Prevalence Of Pulmonary Embolism Research Articles

Structured reporting for efficient epidemiological and in-hospital prevalence analysis of pulmonary embolisms.

Structured reporting (SR) not only offers advantages regarding report quality but, as an IT-based method, also the opportunity to aggregate and analyze large, highly structured datasets (data mining). In this study, a data mining algorithm was used to calculate epidemiological data and in-hospital prevalence statistics of pulmonary embolism (PE) by analyzing structured CT reports.All structured reports for PE CT scans from the last 5 years (n = 2790) were extracted from the SR database and analyzed. The prevalence of PE was calculated for the entire cohort and stratified by referral type and clinical referrer. Distributions of the manifestation of PEs (central, lobar, segmental, subsegmental, as well as left-sided, right-sided, bilateral) were calculated, and the occurrence of right heart strain was correlated with the manifestation.The prevalence of PE in the entire cohort was 24% (n = 678). The median age of PE patients was 71 years (IQR 58-80), and the sex distribution was 1.2/1 (M/F). Outpatients showed a lower prevalence of 23% compared to patients from regular wards (27%) and intensive care units (30%). Surgically referred patients had a higher prevalence than patients from internal medicine (34% vs. 22%). Patients with central and bilateral PEs had a significantly higher occurrence of right heart strain compared to patients with peripheral and unilateral embolisms.Data mining of structured reports is a simple method for obtaining prevalence statistics, epidemiological data, and the distribution of disease characteristics, as demonstrated by the PE use case. The generated data can be helpful for multiple purposes, such as for internal clinical quality assurance and scientific analyses. To benefit from this, consistent use of SR is required and is therefore recommended. · SR-based data mining allows simple epidemiologic analyses for PE.. · The prevalence of PE differs between outpatients and inpatients.. · Central and bilateral PEs have an increased risk of right heart strain.. · Jorg T, Halfmann MC, Graafen D et al. Structured reporting for efficient epidemiological and in-hospital prevalence analysis of pulmonary embolisms. Fortschr Röntgenstr 2024; DOI 10.1055/a-2301-3349.

Increased Risk for Pulmonary Embolism among Patients with Ankylosing Spondylitis-Results from a Large Database Analysis.

Background: Axial spondyloarthropathy(AS) is a chronic inflammatory disease primarily affecting the axial skeleton, often characterized by sacroiliitis. While pulmonary embolism (PE), a potentially lethal condition, has been linked to several autoimmune diseases, limited data exist regarding PE risk among patients with AS. Methods: This retrospective cohort study utilized the Clalit Healthcare Services (CHS) database, including 5825 patients with AS and 28,356 matched controls. Follow-up began at the date of first AS diagnosis for patients and at the matched patient's diagnosis date for controls and continued until PE diagnosis, death, or study end date. Results: Prevalence of PE before AS diagnosis in patients compared to controls was 0.4% vs. 0.2% (p < 0.01). The incidence rate of PE was 11.6 per 10,000 person-years for patients with AS and 6.8 per 10,000 person-years for controls. The adjusted hazard ratio (HR) for PE in patients with AS was 1.70 (p < 0.001). Subgroup analysis demonstrated excess risk for PE in patients with AS regardless of gender and age, with variations among AS treatment categories. Discussion: Our findings highlight a significant association between AS and PE, indicating an increased risk in patients with AS independent of age and sex and suggests a subclinical level of inflammation. Preliminary results suggest a protective role of immunosuppressing drugs. Further research into the impact of treatment strategies should be conducted and could inform clinical management and reduce the life-threatening risk of PE in Patients with AS.

Pulmonary Embolism Increases the Risk of Dyspnea in Pediatric Patients

This study investigated the association between pulmonary embolism (PE) and a subsequent diagnosis of dyspnea in pediatric patients using real world population-based data. We collected de-identified data from TriNetX, a global federated multicenter research database using both UTSouthwestern (UTSW) and Multinational Research Network. Patient ages of 8 to 21 with and without a diagnosis of pulmonary embolism (ICD-10-CM I26) were examined for associations with a new diagnosis of dyspnea (ICD-10-CM R06.0) three or more months after their initial PE diagnosis. The prevalence of PE significantly increased the risk for a new diagnosis of dyspnea after their initial PE diagnosis among all patients in the UTSW Network (risk ratio: 5.00) and Research Network (risk ratio: 6.55). In the Research Network, this risk was significantly higher for females than males (risk ratio: 6.06 Vs. 5.08) (all p&lt;0.001). These findings suggesting that clinicians should consider PE as an independent risk factor for diagnosis of dyspnea in pediatric patients. Supported in part by NHLBI R38HL150214 (PI: Susan Hedayati). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Detection of acute pulmonary embolism using native repeated magnetic resonance imaging acquisitions under free-breathing and without respiratory or cardiac gating. A diagnostic accuracy study

