Alaithan Fatimah A, Aljawad Mahdi H, Ghawas Asia H, Althobaiti Abdulrahman S, Almuslem Qusai A, Bin Nasif Mohammed H, Algharbi Faisal F, Alshehri Reem A, Al Gethami Yousef K, Altowayan Khaled W, Alzahrani Fahad K, Suwaylih Amal A, Alwadai Abdullah S, Badawi Abdulmajeed M, Alshammari Malak
Radiology, Dammam Medical Complex, Dammam, SAU.
Radiology, King Fahd University Hospital, Al-Khobar, SAU.
Cureus. 2021 Oct 19;13(10):e18887. doi: 10.7759/cureus.18887. eCollection 2021 Oct.
Coagulopathy is a well-recognized complication in patients with coronavirus disease 2019 (COVID-19). Pulmonary embolism (PE) has substantial morbidity and mortality if the diagnosis is missed or the management is delayed. Computed tomography pulmonary angiography (CT-PA) is the imaging modality of choice for PE. Therefore, this study aimed to investigate the positive rate of CT-PA for PE among patients with COVID-19.
We conducted a retrospective study examining the diagnostic yield of CT-PA in patients with confirmed COVID-19 and compared it with that in patients without COVID-19. The study included all adult patients with confirmed COVID-19 who presented from June 2020 to June 2021.
The study included 316 patients, including 158 patients with COVID-19, who underwent CT-PA for ruling out PE. Overall, 76 patients were found to have PE on the CT-PA scan, yielding a positive rate of 24.1%, with a significant difference between patients with COVID-19 (8.2%) and those without COVID-19 (39.9%). Further, 138 (87.3%) patients with COVID-19 had elevated D-dimer levels compared with 34 (21.5%) patients without COVID-19. A multivariable regression analysis model revealed that the smoking status (odds ratio [OR] = 1.94; 95% confidence interval [CI]: 1.4-3.8) and obesity (OR = 4.1; 95% CI: 1.5-8.9) were independent predictors of PE among patients with COVID-19. However, the elevated D-dimer level was not significantly associated with PE among patients with COVID-19 (OR = 0.7; 95% CI: 0.4-1.8).
The study found that the positive rate of CT-PA for PE was lower among patients with PE indicating probable overutilization of investigation in these patients. Additionally, patients with COVID-19 had a higher proportion of elevated D-dimer levels that may be a contributor to the increased investigation for PE. Lastly, patients with COVID-19 who were current smokers had a higher tendency of having PE.
凝血功能障碍是2019冠状病毒病（COVID-19）患者中一种公认的并发症。如果漏诊或治疗延迟，肺栓塞（PE）会导致严重的发病率和死亡率。计算机断层扫描肺动脉造影（CT-PA）是诊断PE的首选影像学检查方法。因此，本研究旨在调查COVID-19患者中CT-PA诊断PE的阳性率。
我们进行了一项回顾性研究，检查确诊COVID-19患者的CT-PA诊断率，并将其与未感染COVID-19的患者进行比较。该研究纳入了2020年6月至2021年6月期间所有确诊COVID-19的成年患者。
该研究纳入了316例患者，其中158例确诊COVID-19的患者接受了CT-PA检查以排除PE。总体而言，CT-PA扫描发现76例患者患有PE，阳性率为24.1%，COVID-19患者（8.2%）与未感染COVID-19的患者（39.9%）之间存在显著差异。此外，138例（87.3%）COVID-19患者的D-二聚体水平升高，而未感染COVID-19的患者中这一比例为34例（21.5%）。多变量回归分析模型显示，吸烟状况（比值比[OR]=1.94；95%置信区间[CI]：1.4-3.8）和肥胖（OR=4.1；95%CI：1.5-8.9）是COVID-19患者发生PE的独立预测因素。然而，COVID-19患者中D-二聚体水平升高与PE无显著相关性（OR=0.7；95%CI：0.4-1.8）。
研究发现，COVID-19患者中CT-PA诊断PE的阳性率较低，这表明这些患者可能存在检查过度使用的情况。此外，COVID-19患者中D-二聚体水平升高的比例较高，这可能是导致对PE检查增加的一个因素。最后，目前吸烟的COVID-19患者发生PE的倾向较高。
