value was 6.04 mg/dl and 61% of the patients received at least one dose of anticoagulant treatment. In patients receiving deep venous thrombosis prophlaxis, an optimal D-dimer cut-off point was calculated as 5.69 mg/dl. The area under the curve was 0.753 (p = 0.007; sensivity 64%; specificity 62.5%). The mean Geneva score was 4.31, mean PESI was 72.48 and mean Qanadli score was 11.29. CONCLUSIONS According to this study, traditional clinical predictive scores had little discriminatory power in these patients, and a higher D-dimer cut-off value should be considered to better diagnose patients for pulmonary embolism.
Collapse
Affiliation(s)
- Bayram Bagırtan
- Cardiology Department , Sancaktepe Sehit Prof Dr Ilhan Varank Education and Training Hospital, Istanbul, Turkey
| | - Emine Altuntas
- Cardiology Department , Sancaktepe Sehit Prof Dr Ilhan Varank Education and Training Hospital, Istanbul, Turkey.
| | - Servan Yasar
- Radiology Department, Sancaktepe Sehit Prof Dr Ilhan Varank Education and Training Hospital, Istanbul, Turkey
| | - Kanber Ocal Karabay
- Cardiology Department , Sancaktepe Sehit Prof Dr Ilhan Varank Education and Training Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Luu IHY, Frijns T, Buijs J, Krdzalic J, de Kruif MD, Mostard GJM, Ten Cate H, Martens RJH, Mostard RLM, Leers MPG, van Twist DJL. Systematic screening versus clinical gestalt in the diagnosis of pulmonary embolism in COVID-19 patients in the emergency department. PLoS One 2023; 18:e0283459. [PMID: 36952456 PMCID: PMC10035852 DOI: 10.1371/journal.pone.0283459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/03/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Diagnosing concomitant pulmonary embolism (PE) in COVID-19 patients remains challenging. As such, PE may be overlooked. We compared the diagnostic yield of systematic PE-screening based on the YEARS-algorithm to PE-screening based on clinical gestalt in emergency department (ED) patients with COVID-19. METHODS We included all ED patients who were admitted because of COVID-19 between March 2020 and February 2021. Patients already receiving anticoagulant treatment were excluded. Up to April 7, 2020, the decision to perform CT-pulmonary angiography (CTPA) was based on physician's clinical gestalt (clinical gestalt cohort). From April 7 onwards, systematic PE-screening was performed by CTPA if D-dimer level was ≥1000 ug/L, or ≥500 ug/L in case of ≥1 YEARS-item (systematic screening cohort). RESULTS 1095 ED patients with COVID-19 were admitted. After applying exclusion criteria, 289 were included in the clinical gestalt and 574 in the systematic screening cohort. The number of PE diagnoses was significantly higher in the systematic screening cohort compared to the clinical gestalt cohort: 8.2% vs. 1.0% (3/289 vs. 47/574; p<0.001), even after adjustment for differences in patient characteristics (adjusted OR 8.45 (95%CI 2.61-27.42, p<0.001) for PE diagnosis). In multivariate analysis, D-dimer (OR 1.09 per 1000 μg/L increase, 95%CI 1.06-1.13, p<0.001) and CRP >100 mg/L (OR 2.78, 95%CI 1.37-5.66, p = 0.005) were independently associated with PE. CONCLUSION In ED patients with COVID-19, the number of PE diagnosis was significantly higher in the cohort that underwent systematic PE screening based on the YEARS-algorithm in comparison with the clinical gestalt cohort, with a number needed to test of 7.1 CTPAs to detect one PE.
Collapse
Affiliation(s)
- Inge H Y Luu
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Tim Frijns
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Jacqueline Buijs
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Jasenko Krdzalic
- Department of Radiology, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Martijn D de Kruif
- Department of Pulmonology, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Guy J M Mostard
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Hugo Ten Cate
- Department of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Remy J H Martens
- Department of Clinical Chemistry and Haematology, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Remy L M Mostard
- Department of Pulmonology, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Math P G Leers
- Department of Clinical Chemistry and Haematology, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| | - Daan J L van Twist
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard/Heerlen, The Netherlands
| |
Collapse
|
8
|
Laino ME, Ammirabile A, Motta F, De Santis M, Savevski V, Francone M, Chiti A, Mannelli L, Selmi C, Monti L. Advanced Imaging Supports the Mechanistic Role of Autoimmunity and Plaque Rupture in COVID-19 Heart Involvement. Clin Rev Allergy Immunol 2023; 64:75-89. [PMID: 35089505 PMCID: PMC8796606 DOI: 10.1007/s12016-022-08925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 01/26/2023]
Abstract
The cardiovascular system is frequently affected by coronavirus disease-19 (COVID-19), particularly in hospitalized cases, and these manifestations are associated with a worse prognosis. Most commonly, heart involvement is represented by myocarditis, myocardial infarction, and pulmonary embolism, while arrhythmias, heart valve damage, and pericarditis are less frequent. While the clinical suspicion is necessary for a prompt disease recognition, imaging allows the early detection of cardiovascular complications in patients with COVID-19. The combination of cardiothoracic approaches has been proposed for advanced imaging techniques, i.e., CT scan and MRI, for a simultaneous evaluation of cardiovascular structures, pulmonary arteries, and lung parenchyma. Several mechanisms have been proposed to explain the cardiovascular injury, and among these, it is established that the host immune system is responsible for the aberrant response characterizing severe COVID-19 and inducing organ-specific injury. We illustrate novel evidence to support the hypothesis that molecular mimicry may be the immunological mechanism for myocarditis in COVID-19. The present article provides a comprehensive review of the available evidence of the immune mechanisms of the COVID-19 cardiovascular injury and the imaging tools to be used in the diagnostic workup. As some of these techniques cannot be implemented for general screening of all cases, we critically discuss the need to maximize the sustainability and the specificity of the proposed tests while illustrating the findings of some paradigmatic cases.
Collapse
Affiliation(s)
- Maria Elena Laino
- grid.417728.f0000 0004 1756 8807Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Angela Ammirabile
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Motta
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Maria De Santis
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Victor Savevski
- grid.417728.f0000 0004 1756 8807Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Francone
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Arturo Chiti
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Carlo Selmi
- grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ,grid.417728.f0000 0004 1756 8807Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Lorenzo Monti
- grid.417728.f0000 0004 1756 8807Department of Radiology and Nuclear Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| |
Collapse
|
9
|
COVID-19 and Pulmonary Thrombosis-An Unresolved Clinical Puzzle: A Single-Center Cohort Study. J Clin Med 2022; 11:jcm11237049. [PMID: 36498623 PMCID: PMC9740696 DOI: 10.3390/jcm11237049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/11/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
Pulmonary thrombosis (PT) is a frequent complication of COVID-19. However, the risk factors, predictive scores, and precise diagnostic guidelines on indications for CT pulmonary angiography (CTPA) are still lacking. This study aimed to analyze the clinical and laboratory characteristics associated with PT in patients with COVID-19. We conducted a cohort study of consecutively hospitalized adult patients with COVID-19 who underwent CTPA at the University Hospital for Infectious Diseases in Zagreb, Croatia between 1 April and 31 December 2021. Of 2078 hospitalized patients, 575 (27.6%) underwent CTPA. PT was diagnosed in 178 (30.9%) patients (69.6% males, median age of 61, IQR 50-69 years). The PT group had a higher CRP, LDH, D-dimer, platelets, and CHOD score. PT was more frequent in patients requiring ≥15 L O2/min (25.0% vs. 39.7%). In multivariable analysis, only D-dimer ≥ 1.0 mg/L (OR 1.78, 95%CI 1.12-2.75) and O2 ≥ 15 L (OR 1.89, 95%CI 1.26-2.84) were associated with PT. PT was not associated with in-hospital mortality. In conclusion, our data confirmed a high incidence of PT in hospitalized patients with COVID-19, however, no correlation with traditional risk factors and mortality was found. CTPA should be performed in patients requiring high-flow supplemental oxygen or those with increased D-dimer levels.
Collapse
|
10
|
Fu Z, Bai G, Song B, Wang Y, Song H, Ma M, Zhu J, Zhang Z, Kang Q. Risk factors and mortality of pulmonary embolism in COVID-19 patients: Evidence based on fifty observational studies. Medicine (Baltimore) 2022; 101:e29895. [PMID: 36397410 PMCID: PMC9665895 DOI: 10.1097/md.0000000000029895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND At present, many studies have described acute pulmonary embolism (PE) as a frequent and prognostically relevant complication of coronavirus disease 2019 (COVID-19) infection. Thus we performed the present analysis of 50 studies to evaluate the risk factors and mortality of PE in COVID-19 patients. METHOD Databases including PubMed, Embase, Cochrane Library and Web of Science were searched to October, 2021. Odds ratio (OR), mean difference (MD) or standard MD was used to evaluate the outcomes. The primary outcomes were the difference of mortality between PE and non-PE COVID-19 patients as well as relevant risk factors of PE in COVID-19 patients. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. RESULT A total of 50 studies including 10053 patients were included in this meta-analysis. Our results indicated that COVID-19 patients with PE experienced significantly higher mortality than non-PE patients (21.9% vs. 10.7%), with a pooled OR of 2.21 (95% CI 1.30 - 3.76; P = .003). In addition, COVID-19 patients with PE also experienced more mechanical ventilation (MV) (OR 2.21; 95% CI 1.30 - 3.75; P = .003) and invasive mechanical ventilation (IMV) (OR 3.58; 95% CI 2.47 - 5.20; P < .0001) respectively. Univariate analysis (UVA) results indicated the Sequential Organ Failure Assessment (SOFA) score, time to deep venous thrombosis (DVT), nonintensive care unit (non-ICU) patients and no anticoagulation as risk factors of PE for COVID-19 patients. In addition, multivariate analysis also found that SOFA score, D-dimer, BMI > 30 kg/m2 and history of PE were risk factors of PE for COVID-19 patients. CONCLUSION The present analysis indicated that PE increased the mortality of COVID-19 patients. Mechanical ventilation, especially invasive mechanical ventilation, is correlated with an increased incidence of PE in patients with COVID-19. The incidence of PE for COVID-19 patients may be multifactorial and further researches focused on risk factors were needed in the future.
