Manchester University NHS Foundation Trust, Department of Radiology, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, United Kingdom.
Centre for Biostatistics, Division of Population Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom; Research and Innovation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Nowgen Building, Grafton Street, Manchester, M13 9WU, United Kingdom.
Eur J Radiol. 2020 Nov;132:109336. doi: 10.1016/j.ejrad.2020.109336. Epub 2020 Oct 6.
To define the prevalence of pulmonary thromboembolic (PTE) disease diagnosed on CT pulmonary angiography (CTPA) in COVID-19 patients. To assess distribution of PTE and to evaluate for association between severity of COVID-19 disease, D-dimer values and incidence of PTE.
Patients with diagnosis of COVID-19 presenting to 5 different hospitals across Greater Manchester between 1st March 2020 and 30th April 2020 who had CTPA were included. CTPA images were evaluated for presence of PTE, distribution of PTE (in small and/or large vessels) and distribution of PTE within lungs with or without COVID-19 CT changes. Severity of COVID lung changes were graded. D-dimer values within 72 h of CTPA were obtained. Statistical analyses were performed to evaluate for any significant association between variables. p values of ≤0.05 were regarded as statistically significant.
A total of 974 patients presented across five hospital sites with COVID-19 infection. Eighty-four (n = 84) COVID-19 patients underwent CTPA. Of these, 38 % (32/84) had PTE. PTE was seen in small vessels in 75 % (24/32) and in lungs demonstrating COVID-19 changes in 72 % (23/32). 84 % (27/32) of PTE positive patients had disease severity of moderate or higher score (p = 0.005). D-dimer values were significantly higher (p ≤ 0.001) in PTE patients, median value in PTE group was 6441mcg/L (range 219-90925). A D-dimer cut off value of 2247mcg/L provides sensitivity of 0.72 and specificity of 0.74.
There is increased prevalence of PTE in patients with moderate to severe COVID-19 disease. D-dimer values may have potential in guiding anticoagulation therapy and prognostication.
确定在 COVID-19 患者的 CT 肺动脉造影（CTPA）中诊断出的肺血栓栓塞（PTE）疾病的患病率。评估 PTE 的分布，并评估 COVID-19 疾病严重程度、D-二聚体值与 PTE 发生率之间的关系。
纳入 2020 年 3 月 1 日至 2020 年 4 月 30 日期间在大曼彻斯特 5 家不同医院就诊的诊断为 COVID-19 的患者，这些患者行 CTPA。评估 CTPA 图像中是否存在 PTE、PTE 的分布（小血管和/或大血管）以及 PTE 在有或无 COVID-19 CT 改变的肺部中的分布。对 COVID 肺改变的严重程度进行分级。获得 CTPA 后 72 小时内的 D-二聚体值。进行统计分析以评估变量之间是否存在任何显著关联。p 值≤0.05 被认为具有统计学意义。
共有 974 名患者在五个医院就诊时患有 COVID-19 感染。84 名（n=84）COVID-19 患者接受了 CTPA。其中，38%（32/84）患有 PTE。75%（24/32）的 PTE 见于小血管，72%（23/32）见于有 COVID-19 改变的肺部。84%（27/32）的 PTE 阳性患者疾病严重程度为中度或更高（p=0.005）。PTE 患者的 D-二聚体值明显更高（p≤0.001），PTE 组的中位数为 6441mcg/L（范围 219-90925）。D-二聚体截断值为 2247mcg/L 时，灵敏度为 0.72，特异性为 0.74。
COVID-19 中度至重度疾病患者的 PTE 患病率增加。D-二聚体值可能有助于指导抗凝治疗和预后判断。
