Pulmonary Embolism in Critically Ill COVID-19 And Non-COVID-19 Patients: Systematic Analysis of Risk Factors, Diagnostic and Management Strategies, and Prognosis.
Main Article Content
Abstract
Background: Coronavirus disease of 2019 or COVID-19 is characterised by two main features: the first is the respiratory compromise which corresponds to acute respiratory distress syndrome while the second corresponds to the state of hypercoagulability responsible for thromboembolic complications particularly pulmonary embolism which is the subject of this work. Indeed, a high prevalence of pulmonary embolism has been reported throughout the pandemic period with a significant morbidity and mortality. This reflects the severity of this life-threatening emergency chiefly in the elderly, hemodynamically unstable patients, and patients with severe underlying conditions, mainly cardio-pulmonary comorbidities. The aim of our study is to point out the incidence, the risk factors, the clinical and paraclinical features, the management strategies, and the overall prognosis of pulmonary embolism in critically ill COVID-19 and non-COVID-19 patients.
Patients and methods: It is a retrospective observational study carried out over a two-year-period from January 2019 (non-COVID-19) to December 2020 (COVID-19). Over the study period, 42 cases of COVID-19 and non-COVID-19 pulmonary embolism were collected from an overall set of 611 patients admitted to the medical intensive care unit of the IBN ROCHD university hospital of Casablanca.
Results: The mean age in the COVID-19 group was 64-year-old versus 46-year-old in the non-COVID-19 group. The sex ratio was 1.2 and 0.94 in the non-COVID-19 and COVID-19 group, respectively. Clinical symptomatology was dominated by respiratory failure and chest pain in non-COVID-19 patients while in the COVID-19 group, semiology was dominated by dyspnea, cough, and chest pain. The major sign of severity in both groups was tachypnea.
The chest X-ray was performed in all our patients, it displayed radiological abnormalities in all patients mainly hyper clarity in pulmonary fields. D-dimers were performed in all patients within the two study groups. A chest computed tomography angiogram was performed for all patients and showed unilateral pulmonary embolism in 61% of cases in the non-COVID-19 group versus 61.3% in the COVID-19 group. Cardiac ultrasound was performed for all patients. It showed dilatation of right cavities in both groups (81.8% in non-COVID-19 versus 93.5% in COVID-19 patients). Venous ultrasound of the lower limbs was performed in 96.8% of COVID-19 patients and in 72.7% of non-COVID-19 patients.
With regards to management, all COVID-19 and non-COVID-19 patients received anticoagulation therapy based on standard heparin and anti-vitamin K. Mortality accounted for 54.5% in non-COVID-19 patients versus 74.2% in COVID-19 patients.
Conclusion: COVID-19 pulmonary embolism is often associated with significantly higher morbidity and mortality as compared with non-COVID-19 pulmonary embolism.
Keywords:
Pulmonary embolism, Intensive care unit, COVID-19, Risk factors, Mortality
Article Details
How to Cite
CHARRA, Boubaker; BOU-OUHRICH, Yassine.
Pulmonary Embolism in Critically Ill COVID-19 And Non-COVID-19 Patients: Systematic Analysis of Risk Factors, Diagnostic and Management Strategies, and Prognosis..
Medical Research Archives, [S.l.], v. 11, n. 4, apr. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3759>. Date accessed: 20 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i4.3759.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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6. Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography. Thrombosis Research. 2020;190:58-59. doi:https://doi.org/10.1016/j.thromres.2020.04.011
7. Audo A, Bonato V, Cavozza C, Maj G, Pistis G, Secco GG. Acute Pulmonary Embolism in SARS-CoV-2 Infection Treated with Surgical Embolectomy. The Annals of Thoracic Surgery. Published online April 2020. doi:https://doi.org/10.1016/j.athoracsur.2020.04.013
8. Sulemane S, Baltabaeva A, Barron AJ, Chester R, Rahman-Haley S. Acute pulmonary embolism in conjunction with intramural right ventricular thrombus in a SARS-CoV-2-positive patient. European Heart Journal - Cardiovascular Imaging. 2020;21(9):1054-1054. doi:https://doi.org/10.1093/ehjci/jeaa115
9. Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19. Annals of Internal Medicine. 2020;173(4). doi:https://doi.org/10.7326/m20-2003
10. Klok FA, Kruip MJHA, van der Meer NJM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thrombosis Research. Published online April 30, 2020. doi:https://doi.org/10.1016/j.thromres.2020.04.041
11. Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis Research. 2020;191:9-14. doi:https://doi.org/10.1016/j.thromres.2020.04.024
12. Grillet F, Behr J, Calame P, Aubry S, Delabrousse E. Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected by Pulmonary CT Angiography. Radiology. Published online April 23, 2020:201544. doi:https://doi.org/10.1148/radiol.2020201544
13. Bahloul, Mabrouk, Anis Chaari, Hassen Dammak, Leila Abid, Daoud Salima, Hichem Ksibi, Mohamed Samet, et Mounir Bouaziz. « l’embolie Pulmonaire fibrino-cruorique : fréquence, Physiopathologie, tableau clinique et traitement ». LA TUNISIE MEDICALE 92 (2014): 13.
14. Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous Thromboembolism. American Journal of Preventive Medicine. 2010;38(4):S495-S501. doi:https://doi.org/10.1016/j.amepre.2009.12.017
15. Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection. The American Journal of Emergency Medicine. Published online April 2020. doi:https://doi.org/10.1016/j.ajem.2020.04.011
16. Barbara Lambert. L’embolie pulmonaire en pratique clinique à propos de 839 cas consécutifs en Hôpital Général :Etude STEP.Le 12 Novembre 2003.
17. A.Abbadi. L’embolie pulmonaire (A propos de 40 cas). CHU de Fès 2015.
18. Galeano-Valle F, Oblitas CM, Ferreiro-Mazón MM, et al. Antiphospholipid antibodies are not elevated in patients with severe COVID-19 pneumonia and venous thromboembolism. Thrombosis Research. 2020;192:113-115. doi:https://doi.org/10.1016/j.thromres.2020.05.017
19. Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? European Heart Journal. Published online March 30, 2020. doi:https://doi.org/10.1093/eurheartj/ehaa254
20. Jafari R, Cegolon L, Jafari A, et al. Large saddle pulmonary embolism in a woman infected by COVID-19 pneumonia. European Heart Journal. 2020;41(22):2133-2133. doi:https://doi.org/10.1093/eurheartj/ehaa402
21. Cellina M, Oliva G. Acute pulmonary embolism in a patient with COVID-19 pneumonia. Diagnostic and Interventional Imaging. Published online April 10, 2020. doi:https://doi.org/10.1016/j.diii.2020.04.001
22. Ullah W, Saeed R, Sarwar U, Patel R, Fischman DL. COVID-19 complicated by Acute Pulmonary Embolism and Right-Sided Heart Failure. JACC: Case Reports. Published online April 2020. doi:https://doi.org/10.1016/j.jaccas.2020.04.008
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