Collapse
Affiliation(s)
- Zhaoliang Fu
- Department of lnterventional, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Gengshen Bai
- Department of General Surgery, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Bingsheng Song
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Yongbing Wang
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Hui Song
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Ming Ma
- Department of lnterventional, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Junqiang Zhu
- Department of Radiology, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Zejun Zhang
- Department of Radiology, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Qinghong Kang
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
- *Correspondence: Qinghong Kang, Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, No. 509, Park Road, Baiyin District, Baiyin City 730900, China (e-mail: )
| |
Collapse
|
11
|
Vivan MA, Rigatti B, da Cunha SV, Frison GC, Antoniazzi LQ, de Oliveira PHK, Oliveira JPS, Fontanari C, Seligman BGS, Seligman R. Pulmonary embolism in patients with COVID-19 and D-dimer diagnostic value: A retrospective study. Braz J Infect Dis 2022; 26:102702. [PMID: 36096159 PMCID: PMC9436892 DOI: 10.1016/j.bjid.2022.102702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/25/2022] [Accepted: 08/14/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND D-dimer levels are significantly higher in COVID-19 patients with Pulmonary Thromboembolism (PTE) as compared to those without PTE, but its clinical utility is still uncertain. PURPOSE To determine the D-dimer performance for ruling out PTE in patients with COVID-19. We also assessed clinical and laboratory factors associated with the presence of PTE on CT Pulmonary Angiogram (CTPA). METHODS Retrospective study involving all patients who presented at a tertiary care hospital from March 2020 to May 2021 with severe acute respiratory syndrome from COVID-19, who underwent CTPA and had D-dimer collected within 48 hours from CTPA. The D-dimer ability to classify patients with or without PTE according to CTPA was evaluated. RESULTS A total of 697 patients [382 (54.8%) men; mean (SD) age, 59 (20.5) years] were included, of which 71.5% required intensive care admission, 32.4% had PTE, and 35.6% died during hospitalization. PTE was independently associated with mortality [42.5% vs. 32.3%; p = 0.038]. D-dimer levels were higher in patients with PTE [9.1 (3.9; 20) vs. 2.3 (1.2; 5.1); p < 0.001]. Using the D-dimer cutoff of 0.5 μg/mL or above, sensitivity was 98.2% and specificity 5.7%. The 0.3 μg/mL threshold was associated with 100% of sensitivity for the presence of PTE, with which 99.1% of patients had increased values. ROC curve AUC was 0.77, demonstrating moderate discriminative power of D-dimers to detect PTE. CONCLUSIONS D-dimer levels are higher among COVID-19 hospitalized patients with PTE as compared to those without PTE and have moderate discriminative power to detect PTE, but its use to exclude PTE in this population may have limited clinical utility.
Collapse
Affiliation(s)
- Manoela Astolfi Vivan
- Universidade Federal de Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Cardiologia, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Divisão de Medicina Interna, Porto Alegre, RS, Brazil.
| | - Brenda Rigatti
- Hospital de Clínicas de Porto Alegre (HCPA), Divisão de Medicina Interna, Porto Alegre, RS, Brazil
| | | | | | | | | | | | - Clara Fontanari
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Beatriz Graeff Santos Seligman
- Hospital de Clínicas de Porto Alegre (HCPA), Divisão de Medicina Interna, Porto Alegre, RS, Brazil; Universidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Renato Seligman
- Hospital de Clínicas de Porto Alegre (HCPA), Divisão de Medicina Interna, Porto Alegre, RS, Brazil; Universidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| |
Collapse
|
12
|
Managing two waves of the COVID-19 pandemic in northern emergency departments in Paris: COVIDORG II. JOURNAL EUROPÉEN DES URGENCES ET DE RÉANIMATION 2022. [PMCID: PMC9433346 DOI: 10.1016/j.jeurea.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Context Objective Methods Results Conclusion
Collapse
|
13
|
Woller SC, de Wit K, Robert-Ebadi H, Masias C, Klok FA, den Exter PL, Morange PE, Castelli D, Hansen JB. A systematic review of biomarkers among hospitalized patients with COVID-19 predictive of venous thromboembolism: A communication from the Predictive and Diagnostic Variables Scientific and Standardization Committee of the ISTH. Res Pract Thromb Haemost 2022; 6:e12786. [PMID: 36032214 PMCID: PMC9412137 DOI: 10.1002/rth2.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Thrombosis is reported to occur more often among patients with COVID‐19 than otherwise expected in the setting of viral pneumonia and sepsis. Systemic inflammatory biomarkers may be associated with venous thromboembolism (VTE) risk. The ISTH subcommittee on Predictive and Diagnostic Variables in Thrombotic Disease aimed to report the evidence on prognostic biomarkers for VTE in hospitalized patients with COVID‐19. Methods Using a standardized Preferred Reporting Items for Systematic Reviews and Meta‐analysis methodology, we conducted a systematic literature review to identify studies reporting prognostic biomarkers for VTE among hospitalized patients with COVID‐19. Eligible studies included adults hospitalized with COVID‐19 and reported the prognostic associations between any biomarker measured on admission, and the subsequent diagnosis of deep vein thrombosis or pulmonary embolism. Two authors reviewed titles and abstracts, and three authors extracted study data and performed review of bias. Results were displayed descriptively. Meta‐analysis was not possible. Results From the initial 196 identified studies, full‐text review was performed for 72 studies. Admission D‐dimer levels were associated with VTE during hospitalization in five studies, and elevated platelet count was associated with VTE during hospitalization in one study. The risk of bias ranged from low to high for included studies. Overall, there was a paucity of high‐quality prognostic studies. Studies on other biomarkers did not meet the systematic review inclusion criteria. Conclusions Admission D‐dimer was associated with VTE diagnosis during hospitalization for COVID‐19; however, prospective validation of this finding is needed to identify optimal D‐dimer thresholds to guide VTE prophylaxis measures.
Collapse
Affiliation(s)
- Scott C Woller
- Department of Medicine Intermountain Medical Center, Intermountain Healthcare Murray Utah USA.,Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA
| | - Kerstin de Wit
- Departments of Emergency Medicine and Medicine Queen's University Kingston Ontario Canada.,Departments of Medicine and HEI McMaster University Hamilton Ontario Canada
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Camila Masias
- Florida International University - Herbert Wertheim College of Medicine Miami Florida USA
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands
| | - Paul L den Exter
- Department of Medicine - Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands
| | - Pierre-Emmanuel Morange
- Aix Marseille Univ Marseille France.,Hematology Department La Timone University Hospital of Marseille Marseille France
| | - David Castelli
- Library Sciences Intermountain Healthcare Murray Utah USA
| | | |
Collapse
|
14
|
Johnson SE, Pai E, Voroba A, Chen NW, Bahl A. Examining D-dimer and Empiric Anti-coagulation in COVID-19-Related Thrombosis. Cureus 2022; 14:e26883. [PMID: 35978762 PMCID: PMC9375952 DOI: 10.7759/cureus.26883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Thrombosis is thought to occur frequently in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to elucidate the relationship between macro/microvascular thrombosis, D-dimer levels, and empiric anticoagulation in coronavirus disease 2019 (COVID-19). Methods This was an exploratory prospective, single-site, observational study. Adult emergency department patients with COVID-19 requiring hospitalization received a point-of-care lower extremity venous duplex ultrasound. The primary endpoint was thromboembolism and associated D-dimer level. Secondary endpoints included rates of micro and macro thrombotic complications as well as empiric anticoagulant use. Results Between January 13th and April 12th 2021, 52 patients were enrolled. Median D-dimer at presentation was 650 ng/mL (range 250-10,000 ng/mL) among patients with negative duplex studies. During hospitalization, 18 patients underwent 20 additional studies assessing for venous thromboembolism (VTE). These studies yielded one deep vein thrombosis (DVT) diagnosis. Among patients with negative studies median D-dimer was 1,246 ng/mL (range 329-10,000 ng/mL). Two patients experienced microvascular complications. Seven patients were started on empiric full dose anticoagulation. Conclusion While VTE remains a major concern amongst patients with COVID-19, the normal D-dimer cut off of >500 ng/mL likely should not be used to initiate further VTE workup. Additionally, moderately elevated D-dimer did not correlate strongly with microvascular complications and may not be relevant in the decision to initiate empiric anticoagulation.
Collapse
|
15
|
Cantarinha A, Bassil C, Savignac A, Devilder M, Maxwell F, Crézé M, Purcell YM, Bellin MF, Meyrignac O, Dillenseger JP. "Triple low" free-breathing CTPA protocol for patients with dyspnoea. Clin Radiol 2022; 77:e628-e635. [PMID: 35688771 DOI: 10.1016/j.crad.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
AIM To assess the performance of a "triple-low" free-breathing protocol for computed tomography pulmonary angiography (CTPA) evaluated on patients with dyspnoea and suspected pulmonary embolism and discuss its application in routine clinical practice for the study of the pulmonary parenchyma and vasculature. MATERIAL AND METHODS This study was conducted on a selected group of dyspnoeic patients referred for CTPA. The protocol was designed using fast free-breathing acquisition and a small, fixed volume (35 ml) of contrast agent in order to achieve a low-exposure dose. For each examination, radiodensity of the pulmonary trunk and ascending aorta, and the dose-length product (DLP) were recorded. A qualitative analysis was performed of pulmonary arterial enhancement and the pulmonary parenchyma. RESULTS This study included 134 patients. Contrast enhancement of the pulmonary arteries (409 ± 159 HU) was systematically >250 HU. The duration of acquisition ranged from 0.9 to 1.3 seconds for free-breathing imaging. The mean DLP was in the range of low-dose chest CT acquisitions (145 ± 73 mGy·cm). The analysis was deemed optimal in 90% (120/134) of cases for the pulmonary parenchyma. Sixty-nine per cent (92/134) of cases demonstrated homogeneous enhancement of the pulmonary arteries to the subsegmental level. Only 6% (8/134) of examinations were considered uninterpretable. CONCLUSION The present "triple-low" CTPA protocol allows convenient analysis of the pulmonary parenchyma and arteries without hindrance by respiratory motion artefacts in dyspnoeic patients.
Collapse
Affiliation(s)
- A Cantarinha
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - C Bassil
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - A Savignac
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - M Devilder
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - F Maxwell
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - M Crézé
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France; BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - Y M Purcell
- Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - M-F Bellin
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France; BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - O Meyrignac
- Service de Radiologie Générale Adulte, Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Département Médico Universitaire Smart Imaging, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France; BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
| | - J-P Dillenseger
- Faculté de Médecine, Maïeutique, et Sciences de la Santé, Université de Strasbourg, Strasbourg, France; ICube-UMR 7357, CNRS, Université de Strasbourg, Strasbourg, France.
| |
Collapse
|
16
|
Diagnostic Management of Acute Pulmonary Embolism in COVID-19 and Other Special Patient Populations. Diagnostics (Basel) 2022; 12:diagnostics12061350. [PMID: 35741160 PMCID: PMC9221574 DOI: 10.3390/diagnostics12061350] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 12/28/2022] Open
Abstract
Venous thromboembolism (VTE), in particular acute pulmonary embolism (PE), has been shown to be a frequent and potentially fatal complication of coronavirus disease 2019 (COVID-19). In response to the observed thrombotic complications, a large number of studies has been devoted to the understanding and management of COVID-19-associated coagulopathy. Notably, only a limited number of mostly retrospective studies has focused on the optimal diagnostic strategy for suspected PE in COVID-19 patients. As in other special populations, the accuracy of diagnostic algorithms for PE-exclusion has been debated in this specific patient subgroup as the specificity of D-dimer assays and clinical decision rules (CDRs) may be lower than normal. From this viewpoint, we discuss the current state-of-the-art diagnostic algorithms for acute PE with a focus on patients with COVID-19 in the perspective of other special patient populations. Furthermore, we summarize current knowledge regarding the natural history of PE resolution with anticoagulant treatment in patients with COVID-19.
