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Abuzaid M, Elshami W, Cavli B, Ozturk C, ALMisned G, Tekin HO. A closer look at the utilized radiation doses during computed tomography pulmonary angiography (CTPA) for COVID-19 patients. Radiat Phys Chem Oxf Engl 1993 2023; 211:111025. [PMID: 37250685 PMCID: PMC10210819 DOI: 10.1016/j.radphyschem.2023.111025] [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: 04/06/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
Introduction CTPA stands for computed tomography pulmonary angiography. CTPA is an X-ray imaging that combines X-rays and computer technology to create detailed images of the pulmonary arteries and veins in the lungs. This test diagnoses and monitors conditions like pulmonary embolism, arterial blockages, and hypertension. Coronavirus (COVID-19) has threatened world health over the last three years. The number of (CT) scans increased and played a vital role in diagnosing COVID-19 patients, including life-threatening pulmonary embolism (PE). This study aimed to assess the radiation dose resulted from CTPA for COVID-19 patients. Methods Data were collected retrospectively from CTPA examinations on a single scanner in 84 symptomatic patients. The data collected included the dose length product (DLP), volumetric computed tomography dose index (CTDIvol), and size-specific dose estimate (SSDE). The organ dose and effective dose were estimated using VirtualDose software. Results The study population included 84 patients, 52% male and 48% female, with an average age of 62. The average DLP, CTDIvol, and SSDE were 404.2 mGy cm, 13.5 mGy, and 11.6 mGy\, respectively. The mean effective doses (mSv) for males and females were 3.01 and 3.29, respectively. The maximum to minimum organ doses (mGy) between patients was 0.8 for the male bladder and 7.33 for the female lung. Conclusions The increase in CT scans during the COVID-19 pandemic required close dose monitoring and optimization. The protocol used during CTPA should guarantee a minimum radiation dose with maximum patient benefits.
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Affiliation(s)
- Mohamed Abuzaid
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Wiam Elshami
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | | | | | - Ghada ALMisned
- Department of Physics, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - H O Tekin
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Istinye University, Faculty of Engineering and Natural Sciences, Computer Engineering Department, Istanbul, 34396, Turkey
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2
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Franco-Moreno A, Brown-Lavalle D, Rodríguez-Ramírez N, Muñoz-Roldán C, Rubio-Aguilera AI, Campos-Arenas M, Muñoz-Rivas N, Moya-Mateo E, Ruiz-Giardín JM, Pardo-Guimerá V, Ulla-Anes M, Pedrero-Tomé R, Torres-Macho J, Bustamante-Fermosel A. Clinical prediction model for pulmonary thrombosis diagnosis in hospitalized patients with SARS-CoV-2 infection. J Clin Transl Res 2023; 9:59-68. [PMID: 37034002 PMCID: PMC10075091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Aim We aimed to develop a clinical prediction model for pulmonary thrombosis (PT) diagnosis in hospitalized COVID-19 patients. Methods Non-intensive care unit hospitalized COVID-19 patients who underwent a computed tomography pulmonary angiogram (CTPA) for suspected PT were included in the study. Demographic, clinical, analytical, and radiological variables as potential factors associated with the presence of PT were selected. Multivariable Cox regression analysis to develop a score for estimating the pre-test probability of PT was performed. The score was internally validated by bootstrap analysis. Results Among the 271 patients who underwent a CTPA, 132 patients (48.7%) had PT. Heart rate >100 bpm (OR = 4.63 [95% CI: 2.30-9.34]; P < 0.001), respiratory rate >22 bpm (OR = 5.21 [95% CI: 2.00-13.54]; P < 0.001), RALE score ≥4 (OR = 3.24 [95% CI: 1.66-6.32]; P < 0.001), C-reactive protein (CRP) >100 mg/L (OR = 2.10 [95% CI: 0.95-4.63]; P = 0.067), and D-dimer >3.000 ng/mL (OR = 6.86 [95% CI: 3.54-13.28]; P < 0.001) at the time of suspected PT were independent predictors of thrombosis. Using these variables, we constructed a nomogram (CRP, Heart rate, D-dimer, RALE score, and respiratory rate [CHEDDAR score]) for estimating the pre-test probability of PT. The score showed a high predictive accuracy (area under the receiver-operating characteristics curve = 0.877; 95% CI: 0.83-0.92). A score lower than 182 points on the nomogram confers a low probability for PT with a negative predictive value of 92%. Conclusions CHEDDAR score can be used to estimate the pre-test probability of PT in hospitalized COVID-19 patients outside the intensive care unit. Relevance for Patients Developing a new clinical prediction model for PT diagnosis in COVID-19 may help in the triage of patients, and limit unnecessary exposure to radiation and the risk of nephrotoxicity due to iodinated contrast.
