Prediction of pulmonary embolism in patients with SARS-CoV-2 infection

Abstract

Objective To determine the predictive factors of pulmonary thromboembolic (PTE) in patients with SARS-CoV-2 infection (COVID-19) assessed in the emergency department at a tertiary hospital during the first pandemic wave. Methods Observational single-center study conducted in a retrospective cohort of patients with confirmed SARS-CoV-2 infection (or high clinical-radiological suspicion) who underwent PTE screening by computed tomography pulmonary angiography (CTPA). Predictive factors of PTE were explored using logistic regression, creating two predictive models (without or with D-dimer values). Results Out of a total of 274 CTPA performed, 70 procedures presented diagnostic findings of PTE, representing a cumulative incidence of 25.54% (95% confidence interval [CI]: 20.49–31.14). In the non-D-dimer based model, respiratory rate >22 bpm (odds ratio [OR]: 3.162; 95% CI: 1.627–6.148; p = 0.001) and the absence of findings suggestive of COVID-19 in plain chest X-ray (OR: 3.869; 95% CI: 0.869–17.225; p = 0.076) were predictors of PTE. In the D-dimer-based model, tachypnea remained as a predictive factor (OR: 4.967; 95% CI: 2.053–12.018; p < 0.001), as well as D-dimers > 3,000 ng/ml (OR: 7.494; 95% CI: 3.038–18.485; p < 0.001). Conclusions The presence of tachypnea (>22 bpm) and the absence of radiological findings suggestive of SARS-CoV-2 infection in the chest X-ray, in addition to D-dimer values >3000 ng/mL, were identified as predictive factors of PTE in patients with COVID-19.

Clinical prediction model for pulmonary embolism diagnosis in hospitalized patients with SARS-CoV-2 infection

“…Heart rate was a risk marker of PE, in line with previous reports [28,29]. In a study conducted by Gil et al, tachypnea >22 bpm was a predictive factor of PE in patients with COVID-19 [30]. We found an association between the extension of pneumonia and the con rmation of PE.…”

Mortality, deep vein thrombosis, and D-dimer levels in patients with COVID-19

“…4 The presence of tachypnea (> 22 bpm) and no radiological signs suggestive of infection by SARS-CoV-2 on the chest radiography and D-dimer > 3000 ng/mL have been identifi ed as predictive factors of deep vein thrombosis in patients with COVID-19. 5 A review study showed that infl ammatory factors, such as interleukin-6, ferritin, leukocytes, neutrophils, lymphocytes, platelets, C-reactive protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine and D-dimer, are important biomarkers of cytokine storm syndrome. High levels of interleukin-6 and hyperferritinemia should be considered warning signs of systemic infl ammation and a poor prognosis in cases of COVID-19.…”

Respuesta

“…Agradecemos el interés mostrado por Franco-Moreno y colaboradores 1 en nuestro estudio, que tuvo por objeto analizar los factores predictivos de embolia pulmonar (EP) en pacientes con infección por SARS-CoV-2 (COVID-19) atendidos en un servicio de urgencias 2 . Diversos autores han señalado la necesidad de desarrollar y validar estrategias de despistaje y diagnóstico de EP específicas para esta población, ya sea que estén basadas en la aplicación de las actuales escalas de probabilidad clínica (EPC) o en la interpretación de los niveles de dímeros-D (DD) en escenarios de probabilidad baja o intermedia.…”

“…Por todo ello, estamos de acuerdo con Franco-Moreno y colaboradores 1 en la necesidad de proseguir la investigación en el diagnóstico temprano de la EP en pacientes con COVID-19. La incorporación de los niveles de DD con puntos de corte elevados (> 3.000 ng/mL en nuestra experiencia 2 ) podría contribuir a mejorar el rendimiento diagnóstico de las EPC.…”