A Prospective Study Evaluating Cumulative Incidence and a Specific Prediction Rule in Pulmonary Embolism in COVID-19.
SARS-CoV-2
clinical decision rule
computed tomography angiography
coronavirus infections
fibrin fibrinogen degradation products
pandemics
venous thromboembolism
Journal
Frontiers in medicine
ISSN: 2296-858X
Titre abrégé: Front Med (Lausanne)
Pays: Switzerland
ID NLM: 101648047
Informations de publication
Date de publication:
2022
2022
Historique:
received:
05
05
2022
accepted:
25
05
2022
entrez:
18
7
2022
pubmed:
19
7
2022
medline:
19
7
2022
Statut:
epublish
Résumé
Abnormal values of hypercoagulability biomarkers, such as D-dimer, have been described in Coronavirus Disease 2019 (COVID-19), which has also been associated with disease severity and in-hospital mortality. COVID-19 patients with pneumonia are at greater risk of pulmonary embolism (PE). However, the real incidence of PE is not yet clear, since studies have been limited in size, mostly retrospective, and PE diagnostic procedures were only performed when PE was clinically suspected. (1) To determine the incidence, clinical, radiological, and biological characteristics, and clinical outcomes of PE among patients hospitalized for COVID-19 pneumonia with D-dimer > 1,000 ng/mL. (2) To develop a prognostic model to predict PE in these patients. Single-center prospective cohort study. Consecutive confirmed cases of COVID-19 pneumonia with D-dimer > 1,000 ng/mL underwent computed tomography pulmonary angiography (CTPA). Demographic and laboratory data, comorbidities, CTPA scores, treatments administered, and clinical outcomes were analyzed and compared between patients with and without PE. A risk score was constructed from all these variables. Between 6 April 2020 and 2 February 2021, 179 consecutive patients were included. The overall incidence of PE was 39.7% (71 patients) (CI 95%, 32-47%). In patients with PE, emboli were located mainly in segmental/subsegmental arteries (67%). Patients with PE did not differ from the non-PE group in sex, age, or risk factors for thromboembolic disease. Higher urea, D-Dimer, D-dimer-to-ferritin and D-dimer-to-lactate dehydrogenase (LDH) ratios, platelet distribution width (PDW), and neutrophil-to-lymphocyte ratio (NLR) values were found in patients with PE when compared to patients with non-PE. Besides, lymphocyte counts turned out to be lower in patients with PE. A score for PE prediction was constructed with excellent overall performance [area under the ROC curve-receiver operating characteristic (AUC-ROC) 0.81 (95% CI: 0.73-0.89)]. The PATCOM score stands for COVID-19 patients with pneumonia and D-dimer values > 1,000 ng/mL were presented with a very high incidence of PE, regardless of clinical suspicion. Significant differences in urea, D-dimer, PDW, NLR, and lymphocyte count were found between patients with PE and non-PE. The PATCOM score is presented in this study as a promising PE prediction rule, although validation in further studies is required.
Identifiants
pubmed: 35847817
doi: 10.3389/fmed.2022.936816
pmc: PMC9283900
doi:
Types de publication
Journal Article
Langues
eng
Pagination
936816Informations de copyright
Copyright © 2022 Suarez Castillejo, Toledo-Pons, Calvo, Ramon-Clar, Martínez, Hermoso de Mendoza, Morell-García, Bauça, Berga, Núñez, Preda, Sauleda, Argente Castillo, Ballesteros, Martín, Sala-Llinas and Alonso-Fernández.
Déclaration de conflit d'intérêts
AA-F reports personal fees from Astrazeneca, GSK, Chiesi, and Menarini, from outside the submitted work. JS reports personal fees, as a speaker, from Roche and Boehringer-Ingelheim, with no relationship with the submitted work. ES-L reports personal fees from Astrazeneca, GSK, and Boehringer-Ingelheim, personal and advisory board fees from MSD, and grants, personal, and advisory board fees from Actelion and Janssen, from outside the submitted work. BN reports personal fees from Roche, Brystol, and Boehringer-Ingelheim, with no relationship with the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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