ObjectivesComputed tomography pulmonary angiography (CTPA) is the gold standard diagnostic method for patients with suspected pulmonary embolism (PE), but it has its drawbacks, including exposure to ionizing radiation and iodinated contrast agent. The present study aims to evaluate the diagnostic performance of our in-house developed non-contrast MRI protocol for PE diagnosis in reference to CTPA. Methods107 patients were included, all of whom underwent MRI immediately before or within 36 hours after CTPA. Additional cases examined only with MRI and a negative result were added to reach a PE prevalence of approximately 20%. The protocol was a non-contrast 2D steady-state free precession (SSFP) sequence under free-breathing, without respiratory or cardiac gating, and repeated five times to capture the vessels at different breathing/cardiac phases. The MRIs were blinded and read by two radiologists and the results were compared to CTPA. ResultsOf the 243 patients included, 47 were positive for PE. Readers 1 and 2 demonstrated 89% and 87% sensitivity, 100% specificity, 98% accuracy and Cohen’s kappa of 0.88 on patient level. In the per embolus comparison, readers 1 and 2 detected, 60 and 59/61 (98, 97%) proximal, 101 and 94/113 (89, 83%) segmental, and 5 and 2/32 (16, 6%) subsegmental emboli, resulting in 81 and 75% sensitivity respectively. ConclusionThe repeated 2D SSFP can reliably be used for the diagnosis of acute PE at the proximal and segmental artery levels.

Prevalence, risk factors, and clinical characteristics of pulmonary embolism in patients with acute exacerbation of COPD in Plateau regions: a prospective cohort study

Background and objectiveTo investigate pulmonary thromboembolism (PE) in acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) patients in plateau regions, we performed a prospective cohort study to evaluate the prevalence, risk factors and clinical characteristics of PE in the cohort of hospitalized patients at high altitude.MethodsWe did a prospective study with a total of 636 AE-COPD patients in plateau regions. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities and cardiac ultrasound, and computed tomographic pulmonary angiography (CTPA) variables were obtained, and comparisons were made between groups with and without PE. We also conducted logistic regression to explore the risk factors of PE.ResultsOf the 636 patients hospitalized with AE-COPD (age 67.0 ± 10.7 years, 445[70.0%] male), 188 patients developed PE (29.6% [95% CI: 26.0%, 33.1%]). Multivariable logistic regression showed that ethnic minorities, D-dimer > 1 mg/L, AST > 40 U/L, chest pain, cardiac insufficiency or respiratory failure, Padua score > 3, and DVT were associated with a higher probability of PE.ConclusionsThe prevalence of PE is high and those with a higher Padua score, the occurrence of deep venous thrombosis, higher neutrophil count, chest pain, cardiac insufficiency or respiratory failure, higher levels of AST, and a higher level of D-dimer had a higher risk of PE. The analysis of AE-COPD may help to provide more accurate screening for PE and improve clinical outcomes of patients with AE-COPD in plateau regions.

Diagnostic Strategies in Pulmonary Embolism

AbstractKey to the diagnosis of pulmonary embolism (PE) is a careful bedside evaluation. After this, there are three further diagnostic steps. In all patients, estimation of the clinical probability of PE is performed. The other two steps are measurement of D-dimer when indicated and chest imaging when indicated. The clinical probability of PE is estimated at low, moderate, or high. The prevalence of PE is less than 15% among patients with low clinical probability, 15 to 40% with moderate clinical probability, and &gt;40% in patients with high clinical probability. Clinical gestalt has been found to be very useful in estimating probability of PE. However, clinical prediction rules, such as Wells criteria, the modified Geneva score, and the PE rule out criteria have been advocated as adjuncts. In patients with high clinical probability, the high prevalence of PE can lower the D-dimer negative predictive value, which could increase the risk of diagnostic failure. Consequently, patients with high probability for PE need to proceed directly to chest imaging, without prior measurement of D-dimer level. Key studies in determining which low to moderate probability patients require chest imaging are the Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism (ADJUST-PE), the Simplified diagnostic management of suspected pulmonary embolism (YEARS), and the Pulmonary Embolism Graduated D-Dimer trials. In patients with low clinical probability, PE can be excluded without imaging studies if D-dimer is less than 1,000 ng/mL. In patients in whom there is not a low likelihood for PE, this can be excluded without imaging studies if the D-dimer is below the age-adjusted threshold.

Assessing the Prevalence of Pulmonary Embolism and the Clot Burden in Hospitalized Patients with Chronic Obstructive Pulmonary Disease Exacerbation.

This prospective cohort study aimed to assess the pulmonary embolism (PE) rate and clot burden in patients with chronic obstructive pulmonary disease (COPD) exacerbation. A total of 248 patients entered the study, and their clinical probability of PE was assessed using the Geneva score. Patients with high clinical probability underwent computed tomographic pulmonary angiography, while those with low or intermediate probability underwent a d-dimer test. Among the patients analyzed, 14 individuals (5.6%) were confirmed to have PE using computed tomographic pulmonary angiography. A 3-month follow-up revealed 3 cases of PE out of 232 patients initially deemed PE-free. Mortality rates were higher among patients with venous thromboembolism at admission than those diagnosed with PE during follow-up. Pulmonary embolism (PE) prevalence among patients with COPD exacerbation was 5.6%. The results of this study show the importance of screening for PE in patients with COPD presenting with dyspnea. Not all of them are due to COPD exacerbation; a small minority of them can be due to PE, which needs prompt screening, confirmation, and therapy. However, further research with larger cohorts is required to understand better the potential benefits and implications of systematic screening for pulmonary embolism in this specific patient population.

Overuse of Computed Tomography Pulmonary Angiography and Low Utilization of Clinical Prediction Rules in Suspected Pulmonary Embolism Patients at a Regional Australian Hospital.

A pulmonary embolism (PE) is an obstruction in the pulmonary arterial system and may include non-specific signs and symptoms. Clinical prediction rules (CPRs) assess the pretest probability (PTP) of a PE to prevent the overuse of computed tomography pulmonary angiography (CTPA). CTPA overuse results in patient harm and health system waste. This study aimed to evaluate CTPA usage in an Australian regional hospital through analyzing CTPA encounters. A retrospective chart analysis was undertaken of 100 CTPAs conducted at an Australian regional hospital from April to May 2023. Analysis was undertaken for parameters including risk factors, signs and symptoms, investigations, and the use of CPRs. Overall, 86% of patients had signs and/or symptoms of a PE within a week of examination, and 6% of the population had signs of deep vein thrombosis. More than half of the population had no risk factors, while the most prevalent risk factors were a recent history of immobilization/trauma and/or having surgery that required general anesthesia in the last 4 weeks. The most common co-morbidity was chronic lung disease (11%). For the pre-test diagnostic workup, the ECG was the most ordered investigation. The Wells' score was used at 10%, while most patients did not have any CPRs applied. The prevalence of PEs discovered on CTPAs was 9%. CPRs were under-utilized in this Australian regional hospital. The D-dimers for ruling out subjects with low PTP derived from CPRs were also underused. This led to the inappropriate overordering of CTPAs, resulting in negative implications for patients and unnecessary costs to the health system.

Pregnancy-adapted YEARS Algorithm: A Retrospective Analysis.

Pulmonary embolism (PE) is an imperative diagnosis to make given its associated morbidity. There is no current consensus in the initial workup of pregnant patients suspected of a PE. Prospective studies have been conducted in Europe using a pregnancy-adapted YEARS algorithm, which showed safe reductions in computed tomography pulmonary angiography (CTPA) imaging in pregnant patients suspected of PE. Our objective in this study was 1)to measure the potential avoidance of CTPA use in pregnant patients if the pregnancy-adapted YEARS algorithm had been applied and 2)to serve as an external validation study of the use of this algorithm in the United States. This study was a single-system retrospective chart analysis. Criteria for inclusion in the cohort consisted of keywords: pregnant; older than 18; chief complaints of shortness of breath, chest pain, tachycardia, hemoptysis, deep vein thromboembolism (DVT), and D-dimer-from January 1, 2019- May 31,2022. We then analyzed this cohort retrospectively using the pregnancy-adapted YEARS algorithm, which includes clinical signs of a DVT, hemoptysis, and PE as the most likely diagnosis with a D-dimer assay. Patients within the cohort were then subdivided into two categories: aligned with the YEARS algorithm, or not aligned with the YEARS algorithm. Patients who did not receive a CTPA were analyzed for a subsequent diagnosis of a PE or DVT within 30 days. A total of 74 pregnant patients were included in this study. There was a PE prevalence of 2.7% (two patients). Of the 36 patients who did not require imaging by the algorithm, seven CTPA were performed. Of the patients who did not receive an initial CTPA, zero were diagnosed with PE or DVT within a 30-day follow-up. In total, 85.1% of all the patients in this study were treated in concordance with the pregnancy-adapted YEARS algorithm. The use of the pregnancy-adapted YEARS algorithm could have resulted in decreased utilization of CTPA in the workup of PE in pregnant patients, and the algorithm showed similar reductions compared to prospective studies done in Europe. The pregnancy-adapted YEARS algorithm was also shown to be similar to the clinical rationale used by clinicians in the evaluation of pregnant patients, which indicates its potential for widespread acceptance into clinical practice.

Pulmonary embolism risk stratification: external validation of the 4-level Clinical Pretest Probability Score (4PEPS)

BackgroundThe 4-level clinical pretest probability score (4PEPS) was recently introduced as a clinical decision rule for the diagnosis of pulmonary embolism (PE). Based on the score, patients are classified into clinical pretest probability categories (c-PTP). The “very low” category aims at excluding PE without further testing; “low” and “moderate” categories require D-dimer testing with specific thresholds, while patients with a “high” pretest directly proceed to imaging. ObjectivesTo provide further external validation of the 4PEPS model. MethodsThe 4PEPS was applied to a previously collected prospective database of 756 patients with clinically suspected PE enrolled from European emergency departments in 2002 to 2003. The safety threshold for the failure rate in our study was calculated at 1.95% based on a 26% prevalence of PE in our study, as per the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee guidance. ResultsPatients were classified as follows: 90 (12%) in the very low c-PTP group, of whom 5 (5.6%; 95% CI, 2.4%-12.4%) had PE; 363 (49%) in the low c-PTP group, of whom 34 had PE (9.4%); 246 (34%) in the moderate c-PTP group, of whom 124 (50%) had PE; and 35 (5%) in the high c-PTP group of whom 30 (86%) had PE. Overall, the failure rate of the 4PEPS was 9/734 (1.2%; 95% CI, 0.59%-2.23%) Overall, 9 out of 734 patients (1.2%; 95% CI, 0.59%-2.23%) were diagnosed with PE despite a negative 4PEPS rule; 5 (5.6%) from the very low c-PTP group, 3 (1.4%) in the low c-PTP group, and 1 (3.2%) in the moderate c-PTP group. ConclusionWe provide external validation data of the 4PEPS. In this high-prevalence cohort (26% prevalence), PE prevalence in the very low-risk group was higher than expected. A prospective validation study is needed before implementing the 4PEPS model in routine clinical practice.

Pulmonary embolism in COVID-19; a systematic review

Pulmonary embolism (PE) is the more severe clinical presentation of venous thromboembolism. Pulmonary embolism in COVID-19 patients varies from the classic pulmonary embolism without COVID-19 regarding clinical, demographic, and laboratory. However, there was an inconsistency in these findings. Hence this systemic review was conducted to assess the pulmonary embolism in COVID-19 patients by reviewing previous studies that reported pulmonary embolism during the COVID-19 era and conducted on COVID-19 patients. Studies related to the current study subject were explored using PubMed and Google Scholar databases. The included search keywords were &amp;quot;PE, Prevalence, COVID-19, Risk factors, and Predictors&amp;quot; and were used in various combinations. The inclusion criteria were original studies that reported pulmonary embolism conducted during COVID-19 on COVID-19 patients and full-text articles. A total of 528 articles were obtained, and only eight articles were eligible for the inclusion criteria. The involved studies were conducted on a total number of 2,067 participants and they all were retrospective studies. The prevalence of PE is increased by the emergence of COVID-19 infection which suggested a significant correlation. The risk factors of PE among COVID-19 patients vary from the classical ones. D-dimer was found to be a good predictor for PE among COVID-19 patients. The presence of PE among COVID-19 patients requires and predicts the need for mechanical ventilation.

Prevalence of Pulmonary Embolism in COVID-19 at Quaternary Hospital Running Head: Pulmonary Embolism in COVID-19.

Patients with COVID-19 are at greater risk of pulmonary embolism. The aim of the present study was to evaluate the monthly prevalence of pulmonary embolism diagnosed by angiotomography and mortality between March 2020 and May 2021 in more than 6000 patients hospitalized with COVID-19 at a single institution. A clinical trial was conducted with evaluated medical records the patients hospitalized at the institution who developed pulmonary embolism determined by angiotomography. Monthly and overall mortality rates between March 2020 and May 2021 in this population were evaluated. A total of 6040 patients were hospitalized in this period, 203 of whom (3.36%) had an angiotomographic diagnosis of pulmonary embolism and 119 of these patients (58.62%) died. The largest number of patients with pulmonary embolism occurred in the periods from July to September 2020 and March to May 2021. No significant difference was found between mortality and the two peaks of the pandemic (p = 0.9, Fisher's exact test). Pulmonary embolism is associated a higher mortality rate among patients with COVID-19. Therefore, one of the strategies is an emphasis on the prevention of thrombotic and embolic events.

Chest Computed Tomography Characteristics of Critically Ill COVID-19 Patients with Auto-antibodies Against Type I Interferons

PurposePatients with auto-antibodies neutralizing type I interferons (anti-IFN auto-Abs) are at risk of severe forms of coronavirus disease 19 (COVID-19). The chest computed tomography (CT) scan characteristics of critically ill COVID-19 patients harboring these auto-Abs have never been reported.MethodsBicentric ancillary study of the ANTICOV study (observational prospective cohort of severe COVID-19 patients admitted to the intensive care unit (ICU) for hypoxemic acute respiratory failure between March 2020 and May 2021) on chest CT scan characteristics (severity score, parenchymal, pleural, vascular patterns). Anti-IFN auto-Abs were detected using a luciferase neutralization reporting assay. Imaging data were collected through independent blinded reading of two thoracic radiologists of chest CT studies performed at ICU admission (± 72 h). The primary outcome measure was the evaluation of severity by the total severity score (TSS) and the CT severity score (CTSS) according to the presence or absence of anti-IFN auto-Abs.ResultsTwo hundred thirty-one critically ill COVID-19 patients were included in the study (mean age 59.5 ± 12.7 years; males 74.6%). Day 90 mortality was 29.5% (n = 72/244). There was a trend towards more severe radiological lesions in patients with anti-IFN auto-Abs than in others, not reaching statistical significance (median CTSS 27.5 (21.0–34.8) versus 24.0 (19.0–30.0), p = 0.052; median TSS 14.5 (10.2–17.0) versus 12.0 (9.0–15.0), p = 0.070). The extra-parenchymal evaluation found no difference in the proportion of patients with pleural effusion, mediastinal lymphadenopathy, or thymal abnormalities in the two populations. The prevalence of pulmonary embolism was not significantly different between groups (8.7% versus 5.3%, p = 0.623, n = 175).ConclusionThere was no significant difference in disease severity as evaluated by chest CT in severe COVID-19 patients admitted to the ICU for hypoxemic acute respiratory failure with or without anti-IFN auto-Abs.

Prevalence and Prognostic Role of Lymphedema in Patients with Deep Venous Thrombosis and Thrombophlebitis.

Background: Deep venous thrombosis (DVT) poses a substantial disease burden. Lymphedema may present with similar symptoms making the diagnosis process more difficult. Data on the epidemiology of lymphedema are lacking. Methods: The German nationwide inpatient sample served to analyze all patients hospitalized owing to DVT and/or thrombophlebitis (referred to as DVT) of the legs in Germany between 2005 and 2020. We stratified these patients for additional lymphedema and analyzed the impact of lymphedema on adverse in-hospital events. Results: Overall, 1,136,574 hospitalizations related to DVT were recorded in Germany during 2005-2020 (53.3% women; 51.3% aged ≥70 years). Lymphedema was coded in 9974 (0.9%) patient-cases (82.0% not elsewhere classified, 17.7% secondary lymphedema). Annual numbers of hospitalizations with lymphedema among DVT patients increased from 450 (2005) to 613 (2016) (β 0.57; 95% confidence interval [CI]: 0.48-0.66], p < 0.001) and decreased thereafter. Despite similar age, DVT patients with lymphedema had higher prevalence of cardiovascular diseases, chronic organ failure, and all types of investigated cancer. Prevalence of pulmonary embolism (PE) with shock/CPR (4.1% vs. 1.5%), acute renal failure (6.7% vs. 2.5%), and stroke (5.2% vs. 4.2%) was higher in DVT patients with lymphedema than without. Lymphedema was independently associated with PE with shock/CPR (OR: 2.1; 95% CI: 1.9-2.3) as well as death (OR: 1.3; 95% CI: 1.2-1.4). Conclusions: Comorbidity conditions like cancer, obesity, and cardiovascular risk factors, and also infectious complications, were more prevalent in DVT patients with lymphedema than in those without. Lymphedema was independently associated with severe in-hospital complications, particularly when its genesis was related to severe comorbidities.

Prevalence and Impact of COVID-19 in Young Women of Reproductive Age [18-44 Years] Hospitalized with Pulmonary Embolism in the US in 2020 Using National Inpatient Sample Dataset, in-Hospital Mortality, Racial Disparity and Predictors of Mortality

Title: Prevalence and Impact of COVID -19 on In-hospital Outcomes and Associated Racial Disparities in Young Women of Reproductive Age Group (18-44 years) Hospitalized with Pulmonary Embolism in the US in 2020 Background: Given the potential of thrombotic events such as pulmonary embolism in COVID-19, it is essential to comprehend the specific risks and effects on young women of reproductive age, a high-risk group for venous thromboembolism. There is a paucity of data regarding the prevalence and impact of COVID-19 in young women within the reproductive age group who were hospitalized with pulmonary embolism (PE) in the United States during the year 2020. Methods: Utilizing the National Inpatient Sample (NIS) 2020 and relevant ICD-10-CM codes, we identified admissions for PE with COVID-19 vs. without COVID-19 among Young Women [18-44 years] hospitalized with PE. We compared the baseline characteristics and comorbidities between the two groups with and without COVID-19. Furthermore, we analyzed the multivariable adjusted odds ratio (OR) of all-cause mortality in COVID-19 with the non-COVID-19 cohort as a referent, subgroup odds for white vs. other races, and effect modification by diabetes mellitus (DM) as a comorbidity. Results: We identified 34,730 hospitalizations in young female patients of the reproductive age group (18 to 44 years) in 2020 with the diagnosis of PE, of which 2345 (6.8%) had COVID-19. The prevalence of PE was higher in COVID-19 cohort (1.6% vs. 0.6%, p&amp;lt;0.001). The majority of the patients with PE were Caucasian (58.9%) and in the lowest median income quartile (36.9%). Analysis of various comorbidities in both cohorts revealed a statistically significant higher prevalence of hypertension (29.6% in those with COVID-19 vs. 24.3% in those without COVID-19, p &amp;lt;0.001), Similarly, hyperlipidemia (11.7% vs. 7.3%, p &amp;lt;0.001), DM (20.9% vs. 12.4%, p &amp;lt;0.001), and obesity (50.3% vs. 32.7%, p &amp;lt;0.001), were more prevalent in COVID-19, indicating that patients who were admitted with PE with concomitant COVID-19 were of poorer overall cardiovascular health than those with COVID-19. Unadjusted all-cause mortality odds ratio was 2.41 (1.71-3.38, p &amp;lt;0.001) in PE with COVID-19 than non-COVID-19. Adjusted all-cause mortality for demographics, hospital level covariates, and pre-existing conditions revealed similar statistically significant findings, with the odds ratio being 2.8 (1.94-4.04, p &amp;lt;0.001). There was no racial disparity observed in all-cause mortality for non-whites compared to white patients admitted with PE and COVID-19 (p=0.064). Furthermore, all-cause mortality in patients with COVID-19 and PE was found to have an odds ratio of 3.04 (1.05-8.81, p=0.041) in a subset of DM compared to non-DM. The results have confirmed a further robust positive association with increasing mortality risk with DM in young women hospitalized with PE and COVID-19. Conclusion and Relevance: There was a nearly three times higher prevalence of PE and 2.5 times higher odds of mortality in Young Women of Reproductive age [18-44 years] hospitalized with PE with COVID-19 as compared to without COVID-19. The effect of PE and a higher risk of mortality are already established with COVID-19; however, there is a paucity of data in young women, which warrants more prospective studies to evaluate the long-term thromboembolic risks of PE and associated events in this population. The findings of this research could have significant implications for understanding the relationship between COVID-19 and PE in this patient population. Special emphasis needs to be laid on improved healthcare strategies, targeted interventions, and patient education in this cohort to establish future research agendas and provide better health care outcomes for this vulnerable group with established risk factors like diabetes. Key Words: COVID-19, Young Women, Pulmonary Embolism, In-Hospital Mortality, Racial Disparity, Predictors of Mortality, Diabetes Mellitus, National Inpatient Sample

Outcomes of Catheter-Based Therapy for Cancer-Associated Intermediate or High-Risk Pulmonary Embolism

Background: Pulmonary embolism (PE) is a well-known complication of cancer and is associated with significant morbidity and mortality. The standard of care for the treatment of PE is anticoagulation and systemic thrombolysis for high-risk PE. However, both carry risk of bleeding, and patients with cancer are particularly at higher risk of both bleeding and thrombotic complications. The development of catheter-based therapies (CBT) has provided an alternative reperfusion therapy for patients with high-risk and select intermediate risk PE patients. However, despite the increased prevalence of PE, patients with cancer are often excluded from clinical trials of invasive medical devices, including CBT for PE. Therefore, we investigated outcomes of patients with cancer hospitalized for intermediate or high-risk PE treated with or without CBT. Methods: This was a retrospective cohort analysis of the National Readmission Database (NRD) of adult patients with a primary diagnosis of intermediate or high-risk PE from 2017 and 2018 with a history of cancer, which was identified using ICD-10 codes. High-risk PE was defined as PE with hemodynamic instability (either cardiac arrest, cardiogenic shock, or vasopressor use). Intermediate-risk PE was defined as PE with signs of right ventricular strain (type 2 myocardial infarction or cor pulmonale) without hemodynamic instability. Primary outcome was in-hospital mortality. Secondary outcomes were in-hospital major bleeding (composite of gastrointestinal, intracranial, and post-procedural bleeding), and 90-day any-cause, VTE-related, and bleeding-related readmissions. Propensity scores (PS) for estimating probability of CBT were calculated using non-parsimonious multivariable logistic regression that included all baseline patient characteristics examined. Inverse-probability treatment weighting (IPTW) was utilized to adjust for potential confounders. Patients treated with CBT were compared to those without and standardized mean difference (SMD) was calculated for variables before and after IPTW. Imbalances between groups were significant if SMD for any given covariable was ≥ 0.10. Hazard ratios (HR) were estimated for 90-day readmission outcomes using Cox proportional hazards regression, and odds ratio (OR) were calculated for estimating in-hospital outcomes using logistic regression. Results: 3,333 patients were identified of which 388 (11.6%) were treated with CBT. Prior to IPTW, patients treated with CBT were younger (mean age 66.3 vs 67.6 years) and less likely to have metastatic cancer (43.3% vs 50.3%), Khorana high or intermediate risk cancer type (40.5% vs 49.4%) or high-risk PE (34.5% vs 46.3%), Table 1. After IPTW, baseline characteristics were well balanced between groups. After IPTW, CBT was associated with lower risk of in-hospital death (23.3% vs 28.3%, OR 0.77, 95% CI 0.69 - 0.86) but higher risk of in-hospital bleeding (16.4% vs 13.7%, OR 2.34, 95% CI 2.11 - 2.60) which was driven by post-procedure bleeding (12.5% vs 9.2%, OR 1.40, 95% CI 1.20 - 1.64). CBT was also associated with lower 90-day any-cause (HR 0.88, 95% CI 0.79 - 0.98) and VTE-related (HR 0.54, 95% CI 0.35 - 0.83) but not bleeding-related (HR 0.69, 95% CI 0.34 - 1.40) readmissions, Figure 1. Conclusions: Patients with cancer admitted with intermediate or high-risk PE have high rates of in-hospital death and bleeding. Treatment with CBT was associated with lower in-hospital death and 90-day any-cause and VTE-related readmissions at the cost of increased in-hospital bleeding driven by post-procedural bleeding. Prospective studies and trials of CBT in PE should include patients with cancer and further investigation is warranted to confirm our findings.

Prevalence of Thromboembolic Events, Including Venous Thromboembolism and Arterial Thrombosis, in Patients with COVID-19: A Systematic Review with Meta-Analysis.

Many studies have evaluated thromboembolic events in COVID-19 patients, and most of them have reported a high estimation of the prevalence of such events. The present study sought to evaluate the prevalence of thromboembolic events in patients with COVID-19. This study is a systematic review with meta-analysis that investigated thromboembolic events in patients with COVID-19 from the start of the pandemic to August 31, 2021. The 4 main databases for collecting articles were Medline, Scopus, Google Scholar, and Web of Science. Deep vein thrombosis, pulmonary embolism, arterial thrombosis, and the overall rate of thromboembolic events were considered primary outcomes. In a total of 63 studies (104 920 patients with COVID-19), the overall thrombosis rate was 21% (95% CI, 18% to 25%), the rate of deep vein thrombosis was 20% (95% Cl, 16% to 25%), the rate of pulmonary embolism was 8% (95% Cl, 6% to 10%), and the rate of arterial thrombosis was 5% (95% Cl, 3% to 7%). The prevalence of all primary outcomes in critically ill patients admitted to the intensive care unit (ICU) was significantly higher (P<0.05). In older patients, the prevalence of overall thrombosis, pulmonary embolism, or deep vein thrombosis was significantly higher (P<0.05). This study showed that COVID-19 increases the risk of thromboembolic events, especially in elderly and critically ill patients admitted to the ICU. Therefore, more strategies are needed to prevent thromboembolic events in patients with COVID-19, especially in ICU-admitted and elderly patients.

