Clinical and computed tomography characteristics of COVID-19 associated acute pulmonary embolism: A different phenotype of thrombotic disease?
Clinical and computed tomography characteristics of COVID-19 associated acute pulmonary embolism: A different phenotype of thrombotic disease?
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DOI：
10.1016/j.thromres.2020.06.010
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发表时间：
2020-09-01
影响因子：
7.5
通讯作者：
Klok, F. A.
中科院分区：
文献类型：
--
作者：
van Dam, L. F.;Kroft, L. J. M.;Klok, F. A.
前言：新冠肺炎感染与静脉血栓栓塞症，尤其是肺血栓栓塞症(PE)的高发有关。新冠肺炎相关性PE代表的是原位免疫血栓形成，而不是静脉血栓栓塞症，尽管新冠肺炎患者血栓病变的起源尚不清楚。方法：在这项研究中，我们评估了连续23例新冠肺炎肺炎患者的PE的临床和CT特征，并将这些特征与连续100例新冠肺炎暴发前诊断为急性PE的对照组进行了比较。具体测量并比较右室/左室径比、肺动脉主干内径和血栓总负荷(根据卡纳德利积分)。结果：观察到新冠肺炎患者血栓形成的病变均位于新冠肺炎病变的肺实质内。此外，新冠肺炎患者的血栓负荷较低(卡纳德利评分-8%，95%可信区间[95%CI]-16至-0.36%)以及主/叶动脉最近端PE的发生率(17%对47%；-30%，95%可信区间-44%至-8.2)。此外，新冠肺炎患者的平均RV/LV比值(平均差值-0.23，95%CI-0.39~-0.07)和RV/LV比值>；1.0的患病率(患病率差值-23%，95%CI-41%至-0.86%)也较低。结论：新冠肺炎相关性PE的表型确实不同于无新冠肺炎的PE，这一发现促进了对其病理生理机制的讨论。
Introduction: COVID-19 infections are associated with a high prevalence of venous thromboembolism, particularly pulmonary embolism (PE). It is suggested that COVID-19 associated PE represents in situ immunothrombosis rather than venous thromboembolism, although the origin of thrombotic lesions in COVID-19 patients remains largely unknown.Methods: In this study, we assessed the clinical and computed tomography (CT) characteristics of PE in 23 consecutive patients with COVID-19 pneumonia and compared these to those of 100 consecutive control patients diagnosed with acute PE before the COVID-19 outbreak. Specifically, RV/LV diameter ratio, pulmonary artery trunk diameter and total thrombus load (according to Qanadli score) were measured and compared.Results: We observed that all thrombotic lesions in COVID-19 patients were found to be in lung parenchyma affected by COVID-19. Also, the thrombus load was lower in COVID-19 patients (Qanadli score -8%, 95% confidence interval [95%CI] -16 to -0.36%) as was the prevalence of the most proximal PE in the main/lobar pulmonary artery (17% versus 47%; -30%, 95%CI -44% to -8.2). Moreover, the mean RV/LV ratio (mean difference -0.23, 95%CI -0.39 to -0.07) and the prevalence of RV/LV ratio > 1.0 (prevalence difference -23%, 95%CI -41 to -0.86%) were lower in the COVID-19 patients.Conclusion: Our findings therefore suggest that the phenotype of COVID-19 associated PE indeed differs from PE in patients without COVID-19, fuelling the discussion on its pathophysiology.