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Affiliation(s)
- Anabel Franco-Moreno
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
- Corresponding author: Anabel Franco-Moreno Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre. Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | - David Brown-Lavalle
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
- Corresponding author: Anabel Franco-Moreno Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre. Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | | | - Candela Muñoz-Roldán
- Department of Radiology, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Ana Ignes Rubio-Aguilera
- Department of Radiology, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Maria Campos-Arenas
- Department of Radiology, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Nuria Muñoz-Rivas
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Eva Moya-Mateo
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | | | - Virginia Pardo-Guimerá
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Mariano Ulla-Anes
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Roberto Pedrero-Tomé
- EPINUT-UCM (Ref. 920325) Investigation Group, Universidad Complutense de Madrid, Madrid, Spain
- Fundación para la Investigación e Innovación Biomédica de los Hospitales Universitarios Infanta Leonor y del Sureste, Madrid, Spain
| | - Juan Torres-Macho
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
- Corresponding author: Anabel Franco-Moreno Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre. Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | - Ana Bustamante-Fermosel
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
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3
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Arslanhan G, Ak K, Öztürk F, Türker A, Bozkurtlar E, Arsan S, Yıldızeli B. Pulmonary artery sarcoma treated with pulmonary endarterectomy and leaflet reconstruction using Ozaki technique. J Card Surg 2022; 37:5630-5633. [PMID: 36378914 DOI: 10.1111/jocs.17172] [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: 04/11/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Pulmonary arterial intimal sarcomas (PAIS) are rare malignancies with a poor prognosis. Sarcomas present with signs and symptoms mimicking pulmonary thromboembolic disease, delaying the diagnosis. We present a 29-year-old male patient diagnosed with PAIS in the right and main pulmonary arteries extending to the left pulmonary leaflet. The patient was treated with pulmonary endarterectomy and pulmonary leaflet reconstruction using the Ozaki technique.
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Affiliation(s)
- Gokhan Arslanhan
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Koray Ak
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Fatih Öztürk
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Alperen Türker
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Emine Bozkurtlar
- Department of Pathology, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Sinan Arsan
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Bedrettin Yıldızeli
- Department of Thoracic Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
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4
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Iqbal N, Khanum I, Kazi MAI, Riaz SU, Khawaja UA, Awan S, Irfan M, Zubairi ABS, Khan JA. Post COVID-19 sequelae of the respiratory system. A single center experience reporting the compromise of the airway, alveolar and vascular components. Monaldi Arch Chest Dis 2022. [DOI: 10.4081/monaldi.2022.2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
The long-term sequelae of COVID-19 have now become more common and appreciable. The SARS-CoV-2 virus can cause a variety of infectious and non-infectious pulmonary complications. The purpose of this study is to raise awareness about post-COVID-19 pulmonary sequelae, both infectious and non-infectious, in this geographical area. A retrospective study was conducted from July 1st 2020 to December 20th 2020. A total of 1200 patients were evaluated, with 83 suffering from post-COVID-19 pulmonary complications. The patients' mean age was 62 years (IQR 55-69), with 63 (75.9%) being male. The most common co-morbid illnesses were hypertension (49, 59%) and diabetes (45, 54.2%). The majority of them (37, 44.6%) had severe COVID-19, followed by critical COVID-19 (33, 39.8%). There was no statistically significant difference in recurrence of respiratory symptoms or duration of current illness between non-severe, severe, and critical COVID-19 patients. Non-infectious complications were observed in the majority of patients (n=76, 91.5%), including organizing pneumonia/ground glass opacities in 71 (88%) patients, fibrosis in 44 (55%), pulmonary embolism in 10 (12.5%), pneumomediastinum in 6 (7.4%) and pneumothorax in 7 (8.6%). Infective complications (25, 30.1%) included aspergillus infection in 10 (12.0%) and bacterial infection in 5 (8.47%), with more gram-negative infections and one patient developing Mycobacterium tuberculosis. Post COVID-19 mortality was 11 (13.3%). The long-term pulmonary sequelae of COVID-19 are not rare. Cryptogenic organizing pneumonia, ground glass opacities, and fibrosis were common post-COVID-19 sequelae in our patients. This necessitates frequent close monitoring of these patients in order to initiate early appropriate management and prevent further morbidity and eventual mortality.
