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Pulmonary Thrombosis or Embolism in a Large Cohort of Hospitalized Patients With Covid-19.
Benito, Natividad; Filella, David; Mateo, Jose; Fortuna, Ana M; Gutierrez-Alliende, Juan E; Hernandez, Nerea; Gimenez, Ana M; Pomar, Virginia; Castellvi, Ivan; Corominas, Hector; Casademont, Jordi; Domingo, Pere.
  • Benito N; Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
  • Filella D; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Mateo J; Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
  • Fortuna AM; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Gutierrez-Alliende JE; Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
  • Hernandez N; Thrombosis and Hemostasis Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
  • Gimenez AM; Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
  • Pomar V; Department of Radiology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
  • Castellvi I; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Corominas H; Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
  • Casademont J; Department of Radiology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
  • Domingo P; Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
Front Med (Lausanne) ; 7: 557, 2020.
Article in English | MEDLINE | ID: covidwho-800714
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF hospitalized patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
hospitalized patients
2. Embolism PROCESS_OF Cohort
Subject
Embolism
Predicate
PROCESS_OF
Object
Cohort
3. Pulmonary thrombosis PROCESS_OF Cohort
Subject
Pulmonary thrombosis
Predicate
PROCESS_OF
Object
Cohort
4. Pulmonary Embolism OCCURS_IN hospitalized patients
Subject
Pulmonary Embolism
Predicate
OCCURS_IN
Object
hospitalized patients
5. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
6. Lung LOCATION_OF Computed Tomography Angiography
Subject
Lung
Predicate
LOCATION_OF
Object
Computed Tomography Angiography
7. Computed Tomography Angiography ADMINISTERED_TO Patients
Subject
Computed Tomography Angiography
Predicate
ADMINISTERED_TO
Object
Patients
8. Suspected pulmonary embolism PROCESS_OF Patients
Subject
Suspected pulmonary embolism
Predicate
PROCESS_OF
Object
Patients
9. Computed Tomography Angiography ADMINISTERED_TO inpatient
Subject
Computed Tomography Angiography
Predicate
ADMINISTERED_TO
Object
inpatient
10. Pulmonary Embolism PROCESS_OF Patients
Subject
Pulmonary Embolism
Predicate
PROCESS_OF
Object
Patients
11. Mechanical ventilation TREATS Patients
Subject
Mechanical ventilation
Predicate
TREATS
Object
Patients
12. C-reactive protein ASSOCIATED_WITH Pulmonary Embolism
Subject
C-reactive protein
Predicate
ASSOCIATED_WITH
Object
Pulmonary Embolism
13. Fibrin fragment D ASSOCIATED_WITH Pulmonary Embolism
Subject
Fibrin fragment D
Predicate
ASSOCIATED_WITH
Object
Pulmonary Embolism
14. Hepari NEG_PREVENTS C0034065
Subject
Hepari
Predicate
NEG_PREVENTS
Object
C0034065
15. COVID-19 PROCESS_OF hospitalized patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
hospitalized patients
16. Embolism PROCESS_OF Cohort
Subject
Embolism
Predicate
PROCESS_OF
Object
Cohort
17. Pulmonary thrombosis PROCESS_OF Cohort
Subject
Pulmonary thrombosis
Predicate
PROCESS_OF
Object
Cohort
18. Pulmonary Embolism OCCURS_IN hospitalized patients
Subject
Pulmonary Embolism
Predicate
OCCURS_IN
Object
hospitalized patients
19. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
20. Lung LOCATION_OF Computed Tomography Angiography
Subject
Lung
Predicate
LOCATION_OF
Object
Computed Tomography Angiography
21. Computed Tomography Angiography ADMINISTERED_TO Patients
Subject
Computed Tomography Angiography
Predicate
ADMINISTERED_TO
Object
Patients
22. Suspected pulmonary embolism PROCESS_OF Patients
Subject
Suspected pulmonary embolism
Predicate
PROCESS_OF
Object
Patients
23. Computed Tomography Angiography ADMINISTERED_TO inpatient
Subject
Computed Tomography Angiography
Predicate
ADMINISTERED_TO
Object
inpatient
24. Pulmonary Embolism PROCESS_OF Patients
Subject
Pulmonary Embolism
Predicate
PROCESS_OF
Object
Patients
25. Mechanical ventilation TREATS Patients
Subject
Mechanical ventilation
Predicate
TREATS
Object
Patients
26. C-reactive protein ASSOCIATED_WITH Pulmonary Embolism
Subject
C-reactive protein
Predicate
ASSOCIATED_WITH
Object
Pulmonary Embolism
27. Fibrin fragment D ASSOCIATED_WITH Pulmonary Embolism
Subject
Fibrin fragment D
Predicate
ASSOCIATED_WITH
Object
Pulmonary Embolism
28. Heparin, Low-Molecular-Weight NEG_PREVENTS Pulmonary Embolism
Subject
Heparin, Low-Molecular-Weight
Predicate
NEG_PREVENTS
Object
Pulmonary Embolism
ABSTRACT

Objective:

We set out to analyze the incidence and predictive factors of pulmonary embolism (PE) in hospitalized patients with Covid-19.

Methods:

We prospectively collected data from all consecutive patients with laboratory-confirmed Covid-19 admitted to the Hospital de la Santa Creu i Sant Pau, a university hospital in Barcelona, between March 9 and April 15, 2020. Patients with suspected PE, according to standardized guidelines, underwent CT pulmonary angiography (CTPA).

Results:

A total of 1,275 patients with Covid-19 were admitted to hospital. CTPA was performed on 76 inpatients, and a diagnosis of PE was made in 32 (2.6% [95%CI 1.7-3.5%]). Patients with PE were older, and they exhibited lower PaO2FiO2 ratios and higher levels of D-dimer and C-reactive protein (CRP). They more often required admission to ICU and mechanical ventilation, and they often had longer hospital stays, although in-hospital mortality was no greater than in patients without PE. High CRP and D-dimer levels at admission (≥150 mg/L and ≥1,000 ng/ml, respectively) and a peak D-dimer ≥6,000 ng/ml during hospital stay were independent factors associated with PE. Prophylactic low molecular weight heparin did not appear to prevent PE. Increased CRP levels correlated with increased D-dimer levels and both correlated with a lower PaO2FiO2.

Conclusions:

The 2.6% incidence of PE in Covid-19 hospitalized patients is clearly high. Higher doses of thromboprophylaxis may be required to prevent PE, particularly in patients at increased risk, such as those with high levels of CRP and D-dimer at admission. These findings should be validated in future studies.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Language: English Journal: Front Med (Lausanne) Clinical aspect: Etiology / Prediction / Prognosis Year: 2020

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Language: English Journal: Front Med (Lausanne) Clinical aspect: Etiology / Prediction / Prognosis Year: 2020
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