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"titulo" => "Reply" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "417" "paginaFinal" => "418" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Manuel Gil Mosquera, Mario Fernández-Ruiz" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Manuel" "apellidos" => "Gil Mosquera" "email" => array:1 [ 0 => "manuelgilmosquera@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Mario" "apellidos" => "Fernández-Ruiz" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario "12 de Octubre", Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Enfermedades Infecciosas, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Medicina, Universidad Complutense, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We appreciate the interest shown by Franco-Moreno et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in our study, which aimed to analyse the predictive factors of pulmonary embolism (PE) in patients with SARS-CoV-2 (COVID-19) infection attended to in an A&E.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Various authors have pointed out the need to develop and validate specific PE screening and diagnostic strategies for this population, either based on the application of current clinical probability scales (CPS) or on the interpretation of D-dimer levels (DD) in low or intermediate probability scenarios.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Said CPSs, such as the Wells score or the revised Geneva score, include variables that reflect, to a greater or lesser extent, an embolic phenomenon secondary to thrombosis in extrapulmonary vascular territories as a pathophysiological mechanism. The etiopathogenesis of PE associated with COVID-19 involves both the direct endothelial lesion in the pulmonary vascular bed produced by SARS-CoV-2 as well as the systemic pro-inflammatory effect induced by the infection, which leads to the expression of adhesion molecules (such as P-selectin), platelet activation and aggregation, the release of neutrophil extracellular traps (NETosis) with the associated immunothrombosis phenomenon, and the activation of the extrinsic pathway of coagulation.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Given such a complex scenario, the low diagnostic yield of the CPSs is not surprising, as demonstrated by Franco-Moreno et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The application of the CPS as a screening strategy for PE is based on its high sensitivity and negative predictive value (NPV). However, in the experience of Franco-Moreno et al., the YEARS algorithm and the PERC scale showed a high NPV (88–90%) at the expense of a low positive predictive value (around 50%),<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which implies performing a high number of unnecessary computed tomography pulmonary angiograms (CTPAs). To this we must add that, on many occasions, the diagnosis of PE is thanks to an incidental diagnosis in patients with COVID-19 who underwent a CT angiogram for another reason, and the presence of thrombi in distal locations with little impact on the progress of the condition were demonstrated.</p><p id="par0020" class="elsevierStylePara elsevierViewall">For all these reasons, we agree with Franco-Moreno et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on the need to continue research in the early diagnosis of PE in patients with COVID-19. The incorporation of D-dimer levels with high cut-off points (>3,000 ng/mL in our experience<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>) could contribute to improve the diagnostic performance of CPSs.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">M.F.R. enjoys a «Miguel Servet» (CP 18/00073) research contract from the <span class="elsevierStyleGrantSponsor" id="gs0005">Carlos III Health Institute, Ministry of Science and Innovation</span> – co-funded by the «<span class="elsevierStyleGrantSponsor" id="gs0010">European Social Fund</span>».</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of pulmonary embolism in patients with SARS-CoV-2 infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Franco-Moreno" 1 => "D. Brown-Lavalle" 2 => "A. Bustamante-Fermosel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2022.09.013" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)." "fecha" => "2022" "volumen" => "S0025-7753" "numero" => "22" "paginaInicial" => "00535" "paginaFinal" => "00538" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of pulmonary embolism in patients with SARS-CoV-2 infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Gil Mosquera" 1 => "M. Fernández-Ruiz" 2 => "E. Sanz Rodríguez" 3 => "A. Mata Martínez" 4 => "L. Ibáñez Sanz" 5 => "D. Muñoz Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcle.2021.03.033" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Engl Ed)" "fecha" => "2022" "volumen" => "158" "paginaInicial" => "206" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35155814" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current and novel biomarkers of thrombotic risk in COVID-19: a Consensus Statement from the International COVID-19 Thrombosis Biomarkers Colloquium" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.A. Gorog" 1 => "R.F. Storey" 2 => "P.A. Gurbel" 3 => "U.S. Tantry" 4 => "J.S. Berger" 5 => "M.Y. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41569-021-00665-7" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Cardiol." "fecha" => "2022" "volumen" => "19" "paginaInicial" => "475" "paginaFinal" => "495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35027697" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "COVID-19-associated pulmonary embolism: review of the pathophysiology, epidemiology, prevention, diagnosis, and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Ortega-Paz" 1 => "A.H. Talasaz" 2 => "P. Sadeghipour" 3 => "T.S. Potpara" 4 => "H.D. Aronow" 5 => "L. Jara-Palomares" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0042-1757634" "Revista" => array:2 [ "tituloSerie" => "Semin Thromb Hemost." "fecha" => "2022" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000009/v1_202305121215/S2387020623001444/v1_202305121215/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000009/v1_202305121215/S2387020623001444/v1_202305121215/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623001444?idApp=UINPBA00004N" ]
Journal Information
Vol. 160. Issue 9.
Pages 417-418 (May 2023)
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Vol. 160. Issue 9.
Pages 417-418 (May 2023)
Letter to the Editor
Reply
Respuesta
a Servicio de Urgencias, Hospital Universitario "12 de Octubre", Madrid, Spain
b Unidad de Enfermedades Infecciosas, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
c Departamento de Medicina, Universidad Complutense, Madrid, Spain
d Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Med Clin. 2023;160:137-810.1016/j.medcle.2022.09.011
Anabel Franco-Moreno, David Brown-Lavalle, Ana Bustamante-Fermosel
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