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5
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Chevrot G, Hauguel-Moreau M, Pépin M, Vieillard-Baron A, Lot AS, Ouadahi M, Hergault H, Aïdan V, Greffe S, Costantini A, Dubourg O, Beaune S, Mansencal N. Electrocardiogram abnormalities and prognosis in COVID-19. Front Cardiovasc Med 2022; 9:993479. [PMID: 36277756 PMCID: PMC9581294 DOI: 10.3389/fcvm.2022.993479] [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: 07/13/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background COVID-19 is a major pandemic with potential cardiovascular complications. Few studies have focused on electrocardiogram (ECG) modifications in COVID-19 patients. Method and results We reviewed from our database all patients referred to our hospital for COVID-19 between January 1st, 2020, and December 31st, 2020: 669 patients were included and 98 patients died from COVID-19 (14.6%). We systematically analyzed ECG at admission and during hospitalization if available. ECG was abnormal at admission in 478 patients (71.4%) and was more frequently abnormal in patients who did not survive (88.8 vs. 68.5%, p < 0.001). The most common ECG abnormalities associated with death were left anterior fascicular block (39.8 vs. 20.0% among alive patients, p < 0.001), left and right bundle branch blocks (p = 0.002 and p = 0.02, respectively), S1Q3 pattern (14.3 vs. 6.0%, p = 0.006). In multivariate analysis, at admission, the presence of left bundle branch block remained statistically related to death [OR = 3.82, 95% confidence interval (CI): 1.52–9.28, p < 0.01], as well as S1Q3 pattern (OR = 3.17, 95% CI: 1.38–7.03, p < 0.01) and repolarization abnormalities (OR = 2.41, 95% CI: 1.40–4.14, p < 0.01). On ECG performed during hospitalization, the occurrence of new repolarization abnormality was significantly related to death (OR = 2.72, 95% CI: 1.14–6.54, p = 0.02), as well as a new S1Q3 pattern (OR = 13.23, 95% CI: 1.49–286.56, p = 0.03) and new supraventricular arrhythmia (OR = 3.8, 95% CI: 1.11–13.35, p = 0.03). Conclusion The presence of abnormal ECG during COVID-19 is frequent. Physicians should be aware of the usefulness of ECG for risk stratification during COVID-19.
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Affiliation(s)
- Gabriel Chevrot
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Marie Hauguel-Moreau
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France,*Correspondence: Marie Hauguel-Moreau
| | - Marion Pépin
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France,Department of Geriatrics, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Antoine Vieillard-Baron
- INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France,Intensive Care Unit, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France,FHU SEPSIS IFrancenserm UMR 1144, Université Paris Centre, Paris, France
| | - Anne-Sophie Lot
- Department of Medical Information, Ambroise Paré Hospital, APHP, Boulogne-Billancourt, France
| | - Mounir Ouadahi
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Hélène Hergault
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Vincent Aïdan
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France
| | - Ségolène Greffe
- Department of Internal Medicine, Ambroise Paré University Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Adrien Costantini
- Pneumology Department, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Olivier Dubourg
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
| | - Sébastien Beaune
- FHU SEPSIS IFrancenserm UMR 1144, Université Paris Centre, Paris, France,Department of Emergency Medicine, Ambroise Paré Hospital, AP-HP, UVSQ, Boulogne-Billancourt, France
| | - Nicolas Mansencal
- Department of Cardiology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou rares, Université de Versailles-Saint Quentin (UVSQ), Boulogne-Billancourt, France,INSERM U-1018, CESP, Epidémiologie clinique, UVSQ, Université de Paris Saclay, Villejuif, France
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Rotzinger DC, Qanadli SD. Should Vascular Abnormalities Be Integrated Into the Chest CT Imaging Signature of Coronavirus Disease 2019? Chest 2021; 159:2107-2108. [PMID: 33965133 PMCID: PMC8097331 DOI: 10.1016/j.chest.2020.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- David C Rotzinger
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Salah D Qanadli
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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7
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Li Z, Li X, Shen J, Chan MTV, Wu WKK. Miller Fisher syndrome associated with COVID-19: an up-to-date systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:20939-20944. [PMID: 33677662 PMCID: PMC7936860 DOI: 10.1007/s11356-021-13233-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/26/2021] [Indexed: 05/02/2023]
Abstract
Recently, during the pandemic infection of the novel SARS-CoV-2, some cases of Miller Fisher syndrome (MFS) have been reported. We want to summarize the main features of patients with MFS and COVID-19. A PubMed search was performed on 8 October to identify references reporting cases with MFS associated with COVID-19 from the first report of COVID-19 to 8 October 2020 using the following keywords: "Miller Fisher syndrome" AND "COVID-19" OR "SARS-CoV-2". A systematic review from the first report of coronavirus disease 2019 (COVID-19) to 8 October 2020 revealed 7 cases with Miller Fisher syndrome (MFS) associated with COVID-19. The 7 cases came from 5 countries but most of these patients were from Europe (85.7%), especially Spain. There are 5 cases of MFS diagnosed after the laboratory confirmation of SARS-CoV-2 infection. The mean onset time of MFS-associated neurological symptoms was 14.75 days after the diagnosis of COVID-19. However, the two remaining cases presented initially with MFS-associated neurological symptoms followed by the diagnosis of COVID-19. The most common symptoms of COVID-19-associated MFS were perioral paresthesias (57.1%), ataxia (57.1%), blurred vision (42.9), ophthalmoplegia (42.9), and generalized areflexia (42.9). However, more cohort and case-control studies are required to establish the epidemiological linkage.
