RESUMEN
[Figure: see text].
Asunto(s)
COVID-19/metabolismo , Inflamación/metabolismo , Accidente Cerebrovascular Isquémico/metabolismo , Trombofilia/metabolismo , Anciano , Anciano de 80 o más Años , Sedimentación Sanguínea , Proteína C-Reactiva/metabolismo , COVID-19/complicaciones , Análisis por Conglomerados , Femenino , Ferritinas/metabolismo , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Fibrinógeno/metabolismo , Mortalidad Hospitalaria , Humanos , Interleucina-6/metabolismo , Accidente Cerebrovascular Isquémico/complicaciones , L-Lactato Deshidrogenasa/metabolismo , Recuento de Leucocitos , Modelos Logísticos , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/metabolismo , Tiempo de Tromboplastina Parcial , Embolia Pulmonar/complicaciones , Embolia Pulmonar/metabolismo , Estudios Retrospectivos , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Trombosis de la Vena/complicaciones , Trombosis de la Vena/metabolismoRESUMEN
BACKGROUND AND PURPOSE: Evaluation of the lung apices using computed tomography angiography of the head and neck during acute ischemic stroke (AIS) can provide the first objective opportunity to screen for coronavirus disease 2019 (COVID-19). METHODS: We performed an analysis assessing the utility of apical lung exam on computed tomography angiography for COVID-19-specific lung findings in 57 patients presenting with AIS. We measured the diagnostic accuracy of apical lung assessment alone and in combination with patient-reported symptoms and incorporate both to propose a COVID-19 era AIS algorithm. RESULTS: Apical lung assessment when used in isolation, yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19, in patients presenting to the hospital for AIS. When combined with self-reported clinical symptoms of cough or shortness of breath, sensitivity of apical lung assessment improved to 0.83. CONCLUSIONS: Apical lung assessment on computed tomography angiography is an accurate screening tool for COVID-19 and can serve as part of a combined screening approach in AIS.
Asunto(s)
COVID-19/diagnóstico por imagen , Angiografía Cerebral/métodos , Angiografía por Tomografía Computarizada/métodos , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Anciano , COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/fisiopatología , Prueba de Ácido Nucleico para COVID-19 , Tos/fisiopatología , Disnea/fisiopatología , Femenino , Humanos , Accidente Cerebrovascular Isquémico/complicaciones , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
Background During the peak of the coronavirus disease 2019 (COVID-19) pandemic, the authors noted an increase in positive lower-extremity CT angiography examinations in patients who presented with leg ischemia. The goal of this study was to determine whether lower-extremity arterial thrombosis was associated with COVID-19 and whether it was characterized by greater severity in these patients. Materials and Methods In this retrospective propensity score-matched study approved by the institutional review board, 16 patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who underwent CT angiography of the lower extremities and 32 patients who tested negative for SARS-CoV-2 observed from January to April 2018, January to April 2019, and January to April 2020 were compared using three scoring systems: two systems including all vessels, with weighting in one system given to more proximal vessels and with weighting in the other system given to more distal vessels, and a third system in which only the common iliac through popliteal arteries were considered. Correlation with presenting symptoms and outcomes was computed. Fisher exact tests were used to compare patients who tested positive for COVID-19 with patients who tested negative for COVID-19 regarding the presence of clots and presenting symptoms. A Mantel-Haenszel test was used to associate outcome of death and/or amputation with COVID-19 adjusted according to history of peripheral vascular disease (PVD). Results Sixteen patients with confirmed COVID-19 (70 years ± 14 [standard deviation]; seven women) who underwent CT angiography and 32 propensity score-matched control patients (71 years ± 15; 16 women) were included. All patients with COVID-19 (100%, 95% confidence interval [CI]: 79%, 100%) had at least one thrombus, and only 69% of control patients (95% CI: 50%, 84%) had thrombi (P = .02). Ninety-four percent of patients with COVID-19 (95% CI: 70%, 99.8%) had proximal thrombi compared with 47% of control patients (95% CI: 29%, 65%) (P < .001). The mean thrombus score using any of the three scoring systems yielded greater scores in patients with COVID-19 (P < .001). Adjusted for history of PVD, death or limb amputation was more common in patients with COVID-19 (odds ratio = 25; 95% CI: 4.3, 147; P < .001). Patients with COVID-19 who presented with symptoms of leg ischemia only were more likely to avoid amputation or death than patients who also presented with pulmonary or systemic symptoms (P = .001). Conclusion Coronavirus disease 2019 is associated with lower-extremity arterial thrombosis characterized by a greater clot burden and a more dire prognosis. © RSNA, 2020.