Your browser doesn't support javascript.
Acute pulmonary embolism in patients presenting pulmonary deterioration after hospitalisation for non-critical COVID-19.
Polo Friz, Hernan; Gelfi, Elia; Orenti, Annalisa; Motto, Elena; Primitz, Laura; Donzelli, Tino; Intotero, Marcello; Scarpazza, Paolo; Vighi, Giuseppe; Cimminiello, Claudio; Boracchi, Patrizia.
  • Polo Friz H; Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy.
  • Gelfi E; Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy.
  • Orenti A; Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics Epidemiology and Biometry 'G. A. Maccacaro', University of Milan, Milan, Italy.
  • Motto E; Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy.
  • Primitz L; Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy.
  • Donzelli T; Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy.
  • Intotero M; Radiology, Diagnostic Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy.
  • Scarpazza P; Pulmonology, Medical Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy.
  • Vighi G; Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy.
  • Cimminiello C; Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia ePatologia Vascolare, SIAPAV), Milan, Italy.
  • Boracchi P; Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics Epidemiology and Biometry 'G. A. Maccacaro', University of Milan, Milan, Italy.
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.
Subject(s)
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

Similar

MEDLINE

...
LILACS

LIS


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