Prediction of pulmonary embolism in patients with SARS-CoV-2 infection⋆ Predicción del desarrollo de tromboembolia pulmonar en pacientes con infección por SARS-CoV-2

ABSTRACT

Objective To determine the predictive factors of pulmonary thromboembolic (PTE) in patients with SARS-CoV-2 infection (COVID-19) assessed in the emergency department at a tertiary hospital during the first pandemic wave. Methods Observational single-center study conducted in a retrospective cohort of patients with confirmed SARS-CoV-2 infection (or high clinical-radiological suspicion) who underwent PTE screening by computed tomography pulmonary angiography (CTPA). Predictive factors of PTE were explored using logistic regression, creating two predictive models (without or with D-dimer values). Results Out of a total of 274 CTPA performed, 70 procedures presented diagnostic findings of PTE, representing a cumulative incidence of 25.54% (95% confidence interval [CI] 20.49–31.14). In the non-D-dimer based model, respiratory rate >22 bpm (odds ratio [OR] 3.162;95% CI 1.627–6.148;p = 0.001) and the absence of findings suggestive of COVID-19 in plain chest X-ray (OR 3.869;95% CI 0.869–17.225;p = 0.076) were predictors of PTE. In the D-dimer-based model, tachypnea remained as a predictive factor (OR 4.967;95% CI 2.053–12.018;p < 0.001), as well as D-dimers > 3,000 ng/ml (OR 7.494;95% CI 3.038–18.485;p < 0.001). Conclusions The presence of tachypnea (>22 bpm) and the absence of radiological findings suggestive of SARS-CoV-2 infection in the chest X-ray, in addition to D-dimer values >3000 ng/mL, were identified as predictive factors of PTE in patients with COVID-19.