Acute pulmonary embolism in patients presenting pulmonary deterioration after hospitalisation for non-critical COVID-19.
Intern Med J
; 51(8): 1236-1242, 2021 08.
Article
in English
| MEDLINE | ID: covidwho-1369321
ABSTRACT
BACKGROUND:
Emerging evidence suggests an association between COVID-19 and acute pulmonary embolism (APE).AIMS:
To assess the prevalence of APE in patients hospitalised for non-critical COVID-19 who presented clinical deterioration, and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE in these subjects.METHODS:
All consecutive patients admitted to the internal medicine department of a general hospital with a diagnosis of non-critical COVID-19, who performed a computer tomography pulmonary angiography (CTPA) for respiratory deterioration in April 2020, were included in this retrospective cohort study.RESULTS:
Study populations 41 subjects, median (interquartile range) age 71.7 (63-76) years, CPTA confirmed APE = 8 (19.51%, 95% confidence interval (CI) 8.82-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of d-dimer for predicting APE was 2454 ng/mL, sensitivity (95% CI) 63 (24-91), specificity 73 (54-87), positive predictive value 36 (13-65), negative predictive value 89 (71-98) and AUC 0.62 (0.38-0.85). The standard and age-adjusted d-dimer cut-offs, and the Wells score ≥2 did not associate with confirmed APE, albeit a cut-off value of d-dimer = 2454 ng/mL showed an relative risk 3.21; 95% CI 0.92-13.97; P = 0.073. Heparin at anticoagulant doses was used in 70.73% of patients before performing CTPA.CONCLUSION:
Among patients presenting pulmonary deterioration after hospitalisation for non-critical COVID-19, the prevalence of APE is high. Traditional diagnostic tools to identify high APE pre-test probability patients do not seem to be clinically useful. These results support the use of a high index of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pulmonary Embolism
/
COVID-19
Type of study:
Cohort study
/
Diagnostic study
/
Observational study
/
Prognostic study
Limits:
Aged
/
Humans
Language:
English
Journal:
Intern Med J
Journal subject:
Internal Medicine
Year:
2021
Document Type:
Article
Affiliation country:
Imj.15307
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