Collapse
|
17
|
Ahlers P, Said-Hartley MQ. A retrospective review of CT pulmonary angiogram confirmed pulmonary emboli in COVID-19 patients admitted to Groote Schuur Hospital, Cape Town. SA J Radiol 2022; 26:2280. [PMID: 35284099 PMCID: PMC8905327 DOI: 10.4102/sajr.v26i1.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background A high incidence of thromboembolic phenomena has been widely reported in patients with coronavirus disease 2019 (COVID-19) pneumonia. There is, however, a paucity of data detailing the incidence and characteristics of pulmonary emboli (PE) in COVID-19 patients in the South African setting. Objectives To describe the incidence and characteristics of PE confirmed by CT pulmonary angiogram (CTPA) in patients with COVID-19 pneumonia admitted to a tertiary hospital in the Western Cape, South Africa. Methods This was a retrospective-, descriptive study of all adult patients with COVID-19 pneumonia confirmed by polymerase chain reaction (PCR) undergoing CTPA for suspected PE while admitted to Groote Schuur Hospital. The study period was from 01 April 2020 to 30 September 2020. Results The study cohort consisted of 116 patients, 59% being female, of whom 29% were pregnant or in the postpartum period. The median age for both genders combined was 49.5 years. The overall incidence of PE was 19%, with 20% in our subset of pregnant and postpartum patients. The majority (64%) of PE’s were reported as being segmental in anatomical location. Conclusion The noteworthy cohort included patients with pulmonary tuberculosis (PTB), HIV as well as pregnant and postpartum patients. The overall incidence of PE was 19% with no significant differences in demographics, comorbidities or D-dimer levels between patients with or without PE. The importance of a high clinical index of suspicion together with the role of CTPA in diagnosing PE in hospitalised COVID-19 patients is emphasised.
Collapse
Affiliation(s)
- Petri Ahlers
- Department of Radiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mariam Q. Said-Hartley
- Department of Radiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
18
|
Kapoor M, Panda PK, Saini LK, Bahurupi Y. Disseminated Intravascular Coagulation Score and Sepsis-induced Coagulopathy Score in Prediction of COVID-19 Severity: A Retrospective Analysis. Indian J Crit Care Med 2022; 25:1357-1363. [PMID: 35027794 PMCID: PMC8693109 DOI: 10.5005/jp-journals-10071-24056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The novel disseminated intravascular coagulation (DIC) score (platelet count, prolonged prothrombin time, D-dimer, and fibrinogen) and sepsis-induced coagulopathy (SIC) score (platelet count, international normalized ratio, and sequential organ failure assessment score) are markers of coagulopathy, which, for the first time, are explored in line with the coronavirus disease-2019 (COVID-19) disease outcomes. The correlation of D-dimer with these findings is also studied. Materials and methods A retrospective analysis of hospital-based records of 168 COVID-19 patients was done. Data including D-dimer, routine investigations, DIC, and SIC scorings (all within 3 days of admission) were collected and correlated with the outcomes. The study was conducted in a tertiary care center catering to North India's population. Results Higher DIC score (1.59 ± 1.18 vs 0.96 ± 1.18), SIC score (1.60 ± 0.89 vs 0.63 ± 0.99), and D-dimer titers (1321.33 ± 1627.89 vs 583·66 ± 777.71 ng/mL) were significantly associated with severe COVID-19 disease (p <0.05). DIC score and SIC score ≥1, and D-dimer ≥1315 ng/mL for severe disease; DIC score ≥1, SIC score ≥2, and D-dimer ≥600 ng/mL for pulmonary embolism (PE); and DIC score and SIC score ≥1, and D-dimer level ≥990 ng/mL for mortality were the respective cutoff values we found from our study. Conclusion Higher DIC scores, SIC scores, and D-dimer values are associated with severe COVID-19 disease, inhospital mortality, and PE risk. They can serve as easily accessible early markers of severe disease and prioritize hospital admissions in the presently overburdened scenario and may be used to develop prognostic prediction models. How to cite this article Kapoor M, Panda PK, Saini LK, Bahurupi Y. Disseminated Intravascular Coagulation Score and Sepsis-induced Coagulopathy Score in Prediction of COVID-19 Severity: A Retrospective Analysis. Indian J Crit Care Med 2021;25(12):1357–1363.
Collapse
Affiliation(s)
- Mayank Kapoor
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prasan Kumar Panda
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Lokesh Kumar Saini
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
19
|
Revel MP, Beeker N, Porcher R, Jilet L, Fournier L, Rance B, Chassagnon G, Fontenay M, Sanchez O. What level of D-dimers can safely exclude pulmonary embolism in COVID-19 patients presenting to the emergency department? Eur Radiol 2022; 32:2704-2712. [PMID: 34994845 PMCID: PMC8739682 DOI: 10.1007/s00330-021-08377-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/14/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To identify which level of D-dimer would allow the safe exclusion of pulmonary embolism (PE) in COVID-19 patients presenting to the emergency department (ED). METHODS This retrospective study was conducted on the COVID database of Assistance Publique - Hôpitaux de Paris (AP-HP). COVID-19 patients who presented at the ED of AP-HP hospitals between March 1 and May 15, 2020, and had CTPA following D-dimer dosage within 48h of presentation were included. The D-dimer sensitivity, specificity, and positive and negative predictive values were calculated for different D-dimer thresholds, as well as the false-negative and failure rates, and the number of CTPAs potentially avoided. RESULTS A total of 781 patients (mean age 62.0 years, 53.8% men) with positive RT-PCR for SARS-Cov-2 were included and 60 of them (7.7%) had CTPA-confirmed PE. Their median D-dimer level was significantly higher than that of patients without PE (4,013 vs 1,198 ng·mL-1, p < 0.001). Using 500 ng·mL-1, or an age-adjusted cut-off for patients > 50 years, the sensitivity and the NPV were above 90%. With these thresholds, 17.1% and 31.5% of CTPAs could have been avoided, respectively. Four of the 178 patients who had a D-dimer below the age-adjusted cutoff had PE, leading to an acceptable failure rate of 2.2%. Using higher D-dimer cut-offs could have avoided more CTPAs, but would have lowered the sensitivity and increased the failure rate. CONCLUSION The same D-Dimer thresholds as those validated in non-COVID outpatients should be used to safely rule out PE. KEY POINTS • The median D-dimer level was significantly higher in COVID-19 patients with PE as compared to those without PE (4,013 ng·mL-1 vs 1,198 ng·mL-1 respectively, p < 0.001). • Using 500 ng·mL-1, or an age-adjusted D-dimer cut-off to exclude pulmonary embolism, the sensitivity and negative predictive value were above 90%. • Higher cut-offs would lead to a reduction in the sensitivity below 85% and an increase in the failure rate, especially for patients under 50 years.
Collapse
Affiliation(s)
- Marie-Pierre Revel
- Université de Paris, 75006, Paris, France. .,Radiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Service de Radiologie27 rue du Faubourg Saint Jacques, 75014, Paris, France.
| | - Nathanael Beeker
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Recherche Clinique, Hôpital Cochin, Paris, France
| | - Raphael Porcher
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Centre d'épidémiologie clinique, Hôtel-Dieu, Paris, France
| | - Léa Jilet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Unité de Recherche Clinique, Hôpital Cochin, Paris, France
| | - Laure Fournier
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Radiologie, Hôpital Européen, Georges Pompidou, Paris, France
| | - Bastien Rance
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Département d'Informatique Médicale, Biostatistiques Et Santé Publique, Hôpital Européen Georges Pompidou, Paris, France
| | - Guillaume Chassagnon
- Université de Paris, 75006, Paris, France.,Radiology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Service de Radiologie27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Michaela Fontenay
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de d'hématologie biologique, Hôpital Cochin, Paris, France.,Institut Cochin INSERM U1016, CNRS UMR8104, Paris, France
| | - Olivier Sanchez
- Université de Paris, 75006, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Pneumologie Et Soins Intensifs, Hôpital Européen, Georges Pompidou, INSERM UMRS-1140 Innovative Therapies in Hemostasis and Biosurgical Research Lab (Carpentier Foundation), Paris, France.,F-CRIN INNOVTE, Saint-Etienne, France
| | | |
Collapse
|
20
|
Perera A, Chowdary P, Johnson J, Lamb L, Drebes A, Mir N, Sood T. A 10-fold and greater increase in D-dimer at admission in COVID-19 patients is highly predictive of pulmonary embolism in a retrospective cohort study. Ther Adv Hematol 2022; 12:20406207211048364. [PMID: 34987740 PMCID: PMC8721362 DOI: 10.1177/20406207211048364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023] Open
Abstract
Background: COVID-19 patients present with both elevated D-dimer and a higher incidence of pulmonary embolism (PE). This single-centre retrospective observational study investigated the prevalence of early PE in COVID-19 patients and its relation to D-dimer at presentation. Methods: The study included 1038 COVID-19-positive patients, with 1222 emergency department (ED) attendances over 11 weeks (16 March to 31 May 2020). Computed tomography pulmonary angiogram (CTPA) for PE was performed in 123 patients within 48 h of ED presentation, of whom 118 had D-dimer results. The remaining 875 attendances had D-dimer performed. Results: CTPA performed in 11.8% of patients within 48 h of ED presentation confirmed PE in 37.4% (46/123). Thrombosis was observed at all levels of pulmonary vasculature with and without right ventricular strain. In the CTPA cohort, patients with PE had significantly higher D-dimer, prothrombin time, C-reactive protein, troponin, total bilirubin, neutrophils, white cell count and lower albumin compared with non-PE patients. However, there was no difference in the median duration of inpatient stay or mortality. A receiver operator curve analysis demonstrated that D-dimer could discriminate between PE and non-PE COVID-19 patients (area under the curve of 0.79, p < 0.0001). Furthermore, 43% (n = 62/145) of patients with D-dimer >5000 ng/ml had CTPA with PE confirmed in 61% (n = 38/62), that is, 26% of >5000 ng/ml cohort. The sensitivity and specificity were related to D-dimer level; cutoffs of 2000, 3000, 4000, and 5000 ng/ml, respectively, had a sensitivity of 93%, 90%, 90% and 86%, and a specificity of 38%, 54%, 59% and 68%, and if implemented, an additional 229, 141, 106 and 83 CTPAs would be required. Conclusion: Our data suggested an increased PE prevalence in COVID-19 patients attending ED with an elevated D-dimer, and patients with levels >5000 ng/ml might benefit from CTPA to exclude concomitant PE.
