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Inicio Radiología (English Edition) Pulmonary CT angiography in the first wave of the COVID-19 pandemic: Comparison ...
Journal Information
Vol. 65. Issue 3.
Pages 222-229 (May - June 2023)
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Vol. 65. Issue 3.
Pages 222-229 (May - June 2023)
Original articles
Pulmonary CT angiography in the first wave of the COVID-19 pandemic: Comparison between patients with and without infection and with a pre-pandemic series
Angio-TC pulmonar durante la pandemia de COVID-19: comparación en pacientes con y sin la infección y con una serie prepandémica
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J.M. Castro Garcíaa,b,
Corresponding author
jose_miguel2552@hotmail.com

Corresponding author.
, J.J. Arenas-Jiméneza,b,c, A. Ureña-Vacasa, E. García-Garrigósa,b, P. Sirera-Sirerad
a Servicio de Radiodiagnóstico, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain
b Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
c Departamento de Patología y Cirugía, Universidad Miguel Hernández, Elche, Spain
d Servicio de Análisis Clínicos, Hospital General Universitario de Alicante Dr. Balmis, Alicante, Spain
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Tables (3)
Table 1. Epidemiological data for the patients included in the group A subgroups.
Table 2. Diagnostic yield of the different D-dimer values.
Table 3. Comparison of the PTE distribution in the different patient groups.
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Abstract
Background and aims

To analyze the diagnostic performance of pulmonary CT angiography and to compare different D-dimer cutoffs for the diagnosis of acute pulmonary embolism in patients with and without SARS-CoV-2 infections.

Materials and methods

We retrospectively analysed all consecutive pulmonary CT angiography studies done for suspected pulmonary embolism in a tertiary hospital during two time periods: the first December 2020 through February 2021 and the second December 2017 through February 2018. D-dimer levels were obtained less than 24 h before the pulmonary CT angiography studies. We analysed the sensitivity, specificity, positive and negative predictive values, area under the receiver operating curve (AUC), and pattern of pulmonary embolism for six different values of D-dimer and the extent of the embolism. During the pandemic period, we also analysed whether the patients had COVID-19.

Results

After excluding 29 poor-quality studies, 492 studies were analysed; 352 of these were done during the pandemic, 180 in patients with COVID-19 and 172 in patients without COVID-19. The absolute frequency of pulmonary embolism diagnosed was higher during the pandemic period (34 cases during the prior period and 85 during the pandemic; 47 of these patients had COVID-19). No significant differences were found in comparing the AUCs for the D-dimer values. The optimum values calculated for the receiver operating characteristic curves differed between patients with COVID-19 (2200 mcg/l), without COVID-19 (4800 mcg/l), and diagnosed in the prepandemic period (3200 mcg/l). Peripheral distribution of the emboli was more common in patients with COVID-19 (72%) than in those without COVID-19 and than in those diagnosed before the pandemic [OR 6.6, 95% CI: 1.5–24.6, p < 0.05 when compared to central distribution].

Conclusions

The number of CT angiography studies and the number of pulmonary embolisms diagnosed during the pandemic increased due to SARS-CoV-2 infection. The optimal d-dimer cutoffs and the distribution of the pulmonary embolisms differed between the groups of patients with and without COVID-19.

Keywords:
COVID-19
Pulmonary embolism
Fibrinogen degradation products
Resumen
Antecedentes y objetivo

Analizar el rendimiento diagnóstico de la angio-TC pulmonar y comparar distintos valores de corte del dímero-D para el diagnóstico de tromboembolia pulmonar (TEP) aguda en pacientes con y sin infección por SARS-CoV-2.

Materiales y métodos

Análisis retrospectivo de todas las angio-TC pulmonares realizadas consecutivamente por sospecha de TEP en un hospital de tercer nivel durante 2 periodos distintos. El primero de diciembre del 2020 a febrero del 2021 y el segundo de diciembre del 2017 a febrero del 2018. Se recogieron los resultados del dímero-D durante las 24 h previas a la realización de las angio-TC pulmonares, así como el resultado de estas últimas para todos los pacientes incluidos. Se analizaron la sensibilidad, especificidad, valores predictivos, área bajo la curva (AUC) y patrón de tromboembolia para 6 valores distintos del dímero-D y la extensión del tromboembolia. Durante el periodo de la pandemia se registró si los pacientes tenían enfermedad por SARS-CoV-2.

Resultados

Tras desestimar 29 estudios de baja calidad, se incluyeron 492 para el análisis. De ellos, 352 fueron realizados durante la pandemia; 180 en enfermos con COVID-19 y 172 sin la enfermedad. La frecuencia absoluta de TEP diagnosticados durante la pandemia fue mayor (34 durante el periodo previo a la pandemia y 85 durante la pandemia, correspondiendo 47 de este último grupo a pacientes con COVID-19). No se encontraron diferencias significativas al comparar el AUC para los valores del dímero-D. Los valores óptimos calculados a partir de las curvas ROC fueron distintos (2.200, 4.800 y 3.200 µg/l en pacientes con COVID-19, sin COVID-19 y en diagnosticados durante el periodo prepandemia, respectivamente). La distribución periférica de los trombos fue más frecuente en pacientes con COVID-19 (72%), respecto a los pacientes sin COVID-19 y los diagnosticados antes de la pandemia, con un OR de 6,6, IC del 95%: 1,5–24,6 (p < 0,05) al compararla con la distribución central.

Conclusiones

El número de angio-TC realizadas y TEP diagnosticados durante la pandemia aumentó debido a la infección por SARS-CoV-2. Los valores de corte del dímero-D óptimos y la distribución del TEP fueron distintos en los grupos con y sin COVID-19.

Palabras clave:
COVID-19
Tromboembolia pulmonar
Productos de degradación del fibrinógeno

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