Dataset Information

Prediccion del desarrollo de tromboembolia pulmonar en pacientes con infeccion por SARS-CoV-2 Prediction of pulmonary embolism in patients with SARS-CoV-2 infection

ABSTRACT:

Objetivo

Pretendemos determinar los factores predictores de enfermedad tromboembólica pulmonar (ETEP) en pacientes con infección por SARS-CoV-2 (COVID-19) atendidos en el servicio de urgencias de un hospital terciario durante la primera ola pandémica.

Métodos

Estudio observacional unicéntrico realizado en una cohorte retrospectiva de pacientes con infección confirmada por SARS-CoV-2 (o alta sospecha clínico-radiológica de COVID-19) sometidos a despistaje de ETEP mediante tomografía computarizada de arterias pulmonares (TCAP). Se exploraron los factores predictores de ETEP mediante regresión logística, creándose dos modelos predictivos (sin o con los valores de dímeros-D).

Resultados

De un total de 274 TCAP realizados, 70 procedimientos presentaron hallazgos diagnósticos de ETEP, representando una incidencia acumulada del 25,54% (intervalo de confianza [IC] 95%: 20,49-31,14). En el modelo no ajustado por el nivel de dímeros-D, la frecuencia respiratoria > 22 rpm (odds ratio [OR]: 3,162; IC 95%: 1,627-6,148; p = 0,001) y la ausencia de hallazgos sugerentes de COVID-19 en la radiología simple de tórax (OR: 3,869; IC 95%: 0,869-17,225; p = 0,076) fueron predictores de ETEP. En el segundo modelo se mantuvo la presencia de taquipnea (OR: 4,967; IC 95%: 2,053-12,018; p < 0,001), identificándose además un nivel de dímeros-D > 3.000 ng/mL (OR: 7,494; IC 95%: 3,038-18,485; p < 0,001).

Conclusiones

La presencia de taquipnea (> 22 rpm) y la ausencia de hallazgos radiológicos sugestivos de infección por SARS-CoV-2 en la radiografía simple de tórax, además de los valores de dímero-D > 3.000 ng/mL, fueron identificados como factores predictores de ETEP en pacientes con COVID-19.

SUBMITTER: Gil Mosquera M

PROVIDER: S-EPMC8103176 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background and aimsSeveral studies reported a high incidence of pulmonary embolism (PE) among patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but detailed data about clinical characteristics, risk factors of these patients and prognostic role of PE are still lacking. We aim to evaluate the occurrence of pulmonary embolism among patients with SARS-CoV-2 infection, and to describe their risk factors, clinical characteristics, and in-hospital clinical outcomes.MethodsThis is a multicenter Italian study including 333 consecutive SARS-CoV-2 patients admitted to seven hospitals from February 22 to May 15, 2020. All the patients underwent computed tomography pulmonary angiography (CTPA) for PE detection. In particular, CTPA was performed in case of inadequate response to high-flow oxygen therapy (Fi02≥0.4 to maintain Sp02≥92%), elevated D-dimer (>0.5μg/mL), or echocardiographic signs of right ventricular dysfunction. Clinical, laboratory and radiological data were also analyzed.ResultsAmong 333 patients with laboratory confirmed SARS-CoV-2 pneumonia and undergoing CTPA, PE was detected in 109 (33%) cases. At CTPA, subsegmental, segmental, lobar and central thrombi were detected in 31 (29%), 50 (46%), 20 (18%) and 8 (7%) cases, respectively. In-hospital death occurred in 29 (27%) patients in the PE-group and in 47 (21%) patients in the non-PE group (p = 0.25). Patients in PE-group had a low rate of traditional risk factors and deep vein thrombosis was detected in 29% of patients undergoing compression ultrasonography. In 71% of cases with documented PE, the thrombotic lesions were located in the correspondence of parenchymal consolidation areas.ConclusionsDespite a low rate of risk factors for venous thromboembolism, PE is present in about 1 out 3 patients with SARS-CoV-2 pneumonia undergoing CTPA for inadequate response to oxygen therapy, elevated D-dimer level, or echocardiographic signs of right ventricular dysfunction. In most of the cases, the thromboses were located distally in the pulmonary tree and were mainly confined within pneumonia areas.