Collapse
Affiliation(s)
- Adrian Perera
- Emergency Department, Royal Free London NHS Foundation Trust, London, UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust, London, UK
| | - James Johnson
- Emergency Department, Royal Free London NHS Foundation Trust, London, UK
| | - Lucy Lamb
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Anja Drebes
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust, London, UK
| | - Naheed Mir
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Tara Sood
- Consultant Emergency Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK, NW3 2QG
| |
Collapse
|
21
|
Bledsoe JR, Knox D, Peltan ID, Woller SC, Lloyd JF, Snow GL, Horne BD, Connors JM, Kline JA. D-dimer Thresholds to Exclude Pulmonary Embolism among COVID-19 Patients in the Emergency Department: Derivation with Independent Validation. Clin Appl Thromb Hemost 2022; 28:10760296221117997. [PMID: 35942703 PMCID: PMC9373165 DOI: 10.1177/10760296221117997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To derive and validate a D-dimer cutoff for ruling out pulmonary embolism
(PE) in COVID-19 patients presenting to the emergency department (ED). Methods A retrospective cohort study was performed in an integrated healthcare system
including 22 adult ED's between March 1, 2020, and January 31, 2021. Results
were validated among patients enrolled in the RECOVER Registry, representing
data from 154 ED's from 26 US states. Consecutive ED patients with
laboratory confirmed COVID-19, a D-dimer performed within 48 h of ED
arrival, and with objectively confirmed PE were compared to those without
PE. After identifying a D-dimer threshold at which the 95% confidence lower
bound of the negative predictive value for PE was higher than 98% in the
derivation cohort, it was validated using RECOVER registry data. Results Among 3978 patients with a D-dimer result, 3583 with confirmed COVID-19
infection were included in the derivation cohort. Overall, PE incidence was
4.1% and a D-dimer cutoff of <2 μ/mL (2000 ng/mL)
was associated with a NPV of 98.5% (95% CI = 98.0%−98.9%). In the validation
cohort of 13,091 patients with a D-dimer, 7748 had confirmed COVID-19
infection, and the PE incidence was 1.14%. A D-dimer cutoff of
<2 μ/mL was associated with a NPV of 99.5%
(95% CI = 99.3%−99.7%). Conclusion A D-dimer cutoff of <2 μ/ml was associated with a
high negative predictive value for PE among patients with COVID-19. However,
the resultant sensitivity for PE result at that threshold without pre-test
probability assessment would be considered clinically unsafe.
Collapse
Affiliation(s)
- Joseph R Bledsoe
- Department of Emergency Medicine, Intermountain Healthcare, Salt Lake City, UT, USA.,Department of Emergency Medicine, 158423Stanford Medicine, Stanford, CA, USA
| | - Daniel Knox
- Department of Medicine, Division of Pulmonary/Critical Care, Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | - Ithan D Peltan
- Department of Medicine, Division of Pulmonary/Critical Care, Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | - Scott C Woller
- Department of Internal Medicine, Intermountain Medical Center Department of Medicine and University of Utah, Salt Lake City, UT, USA
| | - James F Lloyd
- Medical Informatics and Analytics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Gregory L Snow
- Intermountain Healthcare, Office of Research, Statistical Data Center, Salt Lake City, UT, USA
| | - Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jean M Connors
- Department of Hematology, Brigham and Womens Hospital, Boston, MA, USA
| | - Jeffrey A Kline
- Department of Emergency Medicine, 12267Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
22
|
Laouan Brem F, Asmae B, Amane Y, Bouazzaoui MA, Chaymae M, Rasras H, Nasri S, Abda N, Skiker I, Kouismi H, Zakaria B, Ismaili N, El Ouafi N. Diagnostic Accuracy of D-Dimers for Predicting Pulmonary Embolism in COVID-19-Patients. Clin Appl Thromb Hemost 2021; 27:10760296211057901. [PMID: 34905979 PMCID: PMC8689602 DOI: 10.1177/10760296211057901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Proinflammatory and hypercoagulable states with marked elevation seen in D-Dimer levels have been accurately described in patients infected by the SARS- Cov2 even without pulmonary embolism (PE). OBJECTIVES To compare D-dimers values in patients infected by the novel Coronavirus 2019 (COVID-19) with and without PE and to establish an optimal D-dimer cut-off to predict the occurrence of PE, which guides pulmonary computed tomography angiography (CTPA) indication. METHODS We retrospectively enrolled all COVID-19-patients admitted between October first and November 22th, 2020, at the University Hospital Center of Mohammed VI, Oujda (Morocco), suspected to have PE and underwent a CTPA. Demographic characteristics and blood test results were compared between PE-positive and PE-negative. The receiver operating characteristics (ROC) curve was constructed to establish an optimal D-Dimer cut-off to predict the occurrence of PE. RESULTS The study population consisted of 84 confirmed COVID-19-patients. The mean age was 64.93 years (SD 14.19). PE was diagnosed on CTPA in 31 (36.9%) patients. Clinical symptoms and in-hospital outcomes were similar in both groups except that more men had PE (p = .025). The median value of D-dimers in the group of patients with PE was significantly higher (14 680[IQR 33620-3450]ng/mL compared to the group of patients without PE 2980[IQR 6870-1600]ng/mL [P < .001]. A D-dimer at 2600 ng/mL was the optimal cut-off for predicting PE with a sensitivity of 90.3%, and AUC was .773[CI 95%, .667 -.876). CONCLUSION A D-dimer cut-off value of 2600 ng/mL is a significant predictor of PE in COVID-19-patients with a sensitivity of 90.3%.
Collapse
Affiliation(s)
- Falmata Laouan Brem
- Department of Cardiology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco
| | - Boudouh Asmae
- Department of Pneumology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco
| | - Yassine Amane
- Department of Radiology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco
| | - Mohammed-Amine Bouazzaoui
- Epidemiological Laboratory of Clinical Research and Public Health, Mohammed First University, Oujda, MAR, Morocco
| | - Miri Chaymae
- Department of Cardiology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco
| | - Hammam Rasras
- Department of Cardiology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco
| | - Siham Nasri
- Department of Radiology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco
| | - Naima Abda
- Epidemiological Laboratory of Clinical Research and Public Health, Mohammed First University, Oujda, MAR, Morocco
| | - Imane Skiker
- Department of Radiology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco
| | - Hatim Kouismi
- Department of Pneumology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco
| | - Bazid Zakaria
- Department of Cardiology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco.,Epidemiological Laboratory of Clinical Research and Public Health, Mohammed First University, Oujda, MAR, Morocco
| | - Nabila Ismaili
- Department of Cardiology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco.,Epidemiological Laboratory of Clinical Research and Public Health, Mohammed First University, Oujda, MAR, Morocco
| | - Noha El Ouafi
- Department of Cardiology, 470522Mohammed VI University Hospital, Mohammed First University, Oujda, MAR, Morocco.,Epidemiological Laboratory of Clinical Research and Public Health, Mohammed First University, Oujda, MAR, Morocco
| |
Collapse
|
23
|
Gerlier C, Pilmis B, Ganansia O, Le Monnier A, Nguyen Van JC. Clinical and operational impact of rapid point-of-care SARS-CoV-2 detection in an emergency department. Am J Emerg Med 2021; 50:713-718. [PMID: 34879491 PMCID: PMC8479552 DOI: 10.1016/j.ajem.2021.09.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
Study objective Rapid point-of-care (POC) SARS-CoV-2 detection with Abbott ID NOW™ COVID-19 test has been implemented in our Emergency Department (ED) for several months. We aimed to evaluate the operational impact and potential benefits of this innovative clinical pathway. Methods We conducted a prospective, descriptive, interventional, non-randomized study, before-after trial with the comparison of patient cohorts from two consecutive periods of seven weeks (observational pre-POC period vs interventional POC period). Results In 2020, throughout weeks 37 to 50, 3333 patients were assessed for eligibility and among them 331 (9.9%) were positive for SARS-CoV-2 infections. Among the included patients, 136 (9.2%) were positive for SARS-CoV-2 infection in the pre-POC period and 195 (10.5%) in the POC period. Among positive patients for SARS-CoV-2 related infection in-hospital mortality rate was similar between the two groups but the hospitalization rate was higher in the POC group (81.6% vs. 65.4%; p < 0.001). More patients in the POC period were able to leave the ED within 6 h. We examined rates of antibiotic, anticoagulant, and corticosteroid prescriptions among patients tested for SARS-CoV-2 in the ED. Only the rate of prescribed anticoagulants was found to be higher in the POC period (40% vs. 24.2%; p < 0.003). Conclusion We demonstrated that COVID-19 point-of-care testing speeds up clinical decision-making, improving use of recommended treatments for COVID-19, such as anticoagulants. Moreover, it improves the boarding time and significantly shortened the length of stay in the ED for patients requiring outpatient care.
Collapse
Affiliation(s)
- Camille Gerlier
- Service des Urgences, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Benoît Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France; Institut Micalis, UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Bactéries Pathogènes et Santé, Châtenay-Malabry, France
| | - Olivier Ganansia
- Service des Urgences, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Alban Le Monnier
- Institut Micalis, UMR 1319, Université Paris-Saclay, INRAe, AgroParisTech, Bactéries Pathogènes et Santé, Châtenay-Malabry, France; Service de Microbiologie Clinique et Plateforme de Dosage des Anti-infectieux, Groupe Hospitalier, Paris, France
| | - Jean-Claude Nguyen Van
- Service de Microbiologie Clinique et Plateforme de Dosage des Anti-infectieux, Groupe Hospitalier, Paris, France.
| |
Collapse
|
24
|
Lehmann A, Prosch H, Zehetmayer S, Gysan MR, Bernitzky D, Vonbank K, Idzko M, Gompelmann D. Impact of persistent D-dimer elevation following recovery from COVID-19. PLoS One 2021; 16:e0258351. [PMID: 34710097 PMCID: PMC8553152 DOI: 10.1371/journal.pone.0258351] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/26/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Elevated D-dimer is known as predictor for severity of SARS-CoV2-infection. Increased D-dimer is associated with thromboembolic complications, but it is also a direct consequence of the acute lung injury seen in COVID-19 pneumonia. OBJECTIVES To evaluate the rate of persistent elevated D-dimer and its association with thromboembolic complications and persistent ground glass opacities (GGO) after recovery from COVID-19. METHODS In this post hoc analysis of a prospective multicenter trial, patients underwent blood sampling, measurement of diffusion capacity, blood gas analysis, and multidetector computed tomography (MDCT) scan following COVID-19. In case of increased D-dimer (>0,5 μg/ml), an additional contrast medium-enhanced CT was performed in absence of contraindications. Results were compared between patients with persistent D-dimer elevation and patients with normal D-dimer level. RESULTS 129 patients (median age 48.8 years; range 19-91 years) underwent D-Dimer assessment after a median (IQR) of 94 days (64-130) following COVID-19. D-dimer elevation was found in 15% (19/129) and was significantly more common in patients who had experienced a severe SARS-CoV2 infection that had required hospitalisation compared to patients with mild disease (p = 0.049). Contrast-medium CT (n = 15) revealed an acute pulmonary embolism in one patient and CTEPH in another patient. A significant lower mean pO2 (p = 0.015) and AaDO2 (p = 0.043) were observed in patients with persistent D-Dimer elevation, but the rate of GGO were similar in both patient groups (p = 0.33). CONCLUSION In 15% of the patients recovered from COVID-19, persistent D-dimer elevation was observed after a median of 3 months following COVID-19. These patients had experienced a more severe COVID and still presented more frequently a lower mean pO2 and AaDO2.
