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Incidence and characterization of acute pulmonary embolism in patients with SARS-CoV-2 pneumonia: A multicenter Italian experience
BACKGROUND AND AIMS: Several studies reported a high incidence of pulmonary embolism (PE) among patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but detailed data about clinical characteristics, risk factors of these patients and prognostic role of PE are still l...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822531/ https://www.ncbi.nlm.nih.gov/pubmed/33481902 http://dx.doi.org/10.1371/journal.pone.0245565 |
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author | Loffi, Marco Regazzoni, Valentina Toselli, Marco Cereda, Alberto Palmisano, Anna Vignale, Davide Moroni, Francesco Pontone, Gianluca Andreini, Daniele Mancini, Elisabetta Maria Monello, Alberto Iannopollo, Gianmarco Casella, Gianni Monetti, Francesco Monti, Lorenzo Ferrillo, Giuseppe Liccardo, Gaetano Tonet, Elisabetta Zucchetti, Ottavio Cossu, Alberto Dugo, Marco Patelli, Gianluigi Sergio, Pietro Esposito, Antonio Colombo, Antonio Giannini, Francesco Piccolo, Raffaele Danzi, Gian Battista |
author_facet | Loffi, Marco Regazzoni, Valentina Toselli, Marco Cereda, Alberto Palmisano, Anna Vignale, Davide Moroni, Francesco Pontone, Gianluca Andreini, Daniele Mancini, Elisabetta Maria Monello, Alberto Iannopollo, Gianmarco Casella, Gianni Monetti, Francesco Monti, Lorenzo Ferrillo, Giuseppe Liccardo, Gaetano Tonet, Elisabetta Zucchetti, Ottavio Cossu, Alberto Dugo, Marco Patelli, Gianluigi Sergio, Pietro Esposito, Antonio Colombo, Antonio Giannini, Francesco Piccolo, Raffaele Danzi, Gian Battista |
author_sort | Loffi, Marco |
collection | PubMed |
description | BACKGROUND AND AIMS: Several studies reported a high incidence of pulmonary embolism (PE) among patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but detailed data about clinical characteristics, risk factors of these patients and prognostic role of PE are still lacking. We aim to evaluate the occurrence of pulmonary embolism among patients with SARS-CoV-2 infection, and to describe their risk factors, clinical characteristics, and in-hospital clinical outcomes. METHODS: This is a multicenter Italian study including 333 consecutive SARS-CoV-2 patients admitted to seven hospitals from February 22 to May 15, 2020. All the patients underwent computed tomography pulmonary angiography (CTPA) for PE detection. In particular, CTPA was performed in case of inadequate response to high-flow oxygen therapy (Fi0(2)≥0.4 to maintain Sp02≥92%), elevated D-dimer (>0.5μg/mL), or echocardiographic signs of right ventricular dysfunction. Clinical, laboratory and radiological data were also analyzed. RESULTS: Among 333 patients with laboratory confirmed SARS-CoV-2 pneumonia and undergoing CTPA, PE was detected in 109 (33%) cases. At CTPA, subsegmental, segmental, lobar and central thrombi were detected in 31 (29%), 50 (46%), 20 (18%) and 8 (7%) cases, respectively. In-hospital death occurred in 29 (27%) patients in the PE-group and in 47 (21%) patients in the non-PE group (p = 0.25). Patients in PE-group had a low rate of traditional risk factors and deep vein thrombosis was detected in 29% of patients undergoing compression ultrasonography. In 71% of cases with documented PE, the thrombotic lesions were located in the correspondence of parenchymal consolidation areas. CONCLUSIONS: Despite a low rate of risk factors for venous thromboembolism, PE is present in about 1 out 3 patients with SARS-CoV-2 pneumonia undergoing CTPA for inadequate response to oxygen therapy, elevated D-dimer level, or echocardiographic signs of right ventricular dysfunction. In most of the cases, the thromboses were located distally in the pulmonary tree and were mainly confined within pneumonia areas. |
format | Online Article Text |
