Dept of Medicine, King's College NHS Foundation Trust, London, UK; Dept Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
Dept of Medicine, King's College NHS Foundation Trust, London, UK.
Thromb Res. 2020 Nov;195:95-99. doi: 10.1016/j.thromres.2020.07.025. Epub 2020 Jul 10.
Coronavirus disease 2019 (COVID-19) is characterised by dyspnoea and abnormal coagulation parameters, including raised D-dimer. Data suggests a high incidence of pulmonary embolism (PE) in ventilated patients with COVID-19.
To determine the incidence of PE in hospitalised patients with COVID-19 and the diagnostic yield of Computer Tomography Pulmonary Angiography (CTPA) for PE. We also examined the utility of D-dimer and conventional pre-test probability for diagnosis of PE in COVID-19.
PATIENTS/METHODS: Retrospective review of single-centre data of all CTPA studies in patients with suspected or confirmed COVID-19 identified from Electronic Patient Records (EPR).
There were 1477 patients admitted with COVID-19 and 214 CTPA scans performed, of which n = 180 (84%) were requested outside of critical care. The diagnostic yield for PE was 37%. The overall proportion of PE in patients with COVID-19 was 5.4%. The proportions with Wells score of ≥4 ('PE likely') was 33/134 (25%) without PE vs 20/80 (25%) with PE (P = 0.951). The median National Early Warning-2 (NEWS2) score (illness severity) was 5 (interquartile range [IQR] 3-9) in PE group vs 4 (IQR 2-7) in those without PE (P = 0.133). D-dimer was higher in PE (median 8000 ng/mL; IQR 4665-8000 ng/mL) than non-PE (2060 ng/mL, IQR 1210-4410 ng/mL, P < 0.001). In the 'low probability' group, D-dimer was higher (P < 0.001) in those with PE but had a limited role in excluding PE.
Even outside of the critical care environment, PE in hospitalised patients with COVID-19 is common. Of note, approaching half of PE events were diagnosed on hospital admission. More data are needed to identify an optimal diagnostic pathway in patients with COVID-19. Randomised controlled trials of intensified thromboprophylaxis are urgently needed.
2019 年冠状病毒病（COVID-19）的特征是呼吸困难和异常的凝血参数，包括升高的 D-二聚体。数据表明，COVID-19 患者中呼吸机通气的患者肺栓塞（PE）发病率很高。
确定住院 COVID-19 患者中 PE 的发生率和计算机断层肺动脉造影（CTPA）对 PE 的诊断效果。我们还检查了 D-二聚体和常规预测试验概率在 COVID-19 中的诊断 PE 的效用。
患者/方法：回顾性分析从电子病历（EPR）中确定的疑似或确诊 COVID-19 患者的单中心 CTPA 研究数据。
有 1477 名 COVID-19 患者入院，共进行了 214 次 CTPA 扫描，其中 n=180（84%）是在重症监护病房外要求进行的。PE 的诊断率为 37%。COVID-19 患者中 PE 的总体比例为 5.4%。具有≥4 分（“PE 可能性大”）的 Wells 评分的患者中，无 PE 的比例为 33/134（25%），而有 PE 的比例为 20/80（25%）（P=0.951）。PE 组的中位国家早期预警-2（NEWS2）评分（疾病严重程度）为 5（四分位距[IQR]3-9），无 PE 组为 4（IQR 2-7）（P=0.133）。PE 组的 D-二聚体更高（中位数 8000ng/mL；IQR 4665-8000ng/mL），而非 PE 组（2060ng/mL，IQR 1210-4410ng/mL，P<0.001）。在“低概率”组中，PE 患者的 D-二聚体更高（P<0.001），但在排除 PE 方面作用有限。
即使在重症监护环境之外，住院 COVID-19 患者中也常见 PE。值得注意的是，近一半的 PE 事件是在入院时诊断出的。需要更多的数据来确定 COVID-19 患者的最佳诊断途径。急需进行强化抗栓治疗的随机对照试验。
