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Inicio Medicina Clínica (English Edition) Prediction of pulmonary embolism in patients with SARS-CoV-2 infection
Journal Information
Vol. 158. Issue 5.
Pages 206-210 (March 2022)
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Vol. 158. Issue 5.
Pages 206-210 (March 2022)
Original article
Prediction of pulmonary embolism in patients with SARS-CoV-2 infection
Predicción del desarrollo de tromboembolia pulmonar en pacientes con infección por SARS-CoV-2
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Manuel Gil Mosqueraa,
Corresponding author
manuelgilmosquera@gmail.com

Corresponding author.
, Mario Fernández-Ruizb, Elena Sanz Rodrígueza, Aránzazu Mata Martíneza, Laín Ibáñez Sanzc, David Muñoz Martínd, Otilia Bisbal Pardoe, Elena Martínez Chamorroc
a Servicio de Urgencias, Hospital Universitario 12 de Octubre, Madrid, Spain
b Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
c Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, Spain
d Hospital Universitario Santiago Apóstol, OSI Araba, Osakidetza, Vitoria, Spain
e Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
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Tables (2)
Table 1. Baseline characteristics of the sample analysed with and without PE.
Table 2. Univariate and multivariate predictive models of PE in patients with COVID-19.
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Additional material (1)
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 > 3000 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.

Keywords:
COVID-19
Pulmonary embolism
Computed tomography pulmonary angiography
D-dimer
Anticoagulant agents
Critical illness
Resumen
Objetivo

Pretendemos determinar los factores predictores de enfermedad tromboembólica pulmonar (ETEP) en pacientes con infección por SARS-CoV-2 (COVID-19) atendidos en el servicio de urgencias de un hospital terciario durante la primera ola pandémica.

Métodos

Estudio observacional unicéntrico realizado en una cohorte retrospectiva de pacientes con infección confirmada por SARS-CoV-2 (o alta sospecha clínico-radiológica de COVID-19) sometidos a despistaje de ETEP mediante tomografía computarizada de arterias pulmonares (TCAP). Se exploraron los factores predictores de ETEP mediante regresión logística, creándose dos modelos predictivos (sin o con los valores de dímeros-D).

Resultados

De un total de 274 TCAP realizados, 70 procedimientos presentaron hallazgos diagnósticos de ETEP, representando una incidencia acumulada de 25,54% (intervalo de confianza [IC] 95%: 20,49–31,14). En el modelo no ajustado por el nivel de dímeros-D, la frecuencia respiratoria >22 rpm (odds ratio [OR]: 3,162; IC 95%: 1,627–6,148; p = 0,001) y la ausencia de hallazgos sugerentes de COVID-19 en la radiología simple de tórax (OR: 3,869; IC 95%: 0,869–17,225; p = 0,076) fueron predictores de ETEP. En el segundo modelo se mantuvo la presencia de taquipnea (OR: 4,967; IC 95%: 2,053–12,018; p < 0,001), identificándose además un nivel de dímeros-D > 3.000 ng/mL (OR: 7,494; IC 95%: 3,038–18,485; p < 0,001).

Conclusiones

La presencia de taquipnea (>22 rpm) y la ausencia de hallazgos radiológicos sugestivos de infección por SARS-CoV-2 en la radiografía simple de tórax, además de los valores de dímero-D > 3.000 ng/mL, fueron identificados como factores predictores de ETEP en pacientes con COVID-19.

Palabras clave:
COVID-19
Embolia pulmonar
Angiografía pulmonar por tomografía computarizada
Dímero D
Agentes anticoagulantes
Enfermedad crítica

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