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1.
J Infect Dev Ctries ; 15(5): 639-345, 2021 05 31.
Article in English | MEDLINE | ID: covidwho-1262631

ABSTRACT

Venous thromboembolism (VTE) represents an important clinical complication of patients with SARS-CoV-2 infection, and high plasma D-dimer levels could suggest a higher risk of hypercoagulability. We aimed to analyse if laboratory exams, risk assessment scores, comorbidity scores were useful in predicting the VTE in SARS-CoV-2 patients admitted in internal medicine (IM). We evaluated 49 older adults with suspected VTE analysing history and blood chemistry, besides we calculated the Padua Prediction Score, the modified early warning scoring (MEWS) and the modified Elixhauser index (mEI). All patients underwent venous color-doppler ultrasounds of the lower limbs. Out of the 49 patients enrolled (mean age 79.3±14 years), 10 (20.4%) had deep vein thrombosis (DVT), and they were more frequently female (80% vs 20%, p = 0.04). We could not find any association with the Padua Prediction Score, the MEWS, and the mEI. D-dimer plasma levels were also not associated with DVT. In elderly people hospitalized with SARS-CoV-2 infection hospitalized in IM, our data, although limited by the sample size, suggest that prediction and diagnosis of VTE is difficult, due to lack of precise biomarkers and scores.


Subject(s)
COVID-19/complications , Venous Thromboembolism/diagnosis , Aged , Aged, 80 and over , Biomarkers/blood , Case-Control Studies , Early Warning Score , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Lower Extremity/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Ultrasonography, Doppler, Color , Venous Thromboembolism/blood , Venous Thromboembolism/etiology
2.
Am J Phys Med Rehabil ; 100(5): 419-423, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1169718

ABSTRACT

OBJECTIVE: The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital. DESIGN: This is a retrospective review. SETTING: The setting is three freestanding inpatient rehabilitation hospitals operating as one system. PARTICIPANTS: The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer. INTERVENTIONS: A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital. OUTCOME MEASURES: Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis. RESULTS: A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness. CONCLUSIONS: The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.


Subject(s)
COVID-19/complications , COVID-19/rehabilitation , Hospitalization , Hospitals, Rehabilitation , Venous Thrombosis/diagnosis , Venous Thrombosis/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/diagnostic imaging , Female , Humans , Lower Extremity/blood supply , Lower Extremity/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Risk Factors , Ultrasonography, Doppler, Duplex , Young Adult
3.
Med Sci Monit ; 27: e929708, 2021 Apr 11.
Article in English | MEDLINE | ID: covidwho-1148368

ABSTRACT

BACKGROUND Since the outbreak of COVID-19 in December 2019, there have been 96 623 laboratory-confirmed cases and 4784 deaths by December 29 in China. We aimed to analyze the risk factors and the incidence of thrombosis from patients with confirmed COVID-19 pneumonia. MATERIAL AND METHODS Eighty-eight inpatients with confirmed COVID-19 pneumonia were reported (31 critical cases, 33 severe cases, and 24 common cases). The thrombosis risk factor assessment, laboratory results, ultrasonographic findings, and prognoses of these patients were analyzed, and compared among groups with different severity. RESULTS Nineteen of the 88 cases developed DVT (12 critical cases, 7 severe cases, and no common cases). In addition, among the 18 patients who died, 5 were diagnosed with DVT. Positive correlations were observed between the increase in D-dimer level (≥5 µg/mL) and the severity of COVID-19 pneumonia (r=0.679, P<0.01), and between the high Padua score (≥4) and the severity (r=0.799, P<0.01). In addition, the CRP and LDH levels on admission had positive correlations with the severity of illness (CRP: r=0.522, P<0.01; LDH: r=0.600, P<0.01). A negative correlation was observed between the lymphocyte count on admission and the severity of illness (r=-0.523, P<0.01). There was also a negative correlation between the lymphocyte count on admission and mortality in critical patients (r=-0.499, P<0.01). Univariable logistic regression analysis showed that the occurrence of DVT was positively correlated with disease severity (crude odds ratio: 3.643, 95% CI: 1.218-10.896, P<0.05). CONCLUSIONS Our report illustrates that critically or severely ill patients have an associated high D-dimer value and high Padua score, and illustrates that a low threshold to screen for DVT may help improve detection of thromboembolism in these groups of patients, especially in asymptomatic patients. Our results suggest that early administration of prophylactic anticoagulant would benefit the prognosis of critical patients with COVID-19 pneumonia and would likely reduce thromboembolic rates.