id | pubmed-7822531 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-78225312021-02-01 Incidence and characterization of acute pulmonary embolism in patients with SARS-CoV-2 pneumonia: A multicenter Italian experience Loffi, Marco Regazzoni, Valentina Toselli, Marco Cereda, Alberto Palmisano, Anna Vignale, Davide Moroni, Francesco Pontone, Gianluca Andreini, Daniele Mancini, Elisabetta Maria Monello, Alberto Iannopollo, Gianmarco Casella, Gianni Monetti, Francesco Monti, Lorenzo Ferrillo, Giuseppe Liccardo, Gaetano Tonet, Elisabetta Zucchetti, Ottavio Cossu, Alberto Dugo, Marco Patelli, Gianluigi Sergio, Pietro Esposito, Antonio Colombo, Antonio Giannini, Francesco Piccolo, Raffaele Danzi, Gian Battista PLoS One Research Article BACKGROUND AND AIMS: Several studies reported a high incidence of pulmonary embolism (PE) among patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but detailed data about clinical characteristics, risk factors of these patients and prognostic role of PE are still lacking. We aim to evaluate the occurrence of pulmonary embolism among patients with SARS-CoV-2 infection, and to describe their risk factors, clinical characteristics, and in-hospital clinical outcomes. METHODS: This is a multicenter Italian study including 333 consecutive SARS-CoV-2 patients admitted to seven hospitals from February 22 to May 15, 2020. All the patients underwent computed tomography pulmonary angiography (CTPA) for PE detection. In particular, CTPA was performed in case of inadequate response to high-flow oxygen therapy (Fi0(2)≥0.4 to maintain Sp02≥92%), elevated D-dimer (>0.5μg/mL), or echocardiographic signs of right ventricular dysfunction. Clinical, laboratory and radiological data were also analyzed. RESULTS: Among 333 patients with laboratory confirmed SARS-CoV-2 pneumonia and undergoing CTPA, PE was detected in 109 (33%) cases. At CTPA, subsegmental, segmental, lobar and central thrombi were detected in 31 (29%), 50 (46%), 20 (18%) and 8 (7%) cases, respectively. In-hospital death occurred in 29 (27%) patients in the PE-group and in 47 (21%) patients in the non-PE group (p = 0.25). Patients in PE-group had a low rate of traditional risk factors and deep vein thrombosis was detected in 29% of patients undergoing compression ultrasonography. In 71% of cases with documented PE, the thrombotic lesions were located in the correspondence of parenchymal consolidation areas. CONCLUSIONS: Despite a low rate of risk factors for venous thromboembolism, PE is present in about 1 out 3 patients with SARS-CoV-2 pneumonia undergoing CTPA for inadequate response to oxygen therapy, elevated D-dimer level, or echocardiographic signs of right ventricular dysfunction. In most of the cases, the thromboses were located distally in the pulmonary tree and were mainly confined within pneumonia areas. Public Library of Science 2021-01-22 /pmc/articles/PMC7822531/ /pubmed/33481902 http://dx.doi.org/10.1371/journal.pone.0245565 Text en © 2021 Loffi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Loffi, Marco Regazzoni, Valentina Toselli, Marco Cereda, Alberto Palmisano, Anna Vignale, Davide Moroni, Francesco Pontone, Gianluca Andreini, Daniele Mancini, Elisabetta Maria Monello, Alberto Iannopollo, Gianmarco Casella, Gianni Monetti, Francesco Monti, Lorenzo Ferrillo, Giuseppe Liccardo, Gaetano Tonet, Elisabetta Zucchetti, Ottavio Cossu, Alberto Dugo, Marco Patelli, Gianluigi Sergio, Pietro Esposito, Antonio Colombo, Antonio Giannini, Francesco Piccolo, Raffaele Danzi, Gian Battista Incidence and characterization of acute pulmonary embolism in patients with SARS-CoV-2 pneumonia: A multicenter Italian experience |
title | Incidence and characterization of acute pulmonary embolism in patients with SARS-CoV-2 pneumonia: A multicenter Italian experience |
title_full | Incidence and characterization of acute pulmonary embolism in patients with SARS-CoV-2 pneumonia: A multicenter Italian experience |
title_fullStr | Incidence and characterization of acute pulmonary embolism in patients with SARS-CoV-2 pneumonia: A multicenter Italian experience |
title_full_unstemmed | Incidence and characterization of acute pulmonary embolism in patients with SARS-CoV-2 pneumonia: A multicenter Italian experience |
title_short | Incidence and characterization of acute pulmonary embolism in patients with SARS-CoV-2 pneumonia: A multicenter Italian experience |
title_sort | incidence and characterization of acute pulmonary embolism in patients with sars-cov-2 pneumonia: a multicenter italian experience |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822531/ https://www.ncbi.nlm.nih.gov/pubmed/33481902 http://dx.doi.org/10.1371/journal.pone.0245565 |
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