Abstract
PurposeRecently coronavirus disease (COVID-19) caused a global pandemic, characterized by acute respiratory distress syndrome (ARDS). The aim of our study was to detect pulmonary embolism (PE) in patients with severe form of COVID-19 infection using pulmonary CT angiography, and its associations with clinical and laboratory parameters.MethodsFrom March to December 2020, we performed a prospective monocentric study collecting data from 374 consecutive patients with confirmed SARS-CoV-2 infection, using real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR) assay of nasopharyngeal swab specimens. We subsequently selected patients with at least two of the following inclusion criteria: (1) severe acute respiratory symptoms (such as dyspnea, persistent cough, fever > 37.5 °C, fatigue, etc.); (2) arterial oxygen saturation ≤ 93% at rest; (3) elevated D-dimer (≥ 500 ng/mL) and C-reactive protein levels (≥ 0.50 mg/dL); and (4) presence of comorbidities. A total of 63/374 (17%) patients met the inclusion criteria and underwent CT angiography during intravenous injection of iodinated contrast agent (Iomeprol 400 mgI/mL). Statistical analysis was performed using Wilcoxon rank-sum and Chi-square tests.ResultsAbout, 26/60 patients (40%) were found positive for PE at chest CT angiography. In these patients, D-dimer and CRP values were significantly higher, while a reduction in SaO2 < 93% was more common than in patients without PE (P < 0.001). Median time between illness onset and CT scan was significantly longer (15 days; P < 0.001) in patients with PE. These were more likely to be admitted to the Intensive Care Unit (19/26 vs. 11/34 patients; P < 0.001) and required mechanical ventilation more frequently than those without PE (15/26 patients vs. 9/34 patients; P < 0.001). Vascular enlargement was significantly more frequent in patients with PE than in those without (P = 0.041).ConclusionsOur results pointed out that patients affected by severe clinical features of COVID-19 associated with comorbidities and significant increase of D-dimer levels developed acute mono- or bi-lateral pulmonary embolism in 40% of cases. Therefore, the use of CT angiography rather than non-contrast CT should be considered in these patients, allowing a better evaluation, that can help the management and improve the outcomes.
Highlights
Despite the known increased risk of acute pulmonary embolism (APE) in patients with COVID-19 infection, only a few studies have evaluated the role of CT angiography in better understanding the disease [14,15,16,17,18]
Patients with pulmonary embolism were more likely to be admitted to the Intensive Care Unit (19/26 [73%] vs. 11/34 [32%] patients, respectively; P < 0.001) and required mechanical ventilation more frequently than those without pulmonary embolism (15/26 patients [57%] vs. 9/34 patients [26%], P < 0.001) (Fig. 1)
In this study of 60 patients hospitalized with COVID-19 and suspected of PE, we found pulmonary embolism in 40%
Summary
Since December 2019, a novel coronavirus (SARS-CoV-2) has spread rapidly from China to most countries causing a public health emergency, declared a pandemic in March 2020 [1].As stated in the Chinese Center for Disease Control and Prevention report, the different forms of COVID-19 can be classified into mild, severe or critical based on the severity of the symptoms, with a frequency of approximately 81%, 14% and 5%, respectively [2, 3].1 3 Vol.:(0123456789)La radiologia medicaas several reports highlight [4,5,6], patients suffering from more severe forms of the disease have an increased risk of venous thrombosis and pulmonary embolism.Thromboinflammation in COVID-19 manifests as elevated levels of procoagulants (such as von Willebrand factor) and endothelial dysfunction, which diminishes the protective antithrombotic activity of the endothelium, that leads to thrombosis, which can be a defense mechanism that compartmentalizes infection and prevents further dissemination [7, 8].Given the large number of COVID-19 patients seeking medical care, the international society on thrombosis and hemostasis (ISTH) advocates the use of laboratory blood tests, including D-dimer test, prothrombin time and platelet count, to stratify the patients at risk of adverse outcome who need hospital admission [9].Due to the primary involvement of the respiratory system, non-contrast chest CT has quickly proved to be a fundamental tool in the diagnosis, management and follow-up of COVID-19 patients [3, 10,11,12], because of the increasing understanding of the temporal progression of the imaging findings at different stages of the disease [13].despite the known increased risk of acute pulmonary embolism (APE) in patients with COVID-19 infection, only a few studies have evaluated the role of CT angiography in better understanding the disease [14,15,16,17,18]. As stated in the Chinese Center for Disease Control and Prevention report, the different forms of COVID-19 can be classified into mild, severe or critical based on the severity of the symptoms, with a frequency of approximately 81%, 14% and 5%, respectively [2, 3]. As several reports highlight [4,5,6], patients suffering from more severe forms of the disease have an increased risk of venous thrombosis and pulmonary embolism. Despite the known increased risk of acute pulmonary embolism (APE) in patients with COVID-19 infection, only a few studies have evaluated the role of CT angiography in better understanding the disease [14,15,16,17,18]
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