Subject(s)
COVID-19/complications , Fibrin Fibrinogen Degradation Products/analysis , Venous Thrombosis/epidemiology , Adult , Aged , Asymptomatic Diseases , COVID-19/blood , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , China/epidemiology , Female , Hospital Mortality , Humans , Incidence , Lower Extremity/blood supply , Lower Extremity/diagnostic imaging , Male , Middle Aged , Patient Admission , Prognosis , Retrospective Studies , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/isolation & purification , Severity of Illness Index , Ultrasonography , Venous Thrombosis/blood , Venous Thrombosis/diagnosis , Venous Thrombosis/etiology
4.
Eur Rev Med Pharmacol Sci ; 25(4): 2123-2130, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1116633

ABSTRACT

OBJECTIVE: Diffuse thrombosis represents one of the most predominant causes of death by COVID-19 and SARS-CoV-2 infection seems to increase the risk of developing venous thromboembolic diseases (VTE). Aim of this study is to analyze the relationship between validated predictive scores for VTE such as IMPROVE and IMPROVEDD and: (1) Intensification of Care (IoC, admission to Pulmonology Department or Intensive Care Unit) (2) in-hospital mortality rate 3) 30-days mortality rate. PATIENTS AND METHODS: We retrospectively evaluated 51 adult patients with laboratory diagnosis of SARS-CoV-2 infection and calculated IMPROVE and IMPROVEDD scores. All patients underwent venous color-Doppler ultrasound of the lower limbs to assess the presence of superficial vein thrombosis (SVT) and/or deep vein thrombosis (DVT). Patients with normal values of D-dimer did not receive heparin therapy (LMWH); patients with ≥ 4 ULN values of D-dimer or with a diagnosis of DVT were treated with therapeutic LMWH dosage, while the remaining patients were treated with prophylactic LMWH dosages. RESULTS: We found strong relations between IMPROVE score and the need for IoC and with the in-hospital mortality rate and between the IMPROVEDD score and the need for IoC. We defined that an IMPROVE score greater than 4 points was significantly associated to in-hospital mortality rate (p = 0.05), while an IMPROVEDD score greater than 3 points was associated with the need for IoC (p = 0.04). Multivariate logistic analysis showed how IMPROVE score was significantly associated to in-hospital and 30-days mortality rates. CONCLUSIONS: IMPROVE score can be considered an independent predictor of in-hospital and 30-days mortality.


Subject(s)
COVID-19/complications , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , SARS-CoV-2 , Venous Thrombosis/prevention & control , Adult , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/mortality , Critical Care/statistics & numerical data , Disease-Free Survival , Fibrin Fibrinogen Degradation Products/analysis , Fibrinolytic Agents/administration & dosage , Heparin, Low-Molecular-Weight/administration & dosage , Humans , Italy , Logistic Models , Lower Extremity/diagnostic imaging , Multivariate Analysis , Retrospective Studies , Risk Assessment , Risk Factors , Ultrasonography, Doppler, Duplex , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiology , Venous Thrombosis/mortality
5.
Clin Imaging ; 75: 1-4, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1039316

ABSTRACT

We describe a 40-year-old man with severe COVID-19 requiring mechanical ventilation who developed aorto-bi-iliac arterial, right lower extremity arterial, intracardiac, pulmonary arterial and ilio-caval venous thromboses and required right lower extremity amputation for acute limb ischemia. This unique case illustrates COVID-19-associated thrombotic complications occurring at multiple, different sites in the cardiovascular system of a single infected patient.


