Coexistent COVID-19 pneumonia and pulmonary embolism: challenges in identifying dual pathology

Adams²,

2021

Eur Radiol

Purpose To investigate, in a meta-analysis, the frequency of pulmonary embolism (PE) in patients with COVID-19 and whether D-dimer assessment may be useful to select patients for computed tomography pulmonary angiography (CTPA). Methods A systematic literature search was performed for original studies which reported the frequency of PE on CTPA in patients with COVID-19. The frequency of PE, the location of PE, and the standardized mean difference (SMD) of D-dimer levels between patients with and without PE were pooled by random effects models. Results Seventy-one studies were included. Pooled frequencies of PE in patients with COVID-19 at the emergency department (ED), general wards, and intensive care unit (ICU) were 17.9% (95% CI: 12.0–23.8%), 23.9% (95% CI: 15.2–32.7%), and 48.6% (95% CI: 41.0–56.1%), respectively. PE was more commonly located in peripheral than in main pulmonary arteries (pooled frequency of 65.3% [95% CI: 60.0–70.1%] vs. 32.9% [95% CI: 26.7–39.0%]; OR = 3.540 [95% CI: 2.308–5.431%]). Patients with PE had significantly higher D-dimer levels (pooled SMD of 1.096 [95% CI, 0.844–1.349]). D-dimer cutoff levels which have been used to identify patients with PE varied between 1000 and 4800 μg/L. Conclusion The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries, which suggests local thrombosis to play a major role. D-dimer assessment may help to select patients with COVID-19 for CTPA, using D-dimer cutoff levels of at least 1000 μg/L. Key Points • The frequency of PE in patients with COVID-19 is highest in the ICU, followed by general wards and the ED. • PE in COVID-19 is more commonly located in peripheral than in central pulmonary arteries. • D-dimer levels are significantly higher in patients with COVID-19 who have PE. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08003-8.

Section: Introductionmentioning

confidence: 99%

Pulmonary embolism in patients with COVID-19 and value of D-dimer assessment: a meta-analysis

Adams²,

2021

Eur Radiol

Current Problems in Cardiology

“…In most COVID-19 patients, no association was found between traditional major risk factors (age, history of VTE disease, malignancy history, smoking and cardiovascular comorbidities including diabetes, hypertension, chronic heart failure and coronary artery disease) and VTE diseases 15 , 24 , 25 . Male gender and obesity were risk factors directly associated with an increased incidence of pulmonary embolism 15 , 16 , 26 . As a noteworthy point in Poyiadji et al study, patients who were on satin therapy prior to admission proved to have fewer pulmonary embolisms occurrence 16 .…”

Section: Vte Diagnosis In Covid-19 Patientsmentioning

confidence: 99%

A Review of Venous Thromboembolism Phenomena in COVID-19 Patients

Kermani-Alghoraishi

Ghahramani

2021

With the outbreak of the second peak of COVID-19 in many countries of the world, re-attention to the symptoms and complications of this disease has received much attention. One of the most important known complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the occurrence of venous thromboembolic (VTE) events, especially in critically ill patients and hospitalized in the intensive care unit. The pathology of this event is complex and multifactorial, but the main problem now is the timely diagnosis of these phenomena, which can reduce the mortality and morbidity of patients. Deterioration of clinical condition in patients with SARS-CoV-2 infection along with increased coagulation markers can increase clinical suspicion of VTE events. Imaging techniques, especially computed tomography pulmonary angiography, can well solve this puzzle and lead to timely treatment of these patients.

“…In addition to DIC, some patients with COVID-19 may present pulmonary embolism ( 153 ) and deep vein thrombosis ( 154 ). The NLRP3 inflammasome has been described as a signaling intermediate between inflammation and thrombosis by modulating clot retraction and platelet spreading ( 155 ).…”

Section: Inflammasome and Disseminated Intravascular Coagulation (Dicmentioning

confidence: 99%

The Inflammasome in Times of COVID-19

Vaccari¹,

et al. 2020

Coronaviruses (CoVs) are members of the genus Betacoronavirus and the Coronaviridiae family responsible for infections such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and more recently, coronavirus disease-2019 (COVID-19). CoV infections present mainly as respiratory infections that lead to acute respiratory distress syndrome (ARDS). However, CoVs, such as COVID-19, also present as a hyperactivation of the inflammatory response that results in increased production of inflammatory cytokines such as interleukin (IL)-1β and its downstream molecule IL-6. The inflammasome is a multiprotein complex involved in the activation of caspase-1 that leads to the activation of IL-1β in a variety of diseases and infections such as CoV infection and in different tissues such as lungs, brain, intestines and kidneys, all of which have been shown to be affected in COVID-19 patients. Here we review the literature regarding the mechanism of inflammasome activation by CoV infection, the role of the inflammasome in ARDS, ventilator-induced lung injury (VILI), and Disseminated Intravascular Coagulation (DIC) as well as the potential mechanism by which the inflammasome may contribute to the damaging effects of inflammation in the cardiac, renal, digestive, and nervous systems in COVID-19 patients.