COVID Section, Unit of Internal Medicine "Guido Baccelli", Department of Precision and Regenerative Medicine and Ionian Area-(DiMePRe-J), U.O.C. Medicina Interna "Guido Baccelli", University of Bari Aldo Moro, Policlinico di Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
Division of Internal Medicine, Department of Medicine, University of Udine, Building 8, 33100, Udine (UD), Italy.
Intern Emerg Med. 2023 Oct;18(7):1981-1993. doi: 10.1007/s11739-023-03383-9. Epub 2023 Aug 17.
COVID-19 induces endotheliitis and one of the main complications is enhanced coagulation. The incidence of pulmonary embolism (PE) in COVID-19 (CPE) has increased and clinical features for a rigorous analysis still need to be determined. Thus, we evaluated the clinical characteristics in CPE and the immune infiltration that occurred. Between January 1 and December 31, 2021, 38 patients were affected by CPE (9 ICU, 19 males/19 females, 70.18 ± 11.24 years) out of 459 COVID-19 cases. Controls were subjects who were evaluated for PE between January 1 2015, and December 31, 2019 (92 patients, 9 ICU, 48 males/45 females, 69.55 ± 16.59 years). All patients underwent complete physical examination, pulmonary computed tomography, laboratory tests, D-dimer, and blood gas analysis. There were no differences in laboratory tests or D-dimer. In patients with CPE, pO2, alveolar-arterial oxygen difference (A-aDO2), oxygen saturation %, and the ratio between arterial partial pressure of oxygen (PaO2) and fraction of inspired oxygen (FiO2), P/F, were significantly increased. There were no differences in PaCO2. Platelet count was inversely correlated to P/F (r = - 0.389, p = 0.02) but directly to A-aDO2 (r = 0.699, p = 0.001) only in patients with CPE. Histology of lung biopsies (7 CPE/7 controls) of patients with CPE showed an increase in CD15 cells, HMGB1, and extracellular MPO as a marker of NETosis, while no significant differences were found in CD3, CD4, CD8, and intracellular MPO. Overall, data suggest that CPE has a different clinical setting. Reduced oxygen content and saturation described in Patients with CPE should not be considered a trustworthy sign of disease. Increased A-aDO2 may indicate that CPE involves the smallest vessels as compared to classical PE. The significant difference in NETosis may suggest the mechanism related to thrombi formation.
COVID-19 可引起血管内皮炎症，其中一个主要并发症是增强的凝血作用。COVID-19 相关肺栓塞（CPE）的发病率增加，仍需要对其严格的临床特征进行分析。因此，我们评估了 CPE 的临床特征以及发生的免疫浸润情况。2021 年 1 月 1 日至 12 月 31 日，459 例 COVID-19 患者中，有 38 例（9 例 ICU，19 名男性/19 名女性，70.18 ± 11.24 岁）发生了 CPE。对照组为 2015 年 1 月 1 日至 2019 年 12 月 31 日期间评估为肺栓塞的患者（92 例，9 例 ICU，48 名男性/45 名女性，69.55 ± 16.59 岁）。所有患者均接受了全面的体格检查、肺部计算机断层扫描、实验室检查、D-二聚体和血气分析。CPE 患者的实验室检查和 D-二聚体无差异。在 CPE 患者中，pO2、肺泡-动脉氧差（A-aDO2）、氧饱和度%以及动脉血氧分压（PaO2）与吸入氧分数（FiO2）的比值，P/F，均显著升高。PaCO2 无差异。血小板计数与 P/F 呈负相关（r=-0.389，p=0.02），但仅在 CPE 患者中与 A-aDO2 呈正相关（r=0.699，p=0.001）。CPE 患者的肺活检组织学（7 例 CPE/7 例对照）显示，CD15 细胞、HMGB1 和作为 NETosis 标志物的细胞外 MPO 增加，而 CD3、CD4、CD8 和细胞内 MPO 无显著差异。总体而言，数据表明 CPE 具有不同的临床特征。CPE 患者中描述的氧含量和饱和度降低不应被视为疾病的可靠征象。增加的 A-aDO2 可能表明 CPE 与经典 PE 相比，涉及更小的血管。NETosis 的显著差异可能表明与血栓形成相关的机制。
