Predictors of pulmonary embolism in hospitalized patients with COVID-19
Background High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). Methods We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE. Results 92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03–1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01–1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04–1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24–154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01). Conclusions In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:21 |
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| Enthalten in: |
Thrombosis journal - 21(2023), 1 vom: 03. Juli |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bahk, Jeeyune [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| Themen: |
Coagulopathy |
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| Anmerkungen: |
© The Author(s) 2023. corrected publication 2023 |
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| doi: |
10.1186/s12959-023-00518-y |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
SPR052136698 |
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| 520 | |a Background High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). Methods We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE. Results 92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03–1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01–1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04–1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24–154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01). Conclusions In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19. | ||
| 650 | 4 | |a Pulmonary embolism |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Venous Thromboembolism |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Coagulopathy |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a D-dimer |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Coronavirus disease 2019 |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Rehman, Abdul |4 aut | |
| 700 | 1 | |a Ho, Kam Sing |4 aut | |
| 700 | 1 | |a Narasimhan, Bharat |4 aut | |
| 700 | 1 | |a Baloch, Hafiza Noor Ul Ain |4 aut | |
| 700 | 1 | |a Zhang, Jiafang |4 aut | |
| 700 | 1 | |a Yip, Rowena |4 aut | |
| 700 | 1 | |a Lookstein, Robert |4 aut | |
| 700 | 1 | |a Steiger, David J |4 aut | |
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