Collapse
Affiliation(s)
- Antje Lehmann
- Department of Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sonja Zehetmayer
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Maximilian Robert Gysan
- Department of Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Dominik Bernitzky
- Department of Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Karin Vonbank
- Department of Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Marco Idzko
- Department of Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Daniela Gompelmann
- Department of Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
25
|
Cui LY, Cheng WW, Mou ZW, Xiao D, Li YY, Li YJ, Li WT, Chen ZM. Risk factors for pulmonary embolism in patients with COVID-19: a systemic review and meta-analysis. Int J Infect Dis 2021; 111:154-163. [PMID: 34418565 PMCID: PMC8372457 DOI: 10.1016/j.ijid.2021.08.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/12/2021] [Accepted: 08/06/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To detect the risk factors for pulmonary embolism (PE) in patients with COVID-19. METHODS Studies were searched for in PubMed, Cochrane Library, Web of Science, and EMBASE. Two authors independently screened articles and extracted data. The data were pooled by meta-analysis and three subgroup analyses were performed. RESULTS Of the 2210 articles identified, 27 studies were included. Pooled analysis suggested that males (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.26-1.75, P = 0.000), obesity (OR 1.37, 95% CI 1.03-1.82, P = 0.033), mechanical ventilation (OR 3.34, 95% CI 1.90-5.86, P = 0.000), severe parenchymal abnormalities (OR 1.92, 95% CI 1.43-2.58, P = 0.000), ICU admission (OR 2.44, 95% CI 1.48-4.03, P = 0.000), and elevated D-dimer and white blood cell values (at two time points: hospital admission or closest to computed tomography pulmonary angiography) (P = 0.000) correlated with a risk for PE occurrence in COVID-19 patients. However, age and common comorbidities had no association with PE occurrence. Computed tomography pulmonary angiography, unclear-ratio/low-ratio, and hospitalization subgroups had consistent risk factors with all studies; however, other subgroups had fewer risk factors for PE. CONCLUSIONS Risk factors for PE in COVID-19 were different from the classic risk factors for PE and are likely to differ in diverse study populations.
Collapse
Affiliation(s)
- Li-Yan Cui
- Department of rehabilitation medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wen-Wen Cheng
- Department of Neurology, Maoming People's Hospital, Maoming, Guangdong 525000, China
| | - Zhi-Wei Mou
- Department of rehabilitation medicine, The Fifth Affiliated Hospital of Jinan University, Guangzhou, China
| | - Duan Xiao
- Department of rehabilitation medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yun-Yi Li
- Department of nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yu-Jie Li
- Songgang People's Hospital, Baoan District, Shenzhen
| | - Wan-Ting Li
- Department of rehabilitation medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhuo-Ming Chen
- Department of rehabilitation medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| |
Collapse
|
26
|
Elberts SJ, Bateman R, Koutsoubis A, London KS, White JL, Fields JM. The impact of COVID-19 on the sensitivity of D-dimer for pulmonary embolism. Acad Emerg Med 2021; 28:1142-1149. [PMID: 34425044 PMCID: PMC8653093 DOI: 10.1111/acem.14348] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022]
Abstract
Objective This study seeks to evaluate the test characteristics of D‐dimer for pulmonary embolism (PE) in patients with a concurrent diagnosis of COVID‐19. We hypothesized that the sensitivity of D‐dimer for PE at current institutional cut points would be similar to those without COVID‐19. Methods This is a multicenter retrospective observational cohort study across five urban and suburban EDs in the same health care system. The electronic health record was queried for all computed tomography pulmonary angiography (CTPA) studies from December 1, 2019, to October 22, 2020. All ED patients who underwent CTPA had D‐dimer and COVID‐19 testing completed in a single encounter were included in the study. Baseline demographics were obtained. Test characteristics of D‐dimer for PE were calculated for patients with and without COVID‐19. Additionally, receiver operator characteristics (ROC) curves were constructed for two different D‐dimer assays. Results There were 1158 patient encounters that met criteria for analysis. Performance of D‐dimer testing for PE was similar between COVID‐19–positive and –negative patients. In COVID‐19–positive patients, the sensitivity was 100% (95% confidence interval [CI] = 87.6%–100%), specificity was 11.9% (95% CI = 7.9%–17.1%), and negative predictive value (NPV) was 100%. In COVID‐19–negative patients the sensitivity was 97.6% (95% CI = 91.5%–99.7%), specificity was 14.4% (95% CI = 12.1%–17%), and NPV was 98.3% (95% CI = 93.8%–99.6%). For assay 1 the area under the curve (AUC) for COVID‐19–positive patients was 0.76 (95% CI = 0.68–0.83), and for COVID‐19–negative patients, 0.73 (95% CI = 0.69–0.77). For assay 2, AUC for COVID‐19–positive patients was 0.85 (95% CI = 0.77–0.92), and for COVID‐19–negative patients, 0.80 (95% CI = 0.77–0.84). Inspection of the ROC curve for assay 1 revealed that 100% sensitivity was maintained up to a threshold of 0.67 FEU (fibrinogen equivalent units; from 0.50 FEU) with an increase in specificity to 29% (from 18.7%), and for assay 2, 100% sensitivity was maintained up to a threshold of 662 D‐dimer units (DDU; from 230 DDU) with an increased specificity to 59% (from 6.1%). Conclusion Results from this multicenter retrospective study did not find a significant difference in sensitivity of D‐dimer for PE due to concomitant COVID‐19 infection. Further study is required to determine if PE can safely be excluded based on D‐dimer results alone in patients with suspected or proven COVID‐19 or if adjusted D‐dimer levels could have a role in management.
Collapse
Affiliation(s)
- Samuel J. Elberts
- Department of Emergency Medicine Thomas Jefferson University Hospital Philadelphia PA USA
| | - Ryan Bateman
- Department of Emergency Medicine Thomas Jefferson University Hospital Philadelphia PA USA
| | | | - Kory S. London
- Department of Emergency Medicine Thomas Jefferson University Hospital Philadelphia PA USA
| | - Jennifer L. White
- Department of Emergency Medicine Thomas Jefferson University Hospital Philadelphia PA USA
| | - J. Matthew Fields
- Department of Emergency Medicine Thomas Jefferson University Hospital Philadelphia PA USA
| |
Collapse
|
27
|
Silva BV, Jorge C, Plácido R, Mendonça C, Urbano ML, Rodrigues T, Brito J, da Silva PA, Rigueira J, Pinto FJ. Pulmonary embolism and COVID-19: A comparative analysis of different diagnostic models performance. Am J Emerg Med 2021; 50:526-531. [PMID: 34547695 PMCID: PMC8423667 DOI: 10.1016/j.ajem.2021.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/28/2021] [Accepted: 09/02/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. Several diagnostic prediction rules based on pretest probability and D-dimer have been validated in non-COVID patients, but it remains unclear if they can be safely applied in COVID-19 patients. We aimed to compare the diagnostic accuracy of the standard approach based on Wells and Geneva scores combined with a standard D-dimer cut-off of 500 ng/mL with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in COVID-19 patients. METHODS This retrospective study included all COVID-19 patients admitted to the Emergency Department (ED) who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. The diagnostic prediction rules for PE were compared between patients with and without PE. RESULTS We included 300 patients and PE was confirmed in 15%. No differences were found regarding comorbidities, traditional risk factors for PE and signs and symptoms between patients with and without PE. Wells and Geneva scores showed no predictive value for PE occurrence, whether a standard or an age-adjusted cut-off was considered. YEARS and PEGeD algorithms were associated with increased specificity (19% CTPA reduction) but raising non-diagnosed PE. Despite elevated in all patients, those with PE had higher D-dimer levels. However, incrementing thresholds to select patients for CTPA was also associated with a substantial decrease in sensitivity. CONCLUSION None of the diagnostic prediction rules are reliable predictors of PE in COVID-19. Our data favour the use of a D-dimer threshold of 500 ng/mL, considering that higher thresholds increase specificity but limits this strategy as a screening test.
Collapse
Affiliation(s)
- Beatriz Valente Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
| | - Cláudia Jorge
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Rui Plácido
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Mendonça
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Maria Luísa Urbano
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Tiago Rodrigues
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Brito
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Alves da Silva
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Rigueira
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Fausto J Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
28
|
Stals MAM, Kaptein FHJ, Bemelmans RHH, van Bemmel T, Boukema IC, Braeken DCW, Braken SJE, Bresser C, Cate HT, Deenstra DD, Dooren YPAV, Faber LM, Grootenboers MJJH, Haan LRD, Haazer C, Sol AID, Kelliher S, Koster T, Kroft LJM, Meijer RI, Pals F, van Thiel ERE, Westerweel PE, Wolde MT, Klok FA, Huisman MV. Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19-A Prospective Cohort Study. TH OPEN 2021; 5:e387-e399. [PMID: 34541450 PMCID: PMC8443402 DOI: 10.1055/s-0041-1735155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023] Open
Abstract
Background
Diagnostic strategies for suspected pulmonary embolism (PE) have not been prospectively evaluated in COVID-19 patients.
Methods
Prospective, multicenter, outcome study in 707 patients with both (suspected) COVID-19 and suspected PE in 14 hospitals. Patients on chronic anticoagulant therapy were excluded. Informed consent was obtained by opt-out approach. Patients were managed by validated diagnostic strategies for suspected PE. We evaluated the safety (3-month failure rate) and efficiency (number of computed tomography pulmonary angiographies [CTPAs] avoided) of the applied strategies.
Results
Overall PE prevalence was 28%. YEARS was applied in 36%, Wells rule in 4.2%, and “CTPA only” in 52%; 7.4% was not tested because of hemodynamic or respiratory instability. Within YEARS, PE was considered excluded without CTPA in 29%, of which one patient developed nonfatal PE during follow-up (failure rate 1.4%, 95% CI 0.04–7.8). One-hundred seventeen patients (46%) managed according to YEARS had a negative CTPA, of whom 10 were diagnosed with nonfatal venous thromboembolism (VTE) during follow-up (failure rate 8.8%, 95% CI 4.3–16). In patients managed by CTPA only, 66% had an initial negative CTPA, of whom eight patients were diagnosed with a nonfatal VTE during follow-up (failure rate 3.6%, 95% CI 1.6–7.0).
