Prevalence of pulmonary embolism in patients with COVID-19 pneumonia and high D-dimer values: A prospective study
Prevalence of pulmonary embolism in patients with COVID-19 pneumonia and high D-dimer values: A prospective study
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DOI：
10.1371/journal.pone.0238216
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发表时间：
2020-08-25
期刊：
影响因子：
3.7
通讯作者：
Sala-LlinaS, Ernest
中科院分区：
文献类型：
--
作者：
Alonso-Fernandez, Alberto;Toledo-Pons, Nuria;Sala-LlinaS, Ernest
简介冠状病毒病2019(新冠肺炎)肺炎与全身炎症和凝血功能异常有关。D-二聚体升高尤其频繁，高于1微克/毫升的数值与疾病严重程度和住院死亡率有关。以往的回顾性研究发现，肺栓塞(PE)的发病率很高，然而，应该强调的是，只有当临床怀疑PE时，才能完成诊断。材料与方法单中心前瞻性队列研究。对2020年4月6日至4月17日连续确诊的D-二聚体和门冬氨酸氨基转移酶浓度为1微克/毫升的新冠肺炎肺炎患者进行了CT肺血管造影检查，以了解肺栓塞的存在和程度。对患有和不患有PE的患者的人口统计学和实验室数据、合并症、CTPA评分、接受的治疗和临床结果进行分析和比较。结果共纳入30例患者(11例女性)。15例(50%)诊断为PE。在PE患者中，栓子主要位于节段动脉(86%)和双侧动脉(60%)。与非PE组相比，PE组患者年龄显著增大(中位年龄67.0(IQR 63.0-73.0)比57.0(IQR 48.0-69.0)岁，p=.048)，并且在性别或血栓栓塞性疾病的危险因素方面没有差异。在PE患者中，D-二聚体、血小板计数和C反应蛋白的值显著升高。D-二聚体水平与PE的放射学分级相关(P
Introduction Coronavirus disease 2019 (COVID-19) pneumonia is associated to systemic hyper-inflammation and abnormal coagulation profile. D-dimer elevation is particularly frequent, and values higher than 1 mu g/mL have been associated with disease severity and in-hospital mortality. Previous retrospective studies found a high pulmonary embolism (PE) prevalence, however, it should be highlighted that diagnoses were only completed when PE was clinically suspected. Material and methods Single-center prospective cohort study. Between April 6(th)and April 17(th)2020, consecutive confirmed cases of COVID-19 pneumonia with D-dimer >1 mu g/mL underwent computed tomography pulmonary angiography (CTPA) to investigate the presence and magnitude of PE. Demographic and laboratory data, comorbidities, CTPA scores, administered treatments, and, clinical outcomes were analysed and compared between patients with and without PE. Results Thirty consecutive patients (11 women) were included. PE was diagnosed in 15 patients (50%). In patients with PE, emboli were located mainly in segmental arteries (86%) and bilaterally (60%). Patients with PE were significantly older (median age 67.0 (IQR 63.0-73.0) vs. 57.0 (IQR 48.0-69.0) years, p = .048) and did not differ in sex or risk factors for thromboembolic disease from the non-PE group. D-dimer, platelet count, and, C reactive protein values were significantly higher among PE patients. D-dimer values correlated with the radiologic magnitude of PE (p