Predictors and outcomes of acute pulmonary embolism in COVID-19; insights from US National COVID cohort collaborative

Autor: Muhammad H. Gul, Zin Mar Htun, Vinicio de Jesus Perez, Muhammad Suleman, Samiullah Arshad, Muhammad Imran, Mahender Vyasabattu, Jeremy P. Wood, Michael Anstead, Peter E. Morris
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Respiratory Research, Vol 24, Iss 1, Pp 1-12 (2023)
Druh dokumentu: article
ISSN: 1465-993X
DOI: 10.1186/s12931-023-02369-7
Popis: Abstract Objectives To investigate whether COVID-19 patients with pulmonary embolism had higher mortality and assess the utility of d-dimer in predicting acute pulmonary embolism. Patients and methods Using the National Collaborative COVID-19 retrospective cohort, a cohort of hospitalized COVID-19 patients was studied to compare 90-day mortality and intubation outcomes in patients with and without pulmonary embolism in a multivariable cox regression analysis. The secondary measured outcomes in 1:4 propensity score-matched analysis included length of stay, chest pain incidence, heart rate, history of pulmonary embolism or DVT, and admission laboratory parameters. Results Among 31,500 hospitalized COVID-19 patients, 1117 (3.5%) patients were diagnosed with acute pulmonary embolism. Patients with acute pulmonary embolism were noted to have higher mortality (23.6% vs.12.8%; adjusted Hazard Ratio (aHR) = 1.36, 95% CI [1.20–1.55]), and intubation rates (17.6% vs. 9.3%, aHR = 1.38[1.18–1.61]). Pulmonary embolism patients had higher admission D-dimer FEU (Odds Ratio(OR) = 1.13; 95%CI [1.1–1.15]). As the d-dimer value increased, the specificity, positive predictive value, and accuracy of the test increased; however, sensitivity decreased (AUC 0.70). At cut-off d-dimer FEU 1.8 mcg/ml, the test had clinical utility (accuracy 70%) in predicting pulmonary embolism. Patients with acute pulmonary embolism had a higher incidence of chest pain and history of pulmonary embolism or deep vein thrombosis. Conclusions Acute pulmonary embolism is associated with worse mortality and morbidity outcomes in COVID-19. We present d-dimer as a predictive risk tool in the form of a clinical calculator for the diagnosis of acute pulmonary embolism in COVID-19.
Databáze: Directory of Open Access Journals
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje