TY - JOUR
T1 - Pulmonary Thrombosis or Embolism in a Large Cohort of Hospitalized Patients With Covid-19
AU - Benito, Natividad
AU - Filella, David
AU - Mateo, Jose
AU - Fortuna, Ana M.
AU - Gutierrez-Alliende, Juan E.
AU - Hernandez, Nerea
AU - Gimenez, Ana M.
AU - Pomar, Virginia
AU - Castellvi, Ivan
AU - Corominas, Hector
AU - Casademont, Jordi
AU - Domingo, Pere
N1 - Publisher Copyright:
© Copyright © 2020 Benito, Filella, Mateo, Fortuna, Gutierrez-Alliende, Hernandez, Gimenez, Pomar, Castellvi, Corominas, Casademont and Domingo.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/8/25
Y1 - 2020/8/25
N2 - 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 PaO2:FiO2 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 PaO2:FiO2. 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.
AB - 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 PaO2:FiO2 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 PaO2:FiO2. 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.
KW - COVID-19
KW - anticoagulant (MeSH)
KW - pulmonary embolism (MeSH)
KW - pulmonary thrombosis
KW - thromboinflammation
KW - thromboprophylaxis
UR - http://www.scopus.com/inward/record.url?scp=85091352087&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fmed.2020.00557
DO - https://doi.org/10.3389/fmed.2020.00557
M3 - Artículo
C2 - 32984388
AN - SCOPUS:85091352087
VL - 7
JO - Frontiers in Medicine
JF - Frontiers in Medicine
SN - 2296-858X
M1 - 557
ER -