Subject(s)
COVID-19 , Hypertension, Pulmonary , Thrombosis , Venous Thrombosis , Adult , Amputation , Humans , Leg/diagnostic imaging , Leg/surgery , Lower Extremity/diagnostic imaging , Lower Extremity/surgery , Male , SARS-CoV-2 , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/surgery , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/surgery
6.
Radiol Med ; 126(5): 722-728, 2021 May.
Article in English | MEDLINE | ID: covidwho-1037984

ABSTRACT

BACKGROUND: Preliminary reports suggest a hypercoagulable state in COVID-19. Deep vein thrombosis (DVT) is perceived as a frequent finding in hospitalized COVID-19 patients, but data describing the prevalence of DVT are lacking. OBJECTIVES: We aimed to report the prevalence of DVT in COVID-19 patients in general wards, blinded to symptoms/signs of disease, using lower extremities duplex ultrasound (LEDUS) in random patients. We tested the association of DVT with clinical, laboratory and inflammatory markers and also reported on the secondary endpoint of in-hospital mortality. PATIENTS/METHODS: n  = 263 COVID-19 patients were screened with LEDUS between March 01, 2020 and April 05, 2020 out of the overall n = 1012 admitted with COVID-19. RESULTS: DVT was detected in n = 67 screened patients (25.5%), n = 41 patients (15.6%) died during the index hospitalization. Multiple logistic regression demonstrated that only C-reactive protein (odds ratio 1.009, 95% CI 1.004-1.013, p < 0.001) was independently associated with the presence of DVT at LEDUS. Both age (odds ratio 1.101, 95% CI 1.054-1.150, p < 0.001) and C-reactive protein (odds ratio 1.012, 95% CI 1.006-1.018, p < 0.001) were instead significantly independently associated with in-hospital mortality. CONCLUSIONS: The main study finding is that DVT prevalence in COVID-19 patients admitted to general wards is 25.5%, suggesting it may be reasonable to screen COVID-19 patients for this potentially severe but treatable complication, and that inflammation, measured with serum C-reactive protein, is the main variable associated with the presence of DVT, where all other clinical or laboratory variables, age or D-dimer included, are instead not independently associated with DVT.


Subject(s)
COVID-19/complications , Venous Thrombosis/epidemiology , Venous Thrombosis/etiology , Aged , COVID-19 Testing , Cross-Sectional Studies , Female , Hospitals , Humans , Lower Extremity/diagnostic imaging , Male , Middle Aged , Prevalence , Ultrasonography, Doppler, Duplex , Venous Thrombosis/diagnosis
7.
Medicina (Kaunas) ; 56(12)2020 Dec 03.
Article in English | MEDLINE | ID: covidwho-963621

ABSTRACT

Pulmonary embolism (PE) is a commonly encountered clinical entity in patients with coronavirus disease 2019 (COVID-19). Up to 1/3 of patients have been found to have PE in the setting of COVID-19. Given the novelty of the virus causing this pandemic, it has not been easy to address diagnostic and management issues in PE. Ongoing research and publications of the scientific literature have helped in dealing with COVID-19 lately and this applies to PE as well. In this article, we attempt to succinctly yet comprehensively discuss PE in patients with COVID-19 with a review of the prevailing literature.


