Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study.
Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study.
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DOI：
10.1007/s00392-020-01766-y
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发表时间：
2021-07
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影响因子：
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通讯作者：
Metra M
中科院分区：
文献类型：
--
作者：
Ameri P;Inciardi RM;Di Pasquale M;Agostoni P;Bellasi A;Camporotondo R;Canale C;Carubelli V;Carugo S;Catagnano F;Danzi G;Dalla Vecchia L;Giovinazzo S;Gnecchi M;Guazzi M;Iorio A;La Rovere MT;Leonardi S;Maccagni G;Mapelli M;Margonato D;Merlo M;Monzo L;Mortara A;Nuzzi V;Piepoli M;Porto I;Pozzi A;Provenzale G;Sarullo F;Sinagra G;Tedino C;Tomasoni D;Volterrani M;Zaccone G;Lombardi CM;Senni M;Metra M
肺栓塞（PE）在2019冠状病毒病（COVID-19）重症患者中已有描述，但来自更多异质性队列的证据有限。数据回顾性获得自2020年3月1日至4月9日在意大利13个心脏病单位住院的连续COVID-19患者，并随访至院内死亡、出院或2020年4月23日。通过考克斯风险回归分析研究基线变量与计算机断层扫描证实的PE的相关性。使用限制性三次样条模型评价D-二聚体水平与PE发病率之间的关系。该研究纳入了689例患者（67.3 ± 13.2岁，69.4%为男性），其中43.6%为无创通气，15.8%为有创通气。52例（7.5%）在15（9-24）天随访期间发生PE。与无PE的受试者相比，这些受试者年龄更小，BMI更高，心力衰竭和慢性肾脏疾病发生率更低，心肺受累更严重，入院时d-二聚体更高[4344（1099- 15，118）vs. 818.5（417-1460）ng/mL，p < 0.001]。他们还接受了更频繁的地瑞那韦/利托那韦，托珠单抗和通气支持。此外，他们面临更多需要输血的出血事件（15.6% vs. 5.1%，p < 0.001）和非显著性较高的住院死亡率（34.6% vs. 22.9%，p = 0.06）。在多变量回归中，仅d-二聚体与PE相关（HR 1.72，95% CI 1.13-2.62; p = 0.01）。D-二聚体浓度与PE发生率呈线性关系，无拐点。只有两名受试者的基线d-二聚体< 500 ng/mL。相当大比例的COVID-19住院患者发生PE。出血事件的影响和d-二聚体在这一人群中的作用需要澄清。本文的在线版本（doi：10.1007/s 00392 -020-01766-y）包含补充材料，可供授权用户使用。
Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. Data were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models. The study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involvement, and higher admission d-dimer [4344 (1099–15,118) vs. 818.5 (417–1460) ng/mL, p < 0.001]. They also received more frequently darunavir/ritonavir, tocilizumab and ventilation support. Furthermore, they faced more bleeding episodes requiring transfusion (15.6% vs. 5.1%, p < 0.001) and non-significantly higher in-hospital mortality (34.6% vs. 22.9%, p = 0.06). In multivariate regression, only d-dimer was associated with PE (HR 1.72, 95% CI 1.13–2.62; p = 0.01). The relation between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer < 500 ng/mL. PE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of d-dimer in this population need to be clarified. The online version of this article (doi:10.1007/s00392-020-01766-y) contains supplementary material, which is available to authorized users.
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168.9
作者：
Huang, Chaolin;Wang, Yeming;Cao, Bin
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