OC 63.4 Prevalence of Pulmonary Embolism in Patients with Chronic Obstructive Pulmonary Disease Exacerbation in North America – A Single Center Experience

OC 63.4 Prevalence of Pulmonary Embolism in Patients with Chronic Obstructive Pulmonary Disease Exacerbation in North America – A Single Center Experience

Successful Management of High-Risk Acute Pulmonary Embolism in Patients with Undetected Hepatocellular Carcinoma: A Case Report

Background: Acute pulmonary embolism (PE) as the first sign of hepatocellular carcinoma (HCC) is rare. It is a deadly disease with high morbidity and mortality. Despite the high prevalence of PE, the diagnosis is still challenging, mainly due to the unpredictability of symptoms. The stratification of acute pulmonary embolism is important because it determines the right steps in decision-making. Case Illustration: A 45-year-old man went to a private hospital's emergency room (ER) with sudden shortness of breath. He was desaturated and shocked. He was assessed as having an acute coronary syndrome (ACS), got loaded with dual antiplatelets, and was referred to our hospital. We rule out ACS because the patient's complaint is sudden shortness of breath and desaturation. Acute PE was diagnosed after bedside transthoracal echocardiography (TTE) in the ER revealed right ventricular (RV) dysfunction. We continued with the computed tomography pulmonary artery (CTPA) examination and found a thrombus in the pulmonary artery. We assessed patients with high-risk PE and performed thrombolysis. Initially, we suspected unprovoked PE because we did not find a clear trigger, such as malignancy, prolonged bedriddenness, recent surgery, or old age. We accidentally found HCC from the patient's CTPA evaluation, and HBsAg was reactive. Conclusion: Every case of dyspnea that shows up at an emergency room should have acute PE taken into consideration in the differential diagnosis. In patients with suspected PE without obvious risk factors, we can use CT to triple-rule out ACS, aortic dissection, and pulmonary embolism. Patients treated with thrombolytic therapy show rapid improvement, which may lead to a lower rate of mortality and morbidity. Keyword: Acute Coronary Syndrome, Acute Pulmonary Embolism, Hepatocellular Carcinoma, Thrombolysis, Unprovoked.

EVALUATION OF THE THORACIC COMPUTED TOMOGRAPHY TECHNIQUE IN THE DIAGNOSIS OF PULMONARY EMBOLISM AT THE LUXEMBOURG MOTHER AND CHILD UNIVERSITY HOSPITAL IN BAMAKO

Introduction: The aim of our study was to evaluate the technique of thoracic computed tomography in the diagnosis of pulmonary embolism at the University Hospital Mère-Enfant le Luxembourg in Bamako. Materials and Methods: This was a descriptive, prospective, cross-sectional study from 1 February to 30 April 2021, a period of 3 months. All patients of any age and sex referred to the radiology department for thoracic computed tomographywho had completed the administrative formalities and agreed to take part in the study, were included in our study. The size of our sample was 46 patients. Data were collected using individual survey forms prepared with the Epi. Info. Version 7.2 tool and filled in on the basis of examination bulletins completed by questioning the patient or accompanying person. Results: At the end of our study in the medical imaging department of the University Hospital Mère-Enfant le Luxembourg in Bamako, the prevalence of pulmonary embolism was 30%. The physical and psychological preparation was 100%, the venous route of the back of the hand with catheter ≤ 20G was the most used 56.52%, the means of restraint were used to 71.7%. Apnoea after deep inspiration of the patient without Valsalva was 84.78%, the automatic 3D reconstruction filter was used in 100% of examinations. The most commonly used PCI was telebris35 (63%) and 45.7% of examinations (n=21) were performed with a volume of 90ml of PCI with an injection rate of 3.5ml/s, i.e. 56.5%. The automatic injector was used in 100% of the examinations, then 81% of the examinations in adults compared with 100% in children (n=4) were performed with a PDL greater than the NRD but neither children nor adults had benefited from any means of radiation protection during the examination. The success rate for a single scan without revision was 52.2%, and the success rate for an examination with good vascular opacification was 95.7%. Conclusion: Thoracic angiography is a key examination in the etiological assessment of pulmonary embolism. It was in high demand during our study period because of the COVID-19 pandemic. In short, thoracic pathologies are becoming increasingly common. The most frequent reason was the onset of pain. However, an early diagnosis is essential for a better prognosis. Angioscan remains the reference examination for vascular pathologies such as pulmonary embolism.