Predictors of pulmonary embolism in hospitalized patients with COVID-19
Abstract Background High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). Methods We performed...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Thrombosis Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12959-023-00518-y |
| _version_ | 1797451746181644288 |
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| author | Jeeyune Bahk Abdul Rehman Kam Sing Ho Bharat Narasimhan Hafiza Noor Ul Ain Baloch Jiafang Zhang Rowena Yip Robert Lookstein David J Steiger |
| author_facet | Jeeyune Bahk Abdul Rehman Kam Sing Ho Bharat Narasimhan Hafiza Noor Ul Ain Baloch Jiafang Zhang Rowena Yip Robert Lookstein David J Steiger |
| author_sort | Jeeyune Bahk |
| collection | DOAJ |
| description | Abstract Background High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). Methods We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE. Results 92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03–1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01–1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04–1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24–154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01). Conclusions In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19. |
| first_indexed | 2024-03-09T14:58:54Z |
| format | Article |
| id | doaj.art-3b9edaab7d5b4753b94bcdc5cd662496 |
| institution | Directory Open Access Journal |
| issn | 1477-9560 |
| language | English |
| last_indexed | 2024-03-09T14:58:54Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Thrombosis Journal |
| spelling | doaj.art-3b9edaab7d5b4753b94bcdc5cd6624962023-11-26T14:00:26ZengBMCThrombosis Journal1477-95602023-07-0121111110.1186/s12959-023-00518-yPredictors of pulmonary embolism in hospitalized patients with COVID-19Jeeyune Bahk0Abdul Rehman1Kam Sing Ho2Bharat Narasimhan3Hafiza Noor Ul Ain Baloch4Jiafang Zhang5Rowena Yip6Robert Lookstein7David J Steiger8Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount SinaiDepartment of Medicine, Rutgers-New Jersey Medical SchoolDepartment of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount SinaiDepartment of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount SinaiDivision of Pulmonary and Critical Care, Department of Medicine, Mount Sinai West and Mount Sinai Beth Israel, Icahn School of Medicine at Mount SinaiDepartment of Biostatistics, Mount Sinai West and Mount Sinai Beth Israel, Icahn School of Medicine at Mount SinaiDepartment of Biostatistics, Mount Sinai West and Mount Sinai Beth Israel, Icahn School of Medicine at Mount SinaiDepartment of Radiology, Mount Sinai Hospital, Icahn School of Medicine at Mount SinaiDivision of Pulmonary and Critical Care, Department of Medicine, Mount Sinai West and Mount Sinai Beth Israel, Icahn School of Medicine at Mount SinaiAbstract Background High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). Methods We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE. Results 92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03–1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01–1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04–1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24–154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01). Conclusions In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19.https://doi.org/10.1186/s12959-023-00518-yPulmonary embolismVenous ThromboembolismCoagulopathyD-dimerCoronavirus disease 2019 |
| spellingShingle | Jeeyune Bahk Abdul Rehman Kam Sing Ho Bharat Narasimhan Hafiza Noor Ul Ain Baloch Jiafang Zhang Rowena Yip Robert Lookstein David J Steiger Predictors of pulmonary embolism in hospitalized patients with COVID-19 Thrombosis Journal Pulmonary embolism Venous Thromboembolism Coagulopathy D-dimer Coronavirus disease 2019 |
| title | Predictors of pulmonary embolism in hospitalized patients with COVID-19 |
| title_full | Predictors of pulmonary embolism in hospitalized patients with COVID-19 |
| title_fullStr | Predictors of pulmonary embolism in hospitalized patients with COVID-19 |
| title_full_unstemmed | Predictors of pulmonary embolism in hospitalized patients with COVID-19 |
| title_short | Predictors of pulmonary embolism in hospitalized patients with COVID-19 |
| title_sort | predictors of pulmonary embolism in hospitalized patients with covid 19 |
| topic | Pulmonary embolism Venous Thromboembolism Coagulopathy D-dimer Coronavirus disease 2019 |
| url | https://doi.org/10.1186/s12959-023-00518-y |
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