Abstract
The incidence of thromboembolic complications in coronavirus disease 2019 (COVID-19) infection is well recognized. The present study retrospectively evaluated the type and prevalence of lung perfusion defects in early-post-COVID-19 patients with hypoxia and was aimed to identify the risk factors for mismatched perfusion defects. Methods: We analyzed SPECT/CT images of 54 early-post-COVID-19 patients (44 men and 10 women). Logistic regression analysis was used to examine the risk. Results: The mean age of the study population was 55.4 y (range, 34-76 y). All received prophylactic anticoagulation from the day of hospitalization to the date of perfusion scanning. The median interval between COVID-19-positive reports and lung perfusion scanning was 22 d. Lung perfusion defects (of any type) were observed in most (87%). Twenty-three subjects (42.6%) had mismatched perfusion defects. Mismatched perfusion defects were segmental in 14 subjects (25.9%) and subsegmental in 11 (20.4%). Higher age was a risk factor for mismatched perfusion defects (odds ratio, 1.06; 95% CI, 0.99-1.13; P = 0.06). Subjects with a serum D-dimer level of at least 2,500 ng/mL on the day before the scan were not at higher risk for having mismatched perfusion defects (odds ratio, 1.14; 95% CI, 0.34-3.9; P = 0.83). Conclusion: Despite prophylactic anticoagulation, mismatched perfusion defects suggestive of pulmonary thromboembolism were observed. Serum D-dimer level in patients early after COVID-19 is a poor predictor of mismatched perfusion defects. Confirmed evidence of pulmonary embolism by imaging studies should support the decision to extend anticoagulant prophylaxis in post-COVID-19 patients.
Highlights
The thrombogenic potential of SARS-CoV-2 infection is well recognized [1]
Lung perfusion scintigraphy by SPECT/CT is a safe alternative for diagnosing pulmonary embolism (PE), especially for COVID-19 patients
The serum D-dimer level on the day before perfusion scanning was available for 44 subjects
Summary
The thrombogenic potential of SARS-CoV-2 infection is well recognized [1]. The coagulation abnormalities, along with prolonged bed rest due to hospitalization, lead to high incidences of venous thromboembolism and thromboembolic complications, mostly pulmonary embolism (PE). Both venous thromboembolism and PE, especially in severe and critically ill COVID-19 patients, have been reported [1]. An observational study of over 500 COVID-19 patients admitted to 8 intensive care units in France reported 22.7% thrombotic complications, mostly PE [2]. A metaanalysis of over 7,000 COVID-19 patients showed that the pooled in-hospital incidence of PE in the general ward and intensive care unit was 14.7% and 23.4%, respectively [3]. Lung perfusion scintigraphy by SPECT/CT is a safe alternative for diagnosing PE, especially for COVID-19 patients. After recovery from active infection, a few COVID-19 patients, especially those who were severely or critically ill, continue to have hypoxia. The presence of perfusion defects in early–post-COVID-19 patients with persistent hypoxia has not, to our knowledge, been previously
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