Conclusion
Our results underline the applicability of YEARS in (suspected) COVID-19 patients with suspected PE. CTPA could be avoided in 29% of patients managed by YEARS, with a low failure rate. The failure rate after a negative CTPA, used as a sole test or within YEARS, was non-negligible and reflects the high thrombotic risk in these patients, warranting ongoing vigilance.
Collapse
Affiliation(s)
- Milou A M Stals
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
| | - Fleur H J Kaptein
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
| | - Remy H H Bemelmans
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, Gelderland, The Netherlands
| | - Thomas van Bemmel
- Department of Internal Medicine, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, Gelderland, The Netherlands
| | - Inge C Boukema
- Department of Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Dionne C W Braeken
- Thrombosis Expertise Center, Maastricht University Medical Center, Maastricht, Limburg, the Netherlands
| | - Sander J E Braken
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
| | - Carlinda Bresser
- Department of Hematology, Red Cross Hospital, Beverwijk, Noord-Holland, The Netherlands
| | - Hugo Ten Cate
- Thrombosis Expertise Center, Maastricht University Medical Centre + , Maastricht, Limburg, The Netherlands
| | - Duco D Deenstra
- Department of Pulmonology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
| | - Yordi P A van Dooren
- Department of Pulmonology, Groene Hart Hospital, Gouda, Zuid-Holland, The Netherlands
| | - Laura M Faber
- Department of Hematology, Red Cross Hospital, Beverwijk, Noord-Holland, The Netherlands
| | | | - Lianne R de Haan
- Department of Internal Medicine, Flevo Hospital, Almere, Flevoland, The Netherlands
| | - Carolien Haazer
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, Zuid-Holland, The Netherlands
| | - Antonio Iglesias Del Sol
- Department of Internal Medicine, Alrijne Hospital Location Leiderdorp, Leiderdorp, Zuid-Holland, The Netherlands
| | - Sarah Kelliher
- Department of Hematology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ted Koster
- Department of Internal Medicine, Groene Hart Hospital, Gouda, Zuid-Holland, The Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Rick I Meijer
- Department of Internal Medicine Amsterdam UMC Locatie VUMC, Amsterdam, Noord-Holland, The Netherlands
| | - Fleur Pals
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
| | - Eric R E van Thiel
- Department of Pulmonology, Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, The Netherlands
| | - Marije Ten Wolde
- Department of Internal Medicine, Flevo Hospital, Almere, Flevoland, The Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
| | | |
Collapse
|
29
|
Gómez CA, Sun CK, Tsai IT, Chang YP, Lin MC, Hung IY, Chang YJ, Wang LK, Lin YT, Hung KC. Mortality and risk factors associated with pulmonary embolism in coronavirus disease 2019 patients: a systematic review and meta-analysis. Sci Rep 2021; 11:16025. [PMID: 34362946 PMCID: PMC8346591 DOI: 10.1038/s41598-021-95512-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
To determine, in patients with coronavirus disease 2019 (COVID-19) infection, the associations of pulmonary embolism (PE) with mortality and risk factors for PE as well as the therapeutic benefit of anticoagulant prophylaxis. Embase, PubMed, Cochrane controlled trials register, and Web of Science databases were searched from inception to October 10, 2020. We included all published trials on PE in patients diagnosed with COVID-19 with eligibility of the trials assessed following the PRISMA guidelines. Sixteen clinical trials with 5826 patients were eligible. There were significant associations of PE with the male gender [odd ratio (OR) = 1.59, 95% CI 1.28-1.97], mechanical ventilation (OR = 3.71, 95% CI 2.57-5.36), intensive care unit admission (OR = 2.99, 95% CI 2.11-4.23), circulating D-dimer [mean difference (MD) = 5.04 µg/mL, 95% CI 3.67-6.42) and CRP (MD = 1.97 mg/dL, 95% CI 0.58- 3.35) concentrations without significant correlation between PE and mortality (OR = 1.31, 95% CI 0.82-2.08) as well as other parameters or comorbidities. After omitting one trial with strict patient selection criteria for anticoagulant prophylaxis, significant prophylactic benefit was noted (OR = 0.31, 95% CI 0.1-0.91). Our findings identified the risk factors associated with PE in COVID-19 patients and supported the therapeutic benefit of anticoagulant prophylaxis against PE in this patient population.
Collapse
Affiliation(s)
- Carlos Andrés Gómez
- grid.411447.30000 0004 0637 1806School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan ,Universidad Nacional Autónoma de Honduras en el Valle de Sula, San Pedro Sula, Honduras
| | - Cheuk-Kwan Sun
- grid.411447.30000 0004 0637 1806School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan ,grid.414686.90000 0004 1797 2180Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - I-Ting Tsai
- grid.411447.30000 0004 0637 1806School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan ,grid.414686.90000 0004 1797 2180Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Yang-Pei Chang
- grid.412019.f0000 0000 9476 5696Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ,grid.412019.f0000 0000 9476 5696Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chung Lin
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004 Taiwan
| | - I-Yin Hung
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004 Taiwan
| | - Ying-Jen Chang
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004 Taiwan
| | - Li-Kai Wang
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004 Taiwan
| | - Yao-Tsung Lin
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004 Taiwan
| | - Kuo-Chuan Hung
- grid.413876.f0000 0004 0572 9255Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung Dist, Tainan, 71004 Taiwan
| |
Collapse
|
30
|
Kollias A, Kyriakoulis KG, Lagou S, Kontopantelis E, Stergiou GS, Syrigos K. Venous thromboembolism in COVID-19: A systematic review and meta-analysis. Vasc Med 2021; 26:415-425. [PMID: 33818197 PMCID: PMC8024143 DOI: 10.1177/1358863x21995566] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Severe coronavirus disease 2019 (COVID-19) is associated with increased risk of venous thromboembolism events (VTE). This study performed a systematic review in PubMed/EMBASE of studies reporting the prevalence of VTE in patients with COVID-19 who were totally screened/assessed for deep vein thrombosis (DVT) and/or for pulmonary embolism (PE). Among 47 candidate studies (n = 6459; 33 in Europe), 17 studies (n = 3973; weighted age 63.0 years, males 60%, intensive care unit (ICU) 16%) reported the prevalence of PE with a pooled estimate of 32% (95% CI: 25, 40%), and 32 studies (n = 2552; weighted age 62.6 years, males 57%, ICU 49%) reported the prevalence of DVT with a pooled estimate of 27% (95% CI: 21, 34%). A total of 36 studies reported the use of at least prophylactic antithrombotic treatment in the majority of their patients. Meta-regression analysis showed that the prevalence of VTE was higher across studies with a higher percentage of ICU patients and higher study population mean D-dimer values, and lower in studies with mixed dosing of anticoagulation in ⩾ 50% of the population compared to studies with standard prophylactic dosing of anticoagulation in < 50% of the population. The pooled odds ratio for death in patients with COVID-19 and VTE versus those without VTE (17 studies, n = 2882) was 2.1 (95% CI: 1.2, 3.6). Hospitalized patients with severe COVID-19 are at high VTE risk despite prophylactic anticoagulation. Further research should investigate the individualized VTE risk of patients with COVID-19 and the optimal preventive antithrombotic therapy. PROSPERO Registration No.: CRD42020185543.
Collapse
Affiliation(s)
- Anastasios Kollias
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| | - Konstantinos G Kyriakoulis
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| | - Styliani Lagou
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- National Institute for Health Research, School for Primary Care Research, University of Manchester, Manchester, UK
| | - George S Stergiou
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| | - Konstantinos Syrigos
- Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| |
Collapse
|
31
|
Nadeem I, Anwar A, Jordon L, Mahdi N, Rasool MU, Dakin J, Lok S. Relationship of D-dimer and prediction of pulmonary embolism in hospitalized COVID-19 patients: a multicenter study. Future Microbiol 2021; 16:863-870. [PMID: 34319144 PMCID: PMC8317973 DOI: 10.2217/fmb-2021-0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: COVID-19 is a known risk factor for pulmonary embolism (PE). In this retrospective, multicenter study, we aimed to determine an optimal D-dimer cutoff to predict PE in hospitalized patients with COVID-19. Materials & methods: A total of 193 patients underwent computerized tomographic pulmonary angiography imaging and were classified into PE positive and negative groups. Physiological, radiological and biochemical parameters were compared and receiver operator curve analysis was conducted to determine a predictive D-dimer threshold. Results: An optimal D-dimer cutoff of 2494 ng/ml was selected (Youden index: 0.906), giving a sensitivity of 100% (95% CI: 100–100) and specificity of 90.62% (95% CI: 90.5–90.8) for predicting PE. Conclusion: We propose that in the absence of other clinical signs, a D-dimer threshold of 2495 ng/ml could be used with high sensitivity and specificity to predict PE in hospitalized patients with COVID-19.
Collapse
Affiliation(s)
- Iftikhar Nadeem
- Department of Respiratory Medicine, East & North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Asad Anwar
- Department of Respiratory Medicine, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Louise Jordon
- Department of Respiratory Medicine, East & North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Noor Mahdi
- Department of Respiratory Medicine, East & North Hertfordshire NHS Foundation Trust, Stevenage, UK
| | - Masood Ur Rasool
- Department of Respiratory Medicine, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
| | - Jonathan Dakin
- Department of Respiratory Medicine, Royal Surrey Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - She Lok
- Department of Respiratory Medicine, East & North Hertfordshire NHS Foundation Trust, Stevenage, UK
| |
Collapse
|
32
|
Investigation of perfusion defects by Q-SPECT/CT in patients with mild-to-moderate course of COVID-19 and low clinical probability for pulmonary embolism. Ann Nucl Med 2021; 35:1117-1125. [PMID: 34173212 PMCID: PMC8231747 DOI: 10.1007/s12149-021-01647-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/17/2021] [Indexed: 01/21/2023]
Abstract
Objective Pulmonary embolism is a severe source of mortality and morbidity in patients with severe and critical coronavirus disease 2019. It is not yet clear whether the tendency to thrombosis is increased in the mild-to-moderate course of COVID-19. Our research aims to show the clinical benefit of Q-SPECT/CT in diagnosing PD in outpatients treated with mild-to-moderate course of COVID-19 and to determine the frequency of perfusion defects in these patients having relatively lower risk. Methods All patients who underwent Q-SPECT/CT with suspicion of embolism were examined retrospectively. Only patients with low clinical probability and mild-to-moderate course of COVID-19 for PE were included in the study. The patients were evaluated comparatively as those with and without perfusion defects. Patients were divided into laboratory suspicion, clinical suspicion, or clinical and laboratory suspicion. Results In outpatients with mild-to-moderate COVID-19 with low clinical probability for PE, PD without CT abnormality was detected with a rate of 36.6% with Q-SPECT/CT performed for complaints of high d-dimer and/or dyspnea. None of the patients had PD at more proximal level than the segment level. PD with no concomitant CT abnormality was observed with a rate of 56.5% in patients with both clinical and laboratory suspicion. For d-dimer = 0.5 mg/dL cut-off sensitivity is 85%, for d-dimer = 1.5 mg/dL cut-off specificity 81%. Conclusion Thrombosis tendency is also present in outpatients with mild-to-moderate COVID-19, and these patients should also be offered anticoagulant prophylaxis during the COVID-19 period.
