Pulmonary Thrombosis or Embolism in a Large Cohort of Hospitalized Patients With Covid-19
Por:
Benito N., Filella D., Mateo J., Fortuna A.M., Gutierrez-Alliende J.E., Hernandez N., Gimenez A.M., Pomar V., Castellvi I., Corominas H., Casademont J., Domingo P.
Publicada:
1 ene 2020
Resumen:
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. © Copyright © 2020 Benito, Filella, Mateo, Fortuna, Gutierrez-Alliende, Hernandez, Gimenez, Pomar, Castellvi, Corominas, Casademont and Domingo.
Filiaciones:
Benito N.:
Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Filella D.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Mateo J.:
Thrombosis and Hemostasis Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Fortuna A.M.:
Department of Respiratory Diseases, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Gutierrez-Alliende J.E.:
Department of Radiology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Hernandez N.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Gimenez A.M.:
Department of Radiology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Pomar V.:
Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Castellvi I.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Rheumatology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Corominas H.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Rheumatology, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Casademont J.:
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Domingo P.:
Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau - Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
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