Abohamr Samah I, Aldossari Mubarak A, Amer Hala A, Saadeddin Hiba M, Abulhamid Sara W, Bhat Fayaz A, Elsheikh Eman
Heart Health Center, King Saud Medical City, Riyadh, Saudi Arabia.
Department of Prevention and Control of Infection, King Saud Medical City, Riyadh, Saudi Arabia.
J Saudi Heart Assoc. 2020 May 6;33(2):128-134. doi: 10.37616/2212-5043.1253. eCollection 2021.
Acute pulmonary embolism (APE) is a common and prognostically significant complication of COVID-19 infection. We investigated the clinical characteristics and chest CT findings of COVID-19 positive patients complicated with APE. A retrospective, record-based, case-series study was performed examining 483 patients admitted to King Saud Medical City during the pandemic, from April 2020 to June 2020. Of these, 92 patients who underwent chest CT scans were included in the final analysis. The incidence of APE, clinical presentations, radiological patterns, and patient outcomes were assessed and compared against those for patients without PE. The incidence of APE was 22% [95% confidence interval (95% CI): 19%-39%], detected by chest CT. Men constituted 85.0% of patients, with a mean age of 48.9 ± 16.7 years. For most patients with APE, risk factors for thromboembolism were established but did not differ significantly from those without PE. The mean D-dimer level of 9.1 (range 7.0-10.2) was significantly higher among patients diagnosed with APE (OR: 1.021; 95% CI: 1.012-1.028; P = 0.001) compared with that in patients without PE. Moreover, the mean levels of lactate dehydrogenase (LDH, 628.5; range: 494.0-928.3; OR: 1.002; 95% CI: 1.000-1.003; P = 0.02), C-reactive protein (CRP; 158.5; range: 105.3-204.5; OR: 1.025; 95% CI: 1.015-1.035; P = 0.001), and cardiac troponin (3.5; range; 2.6-3.8; OR: 1.016; 95% CI: 0.971-1.067; P = 0.01) were also significantly higher in patients with APE than those in patients with PE. The chest CT presentations of APE included massive, segmental, and sub-segmental APE. The need for Intensive Care Unit admission was higher among patients diagnosed with APE, who presented a fatality rate of 10%.. Our study pointed to the incidence and predictors of APE in COVID-19 patients. High levels of D-dimer, CRP, cardiac troponin, and LDH should alert the clinician to the possibility of APE in COVID-19 patients..
急性肺栓塞（APE）是新型冠状病毒肺炎（COVID-19）感染常见且对预后有重要影响的并发症。我们调查了合并APE的COVID-19阳性患者的临床特征和胸部CT表现。进行了一项回顾性、基于记录的病例系列研究，研究对象为2020年4月至2020年6月疫情期间在沙特国王医疗城住院的483例患者。其中，92例行胸部CT扫描的患者纳入最终分析。评估了APE的发病率、临床表现、影像学特征及患者预后，并与无肺栓塞（PE）的患者进行比较。胸部CT检测出APE的发病率为22%[95%置信区间（95%CI）：19%-39%]。男性占患者的85.0%，平均年龄为48.9±16.7岁。对于大多数APE患者，已确定存在血栓栓塞的危险因素，但与无PE的患者相比无显著差异。与无PE的患者相比，诊断为APE的患者D-二聚体平均水平为9.1（范围7.0-10.2）显著更高（比值比：1.021；95%CI：1.012-1.028；P=0.001）。此外，APE患者乳酸脱氢酶（LDH，628.5；范围：494.0-928.3；比值比：1.002；95%CI：1.000-1.003；P=0.02）、C反应蛋白（CRP；158.5；范围：105.3-204.5；比值比：1.025；95%CI：1.015-1.035；P=0.001）和心肌肌钙蛋白（3.5；范围；2.6-3.8；比值比：1.016；95%CI：0.971-1.067；P=0.01）的平均水平也显著高于无PE的患者。APE的胸部CT表现包括大面积、节段性和亚节段性APE。诊断为APE的患者入住重症监护病房的需求更高，病死率为10%。我们的研究指出了COVID-19患者中APE的发病率及预测因素。D-二聚体、CRP、心肌肌钙蛋白和LDH水平升高应提醒临床医生注意COVID-19患者发生APE的可能性。
