Association between pulmonary embolism and COVID-19 severe pneumonia: Experience from two centers in the core of the infection Italian peak. Issue 137 (April 2021)

• Record Type: Journal Article
• Authors: Valle, C.; Bonaffini, P.A.; Dal Corso, M.; Mercanzin, E.; Franco, P.N.; Sonzogni, A.; Vacca, G.; Gianatti, A.; Sironi, S.
• Is Part Of: European journal of radiology. Issue 137(2021)
• Publication Date: 2021-04
• Subjects: COVID-19 coronavirus disease 2019 -- SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 -- DD D-dimer -- DIC disseminated tomography angiography -- ER emergency room -- GGO ground-glass opacities -- ICU intensive care unit -- IQR interquartile range -- PE pulmonary embolism -- VTE venous thromboembolism; COVID-19 -- SARS-CoV-2 -- Pneumonia -- Pulmonary embolism; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.109613
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Pulmonary embolism affects a large percentage of COVID-19 pneumonia patients. D-dimer levels correlate with the occurrence and the extent of PE. PE may manifest despite an ongoing anticoagulant therapy. Pulmonary embolism does not seem to affect short-term mortality. Abstract: Purpose: Pulmonary embolism (PE) in COVID-19 patients can play a key role in precipitating clinical conditions. We aimed to evaluate PE distribution on CTA and to investigate any possible association with D-dimer (DD), pulmonary stage of disease and prognosis. Method: COVID-19 patients of two affiliated Hospitals, undergone a CTA examination for PE suspicion, were retrospectively enrolled. Comorbidities, laboratory tests and clinical outcomes (hospitalization, discharge, death) were assessed. A parenchymal stage (early, progressive, peak, absorption) for lung involvement was assigned. Results: A cohort of 114 patients (mean age 61 years; 26.3 % females) with severe COVID-19 pneumonia were evaluated. At last follow-up 25 (21.9 %) were hospitalized, 72 (63.2 %) discharged, 17 (14.9 %) dead. Eighty-eight patients (77.2 %) had at least one comorbidity, being cardiovascular ones the most frequent (44.7 %). CTA revealed PE in 65 patients (57 %), with concomitant pulmonary trunk and/or main arteries involvement in 16.9 %. PE defects were ubiquitous in 18.5 % of cases. The predominant parenchymal stages were the progressive (24.6 %) and peak (67.7 %). DD levels showed a significant correlation with PE occurrence and extent in pulmonary branches, despite anticoagulant therapies; trend of correlation with pulmonary stages was also noted. Conclusions: PE is a frequent complication in severe COVID-19 patients, particularly during central parenchymal stages and despite ongoing anticoagulant therapy. CTA and DD levels play a crucial role in the assessment of suspected PE, despite anticoagulant therapies, along with proper information about lung involvement extent.