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Affiliation(s)
- Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100042, China
| | - Xingye Li
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua University, Beijing, China
| | - Jianxiong Shen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100042, China.
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - William Ka Kei Wu
- Department of Anaesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, China
- State Key Laboratory of Digestive Disease and LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
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8
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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.
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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.)
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9
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Akhter MS, Hamali HA, Mobarki AA, Rashid H, Oldenburg J, Biswas A. SARS-CoV-2 Infection: Modulator of Pulmonary Embolism Paradigm. J Clin Med 2021; 10:1064. [PMID: 33806540 PMCID: PMC7961449 DOI: 10.3390/jcm10051064] [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: 12/29/2020] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 12/29/2022] Open
Abstract
Pulmonary embolism (PE) is a life-threatening complication arising from venous thromboembolism with a difficult diagnosis and treatment and is often associated with increased mortality and morbidity. PE had a significantly low incidence prior to the COVID-19 epidemic. This condition saw a sharp surge during the COVID-19 pandemic, indicating an evident viral influence on PE's pathophysiology in COVID-19 patients. The hypercoagulable state induced by the viral load seems to be the major contributor, and the classical causative factors seem to play a lesser role. PE in COVID-19 infection has become a mammoth challenge since the diagnosis is quite challenging due to overlapping symptoms, lack of prior-known predisposing risk factors, limited resources, and viral transmittance risk. Numerous factors arising out of the viral load or treatment lead to an increased risk for PE in COVID-19 patients, besides the fact that certain unknown risk factors may also contribute to the incidence of PE in COVID-19 patients. The management of PE in COVID-19 infection mainly comprises thromboprophylaxis and anticoagulant therapy with mechanical ventilation, depending on the risk stratification of the patient, with a post-COVID-19 management that prevents recurrent PE and complications. This review aims to discuss various aspects of COVID-19-infection-associated PE and major differential aspects from non-COVID-19 PE.
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Affiliation(s)
- Mohammad Suhail Akhter
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.S.A.); (H.A.H.); (A.A.M.)
| | - Hassan A. Hamali
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.S.A.); (H.A.H.); (A.A.M.)
| | - Abdullah A. Mobarki
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia; (M.S.A.); (H.A.H.); (A.A.M.)
| | - Hina Rashid
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia;
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, 53127 Bonn, Germany;
| | - Arijit Biswas
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, 53127 Bonn, Germany;
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10
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Lichota A, Szewczyk EM, Gwozdzinski K. Factors Affecting the Formation and Treatment of Thrombosis by Natural and Synthetic Compounds. Int J Mol Sci 2020; 21:E7975. [PMID: 33121005 PMCID: PMC7663413 DOI: 10.3390/ijms21217975] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022] Open
Abstract
Venous thromboembolism (VTE) refers to deep vein thrombosis (DVT), whose consequence may be a pulmonary embolism (PE). Thrombosis is associated with significant morbidity and mortality and is the third most common cardiovascular disease after myocardial infarction and stroke. DVT is associated with the formation of a blood clot in a deep vein in the body. Thrombosis promotes slowed blood flow, hypoxia, cell activation, and the associated release of many active substances involved in blood clot formation. All thrombi which adhere to endothelium consist of fibrin, platelets, and trapped red and white blood cells. In this review, we summarise the impact of various factors affecting haemostatic disorders leading to blood clot formation. The paper discusses the causes of thrombosis, the mechanism of blood clot formation, and factors such as hypoxia, the involvement of endothelial cells (ECs), and the activation of platelets and neutrophils along with the effects of bacteria and reactive oxygen species (ROS). Mechanisms related to the action of anticoagulants affecting coagulation factors including antiplatelet drugs have also been discussed. However, many aspects related to the pathogenesis of thrombosis still need to be clarified. A review of the drugs used to treat and prevent thrombosis and natural anticoagulants that occur in the plant world and are traditionally used in Far Eastern medicine has also been carried out.
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Affiliation(s)
- Anna Lichota
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Faculty of Pharmacy, Medical University of Lodz, 90-235 Lodz, Poland; (A.L.); (E.M.S.)
| | - Eligia M. Szewczyk
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Faculty of Pharmacy, Medical University of Lodz, 90-235 Lodz, Poland; (A.L.); (E.M.S.)
| | - Krzysztof Gwozdzinski
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland
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