ABSTRACT
COVID-19 coagulopathy has gained attention due to the strikingly high prevalence of deep vein thrombosis (DVT) and pulmonary embolism (PE). We describe here a case of bilateral PE preceded by mild COVID-19 contracted 4.5 months earlier in a male patient who presented to the outpatient clinic with exertional dyspnea. The patient had developed PE 9 years earlier, when no underlying genetic factor was detected. In the 4.5 months after contracting mild COVID-19, he presented four times with exertional dyspnea and a thorax computer tomography angiography (CTA) on two occasions and one perfusion scintigraphy revealed no embolism. Based on his high D-dimer values, his symptoms and his history of PE, he was placed on prolonged PE prophylaxis, which was stopped 33 days ago, and at that time, CTA revealed extensive bilateral PE. In conclusion, an unusually longer activation in COVID-19 coagulopathy may co-exist in patients with a history of previous PE, ongoing symptoms and increased D-dimer levels, irrespective of the COVID-19 severity.
ABSTRACT
INTRODUCTION: The magnitude of the coronavirus 2019 (COVID-19) pandemic has produced a great need to determine laboratory parameters of prognostic significance. This information will help identify patients at risk of severe disease and assist in the optimal allocation of limited medical resources. The aim of this study was to determine the usefulness of systemic-immune-inflammation index (SII), lymphocyte-to-CRP ratio (LCR), platelet-to-lymphocyte ratio (PLR) and mean thrombocyte volume-to-platelet count ratio (MPV/PLT) values compared with the commonly used laboratory parameters of absolute lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), as prognostic biomarkers of COVID-19. METHODS: The medical records of patients hospitalized with COVID-19 pneumonia between March 2020 and May 2020 were retrospectively evaluated. The NLR, PLR, LCR, SII, and MPV/PLT values were calculated based on laboratory parameters. The need for oxygen support, non-invasive mechanical ventilation (NIMV), and intensive care treatment were documented, as well as mortal outcomes. The patients were divided into a non-severe group and a severe disease group, which was defined by a respiratory rate of >30/minute or an oxygen saturation <90%. RESULTS: A total of 84 patients were enrolled, including 62 (73.8%) males. The mean age of the study group was 54.07+or-15.70 years. Thirty-seven had at least 1 comorbidity. Twenty-eight patients (33.3%) had severe disease, with 13 (15.5%) requiring NIMV and 13 (15.5%) needing intensive care. Eleven patients died during the study period. Elevated CRP and NLR and decreased absolute lymphocyte counts were statistically significant in predicting disease severity, need for intensive case treatment, and mortality. The SII and PLR findings also reached statistical significance in the prediction of disease severity and the need for intensive care, and the LCR value was a significant predictor of all 3 outcomes. The MPV/PLT ratio was significant only in forecasting mortality. DISCUSSION AND CONCLUSION: Our results indicate that inflammatory indexes can be used as prognostic predictors in COVID-19 pneumonia. These index measurements are cost-effective and readily available, and therefore can aid in the early identification and timely medical management of severe cases.