Collapse
|
33
|
Korevaar DA, Aydemir I, Minnema MW, Azijli K, Beenen LF, Heijmans J, van Es N, Al Masoudi M, Meijboom LJ, Middeldorp S, Nanayakkara PW, Meijer RI, Bonta PI, van Es J. Routine screening for pulmonary embolism in COVID-19 patients at the emergency department: impact of D-dimer testing followed by CTPA. J Thromb Thrombolysis 2021; 52:1068-1073. [PMID: 34160744 PMCID: PMC8221091 DOI: 10.1007/s11239-021-02508-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 12/19/2022]
Abstract
COVID-19 patients have increased risk of pulmonary embolism (PE), but symptoms of both conditions overlap. Because screening algorithms for PE in COVID-19 patients are currently lacking, PE might be underdiagnosed. We evaluated a screening algorithm in which all patients presenting to the ED with suspected or confirmed COVID-19 routinely undergo D-dimer testing, followed by CT pulmonary angiography (CTPA) if D-dimer is ≥ 1.00 mg/L. Consecutive adult patients presenting to the ED of two university hospitals in Amsterdam, The Netherlands, between 01-10-2020 and 31-12-2020, who had a final diagnosis of COVID-19, were retrospectively included. D-dimer and CTPA results were obtained. Of 541 patients with a final diagnosis of COVID-19 presenting to the ED, 25 (4.6%) were excluded because D-dimer was missing, and 71 (13.1%) because they used anticoagulation therapy. Of 445 included patients, 185 (41.6%; 95%CI 37.0–46.3) had a D-dimer ≥ 1.00 mg/L. CTPA was performed in 169 of them, which showed PE in 26 (15.4%; 95%CI 10.3–21.7), resulting in an overall detection rate of 5.8% (95%CI 3.9–8.4) in the complete study group. In patients with and without PE at CTPA, median D-dimer was 9.84 (IQR 3.90–29.38) and 1.64 (IQR 1.17–3.01), respectively (p < 0.001). PE prevalence increased with increasing D-dimer, ranging from 1.2% (95%CI 0.0–6.4) if D-dimer was 1.00–1.99 mg/L, to 48.6% (95%CI 31.4–66.0) if D-dimer was ≥ 5.00 mg/L. In conclusion, by applying this screening algorithm, PE was identified in a considerable proportion of COVID-19 patients. Prospective management studies should assess if this algorithm safely rules-out PE if D-dimer is < 1.00 mg/L.
Collapse
Affiliation(s)
- Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Ilayda Aydemir
- Department of Respiratory Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Maartje W Minnema
- Section Emergency Medicine, Emergency Department, Amsterdam Cardiovascular Sciences, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kaoutar Azijli
- Section Emergency Medicine, Emergency Department, Amsterdam Cardiovascular Sciences, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ludo F Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jarom Heijmans
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mohanad Al Masoudi
- Section Emergency Medicine, Emergency Department, Amsterdam Cardiovascular Sciences, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud UMC, Nijmegen, The Netherlands
| | - Prabath W Nanayakkara
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rick I Meijer
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter I Bonta
- Department of Respiratory Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Josien van Es
- Department of Respiratory Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Matli K, Farah R, Maalouf M, Chamoun N, Costanian C, Ghanem G. Role of combining anticoagulant and antiplatelet agents in COVID-19 treatment: a rapid review. Open Heart 2021; 8:openhrt-2021-001628. [PMID: 34099529 PMCID: PMC8186323 DOI: 10.1136/openhrt-2021-001628] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
Although primarily affecting the respiratory system, COVID-19 causes multiple organ damage. One of its grave consequences is a prothrombotic state that manifests as thrombotic, microthrombotic and thromboembolic events. Therefore, understanding the effect of antiplatelet and anticoagulation therapy in the context of COVID-19 treatment is important. The aim of this rapid review was to highlight the role of thrombosis in COVID-19 and to provide new insights on the use of antithrombotic therapy in its management. A rapid systematic review was performed using preferred reporting items for systematic reviews. Papers published in English on antithrombotic agent use and COVID-19 complications were eligible. Results showed that the use of anticoagulants increased survival and reduced thromboembolic events in patients. However, despite the use of anticoagulants, patients still suffered thrombotic events likely due to heparin resistance. Data on antiplatelet use in combination with anticoagulants in the setting of COVID-19 are quite scarce. Current side effects of anticoagulation therapy emphasise the need to update treatment guidelines. In this rapid review, we address a possible modulatory role of antiplatelet and anticoagulant combination against COVID-19 pathogenesis. This combination may be an effective form of adjuvant therapy against COVID-19 infection. However, further studies are needed to elucidate potential risks and benefits associated with this combination.
Collapse
Affiliation(s)
- Kamal Matli
- Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Raymond Farah
- Department of Sciences, Lebanese University, Beirut, Lebanon
| | - Mario Maalouf
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Nibal Chamoun
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Christy Costanian
- School of Medicine, Lebanese American University, Byblos, Lebanon .,Lebanese American University, Beirut, Lebanon
| | - Georges Ghanem
- Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| |
Collapse
|
35
|
Correlations Between Covid 19 Symptoms and Risk of Pulmonary Embolism. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
The World Health Organization (WHO) declares COVID 19 pandemic in March 2020. Each pandemic wave had different clinical and biological characteristics, the expression of the disease being correlated with the dominant viral variant. Patients with COVID 19 have a pro-coagulant status, which predisposes them to thromboembolic complications.
The current study aims to systematize the symptoms of COVID 19 and to highlight its relationship with the suspicion and confirmation of the diagnosis of pulmonary thromboembolism.
We performed a descriptive retrospective study on patients with COVID 19 for a period of 4 months (September-December 2021). During this period, 183 were hospitalized with COVID 19 and 53 were enrolled in the study. Incidence of COVID 19 was 63% (33) in men and 37% for women. The average age of women was 68 years compared to men where the average age was 61 years. We observed a higher incidence of the disease in men in the 41–60 age group (39% of all men), while, in women, the most affected age group was 61–80 years (60% of all women). Pulmonary thromboembolism (PE) was diagnosed by pulmonary artery angiography, with an incidence of 57% in the study group affecting 60% of women and 55% of men.
The symptoms are dominated by fever, cough and dyspnea. Fever was present in 65% of women and 55% of men, cough was present in 65% of women and 79% of men, while dyspnea involved 40% of women and 42% of men.
In conclusion, PE was a common complication in COVID patients that contributed to adverse outcome and higher mortality. The symptoms were not specific to minor forms of the disease.
Collapse
|
36
|
Thoreau B, Galland J, Delrue M, Neuwirth M, Stepanian A, Chauvin A, Dellal A, Nallet O, Roriz M, Devaux M, London J, Martin-Lecamp G, Froissart A, Arab N, Ferron B, Groff MH, Queyrel V, Lorut C, Regard L, Berthoux E, Bayer G, Comarmond C, Lioger B, Mekinian A, Szwebel TA, Sené T, Amador-Borrero B, Mangin O, Sellier PO, Siguret V, Mouly S, Kevorkian JP, Vodovar D, Sene D. D-Dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients. Viruses 2021; 13:v13050758. [PMID: 33926038 PMCID: PMC8146364 DOI: 10.3390/v13050758] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023] Open
Abstract
The incidence of pulmonary embolism (PE) is high during severe Coronavirus Disease 2019 (COVID-19). We aimed to identify predictive and prognostic factors of PE in non-ICU hospitalized COVID-19 patients. In the retrospective multicenter observational CLOTVID cohort, we enrolled patients with confirmed RT-PCR COVID-19 who were hospitalized in a medicine ward and also underwent a CT pulmonary angiography for a PE suspicion. Baseline data, laboratory biomarkers, treatments, and outcomes were collected. Predictive and prognostics factors of PE were identified by using logistic multivariate and by Cox regression models, respectively. A total of 174 patients were enrolled, among whom 86 (median [IQR] age of 66 years [55–77]) had post-admission PE suspicion, with 30/86 (34.9%) PE being confirmed. PE occurrence was independently associated with the lack of long-term anticoagulation or thromboprophylaxis (OR [95%CI], 72.3 [3.6–4384.8]) D-dimers ≥ 2000 ng/mL (26.3 [4.1–537.8]) and neutrophils ≥ 7.0 G/L (5.8 [1.4–29.5]). The presence of these two biomarkers was associated with a higher risk of PE (p = 0.0002) and death or ICU transfer (HR [95%CI], 12.9 [2.5–67.8], p < 0.01). In hospitalized non-ICU severe COVID-19 patients with clinical PE suspicion, the lack of anticoagulation, D-dimers ≥ 2000 ng/mL, neutrophils ≥ 7.0 G/L, and these two biomarkers combined might be useful predictive markers of PE and prognosis, respectively.
Collapse
Affiliation(s)
- Benjamin Thoreau
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Cochin Hospital, AP-HP, University of Paris, CEDEX 14, 75679 Paris, France;
- INSERM U1016, Cochin Institute, Paris, University of Paris, CNRS UMR 8104, 75014 Paris, France
- Correspondence: ; Tel.: +33-1-58-41-14-36; Fax: +33-1-58-41-14-50
| | - Joris Galland
- Department of Internal Medicine, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP) Université de Paris, 75010 Paris, France; (J.G.); (B.A.-B.); (O.M.); (S.M.); (D.S.)
| | - Maxime Delrue
- Haemostasis Laboratory, Lariboisière Hospital, AP-HP, University of Paris, 75010 Paris, France; (M.D.); (M.N.); (A.S.); (V.S.)
| | - Marie Neuwirth
- Haemostasis Laboratory, Lariboisière Hospital, AP-HP, University of Paris, 75010 Paris, France; (M.D.); (M.N.); (A.S.); (V.S.)
| | - Alain Stepanian
- Haemostasis Laboratory, Lariboisière Hospital, AP-HP, University of Paris, 75010 Paris, France; (M.D.); (M.N.); (A.S.); (V.S.)
| | - Anthony Chauvin
- Emergency Department, Lariboisière Hospital, AP-HP, University of Paris, 75010 Paris, France;
| | - Azeddine Dellal
- Department of Rheumatology and Internal Medicine, Le Raincy-Montfermeil Hospital, 93370 Montfermeil, France;
| | - Olivier Nallet
- Department of Cardiology, Le Raincy-Montfermeil Hospital, 93370 Montfermeil, France;
| | - Melanie Roriz
- Department of Internal Medicine, Hospital Center of Agen, 47923 Agen, France;
| | - Mathilde Devaux
- Department of Internal Medicine, Hospital Center of Poissy-Saint Germain, 78300 Saint Germain en Laye, France;
| | - Jonathan London
- Department of Internal Medicine, Diaconesses Croix Saint-Simon Hospital, 75012 Paris, France;
| | | | - Antoine Froissart
- Department of Internal Medicine, Intermunicipal Hospital Center of Créteil, 94000 Créteil, France; (A.F.); (N.A.)
