tetano
Editor, Senior Moderator
Am J Emerg Med
. 2020 Jul 24;S0735-6757(20)30649-5.
doi: 10.1016/j.ajem.2020.07.054. Online ahead of print.
Pulmonary embolism in COVID-19: Clinical characteristics and cardiac implications
Jason Kho[SUP] 1 [/SUP], Adam Ioannou[SUP] 2 [/SUP], Koenraad Van den Abbeele[SUP] 1 [/SUP], Amit K J Mandal[SUP] 1 [/SUP], Constantinos G Missouris[SUP] 3 [/SUP]
Affiliations
Abstract
Background: The thrombogenic potential of Covid-19 is increasingly recognised. We aim to assess the characteristics of COVID-19 patients diagnosed with pulmonary embolism (PE).
Methods: We conducted a single centre, retrospective observational cohort study of COVID-19 patients admitted between 1st March and 30th April 2020 subsequently diagnosed with PE following computed tomography pulmonary angiogram (CTPA). Patient demographics, comorbidities, presenting complaints and inpatient investigations were recorded.
Results: We identified 15 COVID-19 patients diagnosed with PE (median age = 58 years [IQR = 23], 87% male). 2 died (13%), both male patients >70 years. Most common symptoms were dyspnoea (N = 10, 67%) and fever (N = 7, 47%). 12 (80%) reported 7 days or more of non-resolving symptoms prior to admission. 7 (47%) required continuous positive airway pressure (CPAP), 2 (13%) of which were subsequently intubated. All patients had significantly raised D-dimer levels, lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin and prothrombin times. The distribution of PEs correlated with the pattern of consolidation observed on CTPA in 9 (60%) patients; the majority being peripheral or subsegmental (N = 14, 93%) and only 1 central PE. 10 (67%) had an abnormal resting electrocardiogram (ECG), the commonest finding being sinus tachycardia. 6 (40%) who underwent transthoracic echocardiography (TTE) had structurally and functionally normal right hearts.
Conclusion: Our study suggests that patients who demonstrate acute deterioration, a protracted course of illness with non-resolving symptoms, worsening dyspnoea, persistent oxygen requirements or significantly raised D-dimer levels should be investigated for PE, particularly in the context of COVID-19 infection. TTE and to a lesser degree the ECG are unreliable predictors of PE within this context.
Keywords: COVID-19; Coagulopathy; Coronavirus; Pulmonary embolism; Venous thromboembolism.
. 2020 Jul 24;S0735-6757(20)30649-5.
doi: 10.1016/j.ajem.2020.07.054. Online ahead of print.
Pulmonary embolism in COVID-19: Clinical characteristics and cardiac implications
Jason Kho[SUP] 1 [/SUP], Adam Ioannou[SUP] 2 [/SUP], Koenraad Van den Abbeele[SUP] 1 [/SUP], Amit K J Mandal[SUP] 1 [/SUP], Constantinos G Missouris[SUP] 3 [/SUP]
Affiliations
- PMID: 33046316
- DOI: 10.1016/j.ajem.2020.07.054
Abstract
Background: The thrombogenic potential of Covid-19 is increasingly recognised. We aim to assess the characteristics of COVID-19 patients diagnosed with pulmonary embolism (PE).
Methods: We conducted a single centre, retrospective observational cohort study of COVID-19 patients admitted between 1st March and 30th April 2020 subsequently diagnosed with PE following computed tomography pulmonary angiogram (CTPA). Patient demographics, comorbidities, presenting complaints and inpatient investigations were recorded.
Results: We identified 15 COVID-19 patients diagnosed with PE (median age = 58 years [IQR = 23], 87% male). 2 died (13%), both male patients >70 years. Most common symptoms were dyspnoea (N = 10, 67%) and fever (N = 7, 47%). 12 (80%) reported 7 days or more of non-resolving symptoms prior to admission. 7 (47%) required continuous positive airway pressure (CPAP), 2 (13%) of which were subsequently intubated. All patients had significantly raised D-dimer levels, lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin and prothrombin times. The distribution of PEs correlated with the pattern of consolidation observed on CTPA in 9 (60%) patients; the majority being peripheral or subsegmental (N = 14, 93%) and only 1 central PE. 10 (67%) had an abnormal resting electrocardiogram (ECG), the commonest finding being sinus tachycardia. 6 (40%) who underwent transthoracic echocardiography (TTE) had structurally and functionally normal right hearts.
Conclusion: Our study suggests that patients who demonstrate acute deterioration, a protracted course of illness with non-resolving symptoms, worsening dyspnoea, persistent oxygen requirements or significantly raised D-dimer levels should be investigated for PE, particularly in the context of COVID-19 infection. TTE and to a lesser degree the ECG are unreliable predictors of PE within this context.
Keywords: COVID-19; Coagulopathy; Coronavirus; Pulmonary embolism; Venous thromboembolism.