Subject(s)
COVID-19/blood , Pulmonary Embolism/diagnosis , Pulmonary Embolism/therapy , Thrombophilia/blood , Anticoagulants/therapeutic use , COVID-19/complications , Computed Tomography Angiography , Disease Management , Disseminated Intravascular Coagulation/blood , Echocardiography , Extracorporeal Membrane Oxygenation , Fibrin Fibrinogen Degradation Products/metabolism , Fibrinogen/metabolism , Humans , Lower Extremity/diagnostic imaging , Partial Thromboplastin Time , Platelet Count , Point-of-Care Systems , Prothrombin Time , Pulmonary Embolism/blood , Pulmonary Embolism/etiology , Thrombolytic Therapy , Thrombophilia/complications , Ultrasonography, Doppler, Duplex , Venous Thrombosis/diagnostic imaging , Ventilation-Perfusion Scan
8.
J Vasc Surg Venous Lymphat Disord ; 9(4): 853-858, 2021 07.
Article in English | MEDLINE | ID: covidwho-957280

ABSTRACT

OBJECTIVE: COVID-19 patients may develop coagulopathy, which is associated with poor prognosis and high risk of thrombosis. The main objective of this work was to evaluate the prevalence of deep venous thrombosis of lower limbs (DVT) through ultrasonography in patients infected with COVID-19 admitted to conventional units at our hospital with 5 days of monitoring. The secondary objective was to determine if D-dimer levels, body mass index, and C-reactive protein were associated with DVT. METHODS: A total of 72 patients, with a mean age of 65 ± 12.3 years, infected with COVID-19 were admitted to three conventional units at our institution; 28 patients were women. A COVID-19 diagnosis was made by a transcriptase polymerase chain reaction by means of nasopharyngeal swab or by chest computer tomography without iodine contrast media. Demographics, comorbidities, and laboratory parameters were collected. A preventive anticoagulation treatment was established on admission with low-molecular-weight heparin. A complete venous duplex ultrasound (DU) test of lower limbs was performed on day (D) 0 and D5. A pulmonary computer tomography angiogram with iodine contrast media was required when pulmonary embolism was suspected. RESULTS: On D0, the DU showed acute DVT in seven patients (9.75%). A pulmonary computer tomography angiogram was performed in 12 patients (16.65%), 3 (25%) of whom had an acute pulmonary embolism. On D0, acute DVT was not significantly associated with C-reactive protein (mean 101 ± 98.6 in the group without DVT vs 67.6 ± 58.4 mg/L, P = .43) or body mass index (27.7 ± 5.04 vs 28.1 ± 2.65 kg/m2, P = .54). However, we found a significant association between acute DVT and D-dimer levels (1536 ± 2347 vs 9652 ± 10,205 ng/mL, P < .01). Among the patients included on D0, only 32 had a DU on D5. Forty of them (55.55%) were not examined for the following reasons: 7 (9.7%) were previously diagnosed with venous thromboembolism on D0 and therefore were excluded on D5, 8 (11%) were transferred to the intensive care unit, 10 (14%) were discharged from the hospital, 5 (7%) died, and 10 (13.9%) were excluded because of technical issues. On D5, five (15.6%) patients had acute DVT in addition to those found on D0; three were distal and two proximal despite preventive anticoagulation with low-molecular-weight heparin. CONCLUSIONS: Hospitalized non-intensive care unit patients with COVID-19 pneumonia have a high frequency of venous thrombotic events justifying screening with DU.


Subject(s)
COVID-19/complications , Ultrasonography, Doppler, Duplex , Venous Thrombosis/diagnostic imaging , Aged , Anticoagulants/therapeutic use , Body Mass Index , C-Reactive Protein/metabolism , COVID-19/diagnostic imaging , COVID-19 Testing , Computed Tomography Angiography , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Lower Extremity/diagnostic imaging , Lung/diagnostic imaging , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Venous Thrombosis/etiology , Venous Thrombosis/prevention & control
9.
Skeletal Radiol ; 49(11): 1879-1884, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-731178

ABSTRACT

While initial reports regarding coronavirus disease 2019 (COVID-19) focused on its pulmonary manifestations, more recent literature describes multisystem abnormalities related to its associated microvascular angiopathy. Calciphylaxis is a rare systemic condition characterized by tissue necrosis in the setting of systemic microvascular calcifications. Both COVID-19 and calciphylaxis are procoagulant diagnoses associated with vascular-mediated cutaneous findings. To our knowledge, this is the first report to document the coexistence of COVID-19 associated retiform thrombotic purpura and calciphylaxis in a single patient, to link the pathologic etiologies of the two entities, and to describe the concomitant diagnoses' associated radiologic findings.


