Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Am J Cardiol. 2020 Oct 15;133:148-153. doi: 10.1016/j.amjcard.2020.07.036. Epub 2020 Jul 24.
Pulmonary embolisms (PEs) in coronavirus disease 2019 (COVID-19) have increasingly been reported in observational studies. However, limited information describing their clinical characteristics and outcomes exists. Our study aims to describe clinical features and risk stratification strategies of hospitalized COVID-19 patients with PE. We retrospectively analyzed 101 hospitalized patients with COVID-19 infection and acute PE. Clinical outcomes measured were intensive care unit admission, mechanical ventilation, bleeding and transfusion events, acute kidney injury (AKI) and mortality. Pulmonary severity index (PESI) scores were used for risk stratification. The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among this cohort. Baseline D-dimer abnormalities (4,647.0 ± 8,281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13,288.4 ± 14,917.9; p <0.05). Five (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. Thirty-one (31%) patients developed AKI and 1 (1%) patient required renal replacement therapy. Twenty-three (23%) patients were admitted to intensive care unit, of which 20 (20%) patients received mechanical ventilation. The mortality rate was 20%. Most patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. In conclusion, this study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. PESI scores were utilized for risk stratifying clinical outcomes. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection.
新型冠状病毒疾病 2019（COVID-19）中的肺栓塞（PE）在观察性研究中越来越多地被报道。然而，关于其临床特征和结局的信息有限。我们的研究旨在描述住院 COVID-19 患者合并 PE 的临床特征和风险分层策略。我们回顾性分析了 101 例住院 COVID-19 感染合并急性 PE 的患者。测量的临床结局包括入住重症监护病房、机械通气、出血和输血事件、急性肾损伤（AKI）和死亡率。使用肺部严重指数（PESI）评分进行风险分层。该队列中最常见的合并症是高血压（50%）、肥胖症（27%）和高脂血症（32%）。入院时发现基线 D-二聚体异常（4,647.0 ± 8,281.8），PE 诊断时增加了 3 倍（13,288.4 ± 14,917.9；p<0.05）。5 例（5%）患者需要全身溶栓，12 例（12%）患者发生中重度出血。31 例（31%）患者发生 AKI，1 例（1%）患者需要肾脏替代治疗。23 例（23%）患者入住重症监护病房，其中 20 例（20%）患者接受机械通气。死亡率为 20%。大多数患者（65%）的 PESI 评分处于中高危（>85），预示着预后较差，死亡率和住院时间较长。总之，本研究提供了住院 COVID-19 患者合并急性肺栓塞的特征和早期结局。PESI 评分用于对临床结局进行风险分层。我们的研究结果应该引起医学界对 COVID-19 感染相关静脉血栓栓塞并发症的高度警惕。