| | - Nouara Arab
- Department of Internal Medicine, Intermunicipal Hospital Center of Créteil, 94000 Créteil, France; (A.F.); (N.A.)
| | - Bertrand Ferron
- Department of Internal Medicine, Hospital Center of Sens, 89100 Sens, France;
| | - Marie-Helene Groff
- Department of Internal Medicine, Hospital Center of Nord-Mayenne, 53100 Mayenne, France;
| | - Viviane Queyrel
- Department of Rheumatology, University Hospital of Nice, 06000 Nice, France;
| | - Christine Lorut
- Department of Pneumology, Cochin Hospital, AP-HP, Université de Paris, 75014 Paris, France; (C.L.); (L.R.)
| | - Lucile Regard
- Department of Pneumology, Cochin Hospital, AP-HP, Université de Paris, 75014 Paris, France; (C.L.); (L.R.)
| | - Emilie Berthoux
- Department of Internal Medicine, Saint Luc-Saint Joseph Hospital, 69007 Lyon, France;
| | - Guillaume Bayer
- Department of Internal Medicine, Claude Galien Hospital, 91480 Quincy sous Senart, France;
| | - Chloe Comarmond
- Department of Internal Medicine, Pitié-Salpétrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France;
| | - Bertrand Lioger
- Department of Internal Medicine, Simone Veil Hospital, 41000 Blois, France;
| | - Arsène Mekinian
- Department of Internal Medicine, Saint Antoine Hospital, APHP, 75012 Paris, France;
| | - Tali-Anne Szwebel
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Cochin Hospital, AP-HP, University of Paris, CEDEX 14, 75679 Paris, France;
| | - Thomas Sené
- Department of Internal Medicine, Fondation Rothschild, 75019 Paris, France;
| | - Blanca Amador-Borrero
- Department of Internal Medicine, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP) Université de Paris, 75010 Paris, France; (J.G.); (B.A.-B.); (O.M.); (S.M.); (D.S.)
| | - Olivier Mangin
- Department of Internal Medicine, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP) Université de Paris, 75010 Paris, France; (J.G.); (B.A.-B.); (O.M.); (S.M.); (D.S.)
| | - Pierre O. Sellier
- Department of Infectious Disease, Lariboisière Hospital, APHP, 75010 Paris, France;
| | - Virginie Siguret
- Haemostasis Laboratory, Lariboisière Hospital, AP-HP, University of Paris, 75010 Paris, France; (M.D.); (M.N.); (A.S.); (V.S.)
| | - Stéphane Mouly
- Department of Internal Medicine, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP) Université de Paris, 75010 Paris, France; (J.G.); (B.A.-B.); (O.M.); (S.M.); (D.S.)
| | | | | | - Dominique Vodovar
- Centre Anti-Poison, Fernand Widal Hospital, AP-HP, University of Paris, 75010 Paris, France;
- INSERM UMRS 1144, 75006 Paris, France
| | - Damien Sene
- Department of Internal Medicine, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, (AP-HP) Université de Paris, 75010 Paris, France; (J.G.); (B.A.-B.); (O.M.); (S.M.); (D.S.)
| |
Collapse
|
37
|
Remy-Jardin M, Duthoit L, Perez T, Felloni P, Faivre JB, Fry S, Bautin N, Chenivesse C, Remy J, Duhamel A. Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients. EClinicalMedicine 2021; 34:100778. [PMID: 33817609 PMCID: PMC8008988 DOI: 10.1016/j.eclinm.2021.100778] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND During COVID-19, the main manifestations of the disease are not only pneumonia but also coagulation disorders. The purpose of this study was to evaluate pulmonary vascular abnormalities 3 months after hospitalization for SARS-CoV-2 pneumonia in patients with persistent respiratory symptoms. METHODS Among the 320 patients who participated in a systematic follow-up 3 months after hospitalization, 76 patients had residual symptoms justifying a specialized follow-up in the department of pulmonology. Among them, dual-energy CT angiography (DECTA) was obtained in 55 patients. FINDINGS The 55 patients had partial (n = 40; 72.7%) or complete (n = 15; 27.3%) resolution of COVID-19 lung infiltration. DECTA was normal in 52 patients (52/55; 94.6%) and showed endoluminal filling defects in 3 patients (3/55; 5.4%) at the level of one (n = 1) and two (n = 1) segmental arteries of a single lobe and within central and peripheral arteries (n = 1). DECT lung perfusion was rated as non-interpretable (n = 2;3.6%), normal (n = 17; 30.9%) and abnormal (n = 36; 65.5%), the latter group comprising 32 patients with residual COVID-19 opacities (32/36; 89%) and 4 patients with normal lung parenchyma (4/36; 11%). Perfusion abnormalities consisted of (a) patchy defects (30/36; 83%), (b) PE-type defects (6/36; 16.6%) with (n = 1) or without proximal thrombosis (n = 5); and (c) focal areas of hypoperfusion (2/36; 5.5%). Increased perfusion was seen in 15 patients, always matching GGOs, bands and/or vascular tree-in- bud patterns. INTERPRETATION DECT depicted proximal arterial thrombosis in 5.4% of patients and perfusion abnormalities suggestive of widespread microangiopathy in 65.5% of patients. Lung microcirculation was abnormal in 4 patients with normal lung parenchyma.
Collapse
Affiliation(s)
- Martine Remy-Jardin
- Univ.Lille, CHU Lille, Department of Thoracic Imaging, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
| | - Louise Duthoit
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Univ.Lille, CHU Lille, Department of Pulmonology, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Thierry Perez
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Department of Pulmonary Function Testing, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Paul Felloni
- Univ.Lille, CHU Lille, Department of Thoracic Imaging, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
| | - Jean-Baptiste Faivre
- Univ.Lille, CHU Lille, Department of Thoracic Imaging, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
| | - Stéphanie Fry
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Univ.Lille, CHU Lille, Department of Pulmonology, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Nathalie Bautin
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Univ.Lille, CHU Lille, Department of Pulmonology, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Cécile Chenivesse
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Univ.Lille, CHU Lille, Department of Pulmonology, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Jacques Remy
- Univ.Lille, CHU Lille, Department of Thoracic Imaging, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
| | - Alain Duhamel
- Univ.Lille, CHU Lille, Department of Biostatistics, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
| |
Collapse
|
38
|
Henrina J, Santosa Putra IC, Cahyadi I, Lawrensia S, Hadi Gunawan HF, Cahyadi A, Franke J, Suciadi LP. Clinical characteristics and outcomes of venous thromboembolism in patients hospitalized for COVID-19: Systematic review and meta-analysis. THROMBOSIS UPDATE 2021; 2:100037. [PMID: 38620815 PMCID: PMC7857988 DOI: 10.1016/j.tru.2021.100037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/19/2022] Open
Abstract
Venous thromboembolism is prevalent in hospitalized COVID-19 patients. Through systematic review and meta-analysis, we have investigated the differences in clinical characteristics and outcome of hospitalized COVID-19 patients with (+) and without (-) venous thromboembolism (VTE). 45 studies with a total of 8859 patients were included in the qualitative synthesis. Subsequently, 38 studies with a total of 7847 patients, were quantitatively analyzed. There was no mortality difference between the VTE (-) and VTE (+) hospitalized COVID-19 patients (RR1.32 (0.97, 1.79); 0.07; I2 64%, p < 0.001). Patients with VTE (+) were more likely to get admitted to the intensive care unit (RR1.77 (1.26, 2.50); p < 0.001; I2 63%, p = 0.03) and mechanically ventilated (RR 2.35 (1.22, 4.53); p = 0.01; I2 88%, p < 0.001). Moreover, male gender (RR 1.19 (1.14,1.24), p < 0.001; I2 0%, p = 0.68), increased the risk of VTE. Regarding patients lab values', VTE (+) was significantly associated with higher white blood cell, neutrophil count, D-Dimer, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and C-reactive protein (CRP), along with prolonged prothrombin time. On the contrary, VTE (+) was associated with lower albumin and neutrophil-lymphocyte ratio (NLR). This findings provide the initial framework for risk stratification of hospitalized COVID-19 patients with VTE.
Collapse
Affiliation(s)
| | | | | | - Sherly Lawrensia
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jl. Pluit Raya No.2, RT.21/RW.8, Penjaringan, Kec. Penjaringan, Kota Jakarta Utara, Daerah Khusus Ibukota Jakarta, 14440, Indonesia
| | | | - Alius Cahyadi
- Department of Internal Medicine, School of Medicine and Health Sciences. Atma Jaya Catholic University of Indonesia/ Atma Jaya Hospital, Jakarta, Indonesia
| | | | | |
Collapse
|
39
|
Kwee RM, Adams HJA, Kwee TC. Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis. Eur Radiol 2021; 31:8168-8186. [PMID: 33966132 PMCID: PMC8106765 DOI: 10.1007/s00330-021-08003-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/24/2021] [Accepted: 04/19/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate, in a meta-analysis, the frequency of pulmonary embolism (PE) in patients with COVID-19 and whether D-dimer assessment may be useful to select patients for computed tomography pulmonary angiography (CTPA). METHODS A systematic literature search was performed for original studies which reported the frequency of PE on CTPA in patients with COVID-19. The frequency of PE, the location of PE, and the standardized mean difference (SMD) of D-dimer levels between patients with and without PE were pooled by random effects models. RESULTS Seventy-one studies were included. Pooled frequencies of PE in patients with COVID-19 at the emergency department (ED), general wards, and intensive care unit (ICU) were 17.9% (95% CI: 12.0-23.8%), 23.9% (95% CI: 15.2-32.7%), and 48.6% (95% CI: 41.0-56.1%), respectively. PE was more commonly located in peripheral than in main pulmonary arteries (pooled frequency of 65.3% [95% CI: 60.0-70.1%] vs. 32.9% [95% CI: 26.7-39.0%]; OR = 3.540 [95% CI: 2.308-5.431%]). Patients with PE had significantly higher D-dimer levels (pooled SMD of 1.096 [95% CI, 0.844-1.349]). D-dimer cutoff levels which have been used to identify patients with PE varied between 1000 and 4800 μg/L. CONCLUSION The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries, which suggests local thrombosis to play a major role. D-dimer assessment may help to select patients with COVID-19 for CTPA, using D-dimer cutoff levels of at least 1000 μg/L. KEY POINTS • The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. • PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries. • D-dimer levels are significantly higher in patients with COVID-19 who have PE.
Collapse
Affiliation(s)
- Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands.
| | | | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|