Subject(s)
Betacoronavirus , Calciphylaxis/complications , Coronavirus Infections/complications , Pneumonia, Viral/complications , Purpura/complications , COVID-19 , Calciphylaxis/diagnostic imaging , Calciphylaxis/pathology , Computed Tomography Angiography/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/pathology , Diagnosis, Differential , Fatal Outcome , Female , Humans , Lower Extremity/diagnostic imaging , Lower Extremity/pathology , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/pathology , Polymerase Chain Reaction , SARS-CoV-2 , Ultrasonography/methods
10.
Circulation ; 142(2): 114-128, 2020 07 14.
Article in English | MEDLINE | ID: covidwho-684109

ABSTRACT

BACKGROUND: To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center. METHODS: We studied a total of 143 patients with COVID-19 from January 29, 2020 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, and comparisons were made between groups with and without DVT. RESULTS: Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 74 [51.7%] men), 66 patients developed lower extremity DVT (46.1%: 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased proportion of deaths (23 [34.8%] versus 9 [11.7%]; P=0.001) and a decreased proportion of patients discharged (32 [48.5%] versus 60 [77.9%]; P<0.001). Multivariant analysis showed an association only between CURB-65 (confusion status, urea, respiratory rate, and blood pressure) score 3 to 5 (odds ratio, 6.122; P=0.031), Padua prediction score ≥4 (odds ratio, 4.016; P=0.04), D-dimer >1.0 µg/mL (odds ratio, 5.818; P<0.014), and DVT in this cohort, respectively. The combination of a CURB-65 score 3 to 5, a Padua prediction score ≥4, and D-dimer >1.0 µg/mL has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 hours after admission, DVT was present in 18 (34.0%) patients in the subgroup receiving venous thromboembolism prophylaxis versus 35 (66.0%) patients in the nonprophylaxis group (P=0.010). CONCLUSIONS: The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in hospitalized patients.


Subject(s)
Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Venous Thrombosis/diagnosis , Adult , Aged , Anticoagulants/therapeutic use , Betacoronavirus/isolation & purification , Blood Pressure , COVID-19 , China/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Kaplan-Meier Estimate , Lower Extremity/diagnostic imaging , Male , Middle Aged , Odds Ratio , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Prevalence , Prognosis , Respiratory Rate , Retrospective Studies , Risk Factors , SARS-CoV-2 , Treatment Outcome , Venous Thrombosis/complications , Venous Thrombosis/drug therapy , Venous Thrombosis/epidemiology
11.
J Ultrasound Med ; 40(2): 385-390, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-684709

ABSTRACT

To date, coronavirus disease 2019 (COVID-19) has infected millions of people worldwide. Ultrasound plays an indispensable role in the diagnosis, monitoring, and follow-up of patients with COVID-19. In this study, we used a robotic tele-echography system based on a 5G communication network for remote diagnosis. The system has great potential for lung, heart, and vasculature information, medical staff protection, and resource sharing, can be a valuable tool for treating patients during the pandemic, and can be expected to expand to more specialized fields.


Subject(s)
COVID-19/complications , Robotics/methods , Telemedicine/methods , Ultrasonography/methods , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/etiology , Aged, 80 and over , Disease Progression , Heart/diagnostic imaging , Humans , Lower Extremity/diagnostic imaging , Lung/diagnostic imaging , Male , Quarantine/methods , SARS-CoV-2 , Telemedicine/instrumentation , Ultrasonography/instrumentation
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