Abstract
Background: Coagulopathy is a well-recognized complication in patients with coronavirus disease 2019 (COVID-19). Pulmonary embolism (PE) has substantial morbidity and mortality if the diagnosis is missed or the management is delayed. Computed tomography pulmonary angiography (CT-PA) is the imaging modality of choice for PE. Therefore, this study aimed to investigate the positive rate of CT-PA for PE among patients with COVID-19.Methods: We conducted a retrospective study examining the diagnostic yield of CT-PA in patients with confirmed COVID-19 and compared it with that in patients without COVID-19. The study included all adult patients with confirmed COVID-19 who presented from June 2020 to June 2021.Results: The study included 316 patients, including 158 patients with COVID-19, who underwent CT-PA for ruling out PE. Overall, 76 patients were found to have PE on the CT-PA scan, yielding a positive rate of 24.1%, with a significant difference between patients with COVID-19 (8.2%) and those without COVID-19 (39.9%). Further, 138 (87.3%) patients with COVID-19 had elevated D-dimer levels compared with 34 (21.5%) patients without COVID-19. A multivariable regression analysis model revealed that the smoking status (odds ratio [OR] = 1.94; 95% confidence interval [CI]: 1.4-3.8) and obesity (OR = 4.1; 95% CI: 1.5-8.9) were independent predictors of PE among patients with COVID-19. However, the elevated D-dimer level was not significantly associated with PE among patients with COVID-19 (OR = 0.7; 95% CI: 0.4-1.8).Conclusion: The study found that the positive rate of CT-PA for PE was lower among patients with PE indicating probable overutilization of investigation in these patients. Additionally, patients with COVID-19 had a higher proportion of elevated D-dimer levels that may be a contributor to the increased investigation for PE. Lastly, patients with COVID-19 who were current smokers had a higher tendency of having PE.
Highlights
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) that was first identified as the pathogen responsible for a cluster of pneumonia cases in Wuhan, China, at the end of 2019
The study found that the positive rate of Computed tomography pulmonary angiography (CT-PA) for Pulmonary embolism (PE) was lower among patients with PE indicating probable overutilization of investigation in these patients
The study aimed to investigate the positive rate of CT-PA for PE in patients with COVID-19 and to identify the factors that serve as independent predictors of PE in such patients
Summary
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) that was first identified as the pathogen responsible for a cluster of pneumonia cases in Wuhan, China, at the end of 2019. It was officially declared as a pandemic by the World Health Organization on March 11, 2020 [1]. While COVID-19 predominantly affects respiratory symptoms, the involvement of the organ systems is not uncommon [2]. This study aimed to investigate the positive rate of CT-PA for PE among patients with COVID-19
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