Pulmonary Thrombosis or Embolism in a Large Cohort of Hospitalized Patients With Covid-19
Pulmonary Thrombosis or Embolism in a Large Cohort of Hospitalized Patients With Covid-19
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DOI：
10.3389/fmed.2020.00557
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发表时间：
2020-08-25
影响因子：
3.9
通讯作者：
Domingo, Pere
中科院分区：
文献类型：
--
作者：
Benito, Natividad;Filella, David;Domingo, Pere
目的：分析新型冠状病毒肺炎住院患者肺栓塞（PE）的发生率及预测因素。方法：前瞻性收集2020年3月9日至4月15日期间在巴塞罗那大学医院de la Santa Creu i Sant Pau住院的所有连续实验室确诊Covid-19患者的数据。疑似PE的患者，根据标准化指南，行CT肺血管造影（CTPA）。结果：1275例新冠肺炎患者住院。76例住院患者行CTPA检查，32例诊断为PE （2.6% [95%CI 1.7-3.5%]）。PE患者年龄较大，PaO2:FiO(2)比较低，d -二聚体和c反应蛋白（CRP）水平较高。他们更经常需要进入ICU和机械通气，他们通常住院时间更长，尽管住院死亡率并不比没有PE的患者高。入院时高CRP和d -二聚体水平（>= 150 mg/L, >= 1,000 ng/ml）和住院期间d -二聚体峰值>= 6,000 ng/ml是PE相关的独立因素。预防性低分子量肝素似乎不能预防PE。CRP水平升高与d -二聚体水平升高相关，两者均与PaO2:FiO降低相关(2)。结论：新冠肺炎住院患者PE发生率为2.6%，明显偏高。可能需要更高剂量的血栓预防来预防PE，特别是那些风险增加的患者，例如入院时CRP和d -二聚体水平高的患者。这些发现应该在未来的研究中得到验证。
Objective:We set out to analyze the incidence and predictive factors of pulmonary embolism (PE) in hospitalized patients with Covid-19. Methods:We prospectively collected data from all consecutive patients with laboratory-confirmed Covid-19 admitted to the Hospital de la Santa Creu i Sant Pau, a university hospital in Barcelona, between March 9 and April 15, 2020. Patients with suspected PE, according to standardized guidelines, underwent CT pulmonary angiography (CTPA). Results:A total of 1,275 patients with Covid-19 were admitted to hospital. CTPA was performed on 76 inpatients, and a diagnosis of PE was made in 32 (2.6% [95%CI 1.7-3.5%]). Patients with PE were older, and they exhibited lower PaO2:FiO(2)ratios and higher levels of D-dimer and C-reactive protein (CRP). They more often required admission to ICU and mechanical ventilation, and they often had longer hospital stays, although in-hospital mortality was no greater than in patients without PE. High CRP and D-dimer levels at admission (>= 150 mg/L and >= 1,000 ng/ml, respectively) and a peak D-dimer >= 6,000 ng/ml during hospital stay were independent factors associated with PE. Prophylactic low molecular weight heparin did not appear to prevent PE. Increased CRP levels correlated with increased D-dimer levels and both correlated with a lower PaO2:FiO(2). Conclusions:The 2.6% incidence of PE in Covid-19 hospitalized patients is clearly high. Higher doses of thromboprophylaxis may be required to prevent PE, particularly in patients at increased risk, such as those with high levels of CRP and D-dimer at admission. These findings should be validated in future studies.