scholarly journals Widespread Parenchymal Abnormalities and Pulmonary Embolism on Contrast-Enhanced CT Predict Disease Severity and Mortality in Hospitalized COVID-19 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Francesca Campoccia Jalde ◽  
Mats O. Beckman ◽  
Ann Mari Svensson ◽  
Max Bell ◽  
Magnus Sköld ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Troponin T ◽  
Main Pulmonary Artery ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Parenchymal Abnormalities ◽  
Pulmonary Artery Diameter ◽  
D Dimer

Purpose: Severe COVID-19 is associated with inflammation, thromboembolic disease, and high mortality. We studied factors associated with fatal outcomes in consecutive COVID-19 patients examined by computed tomography pulmonary angiogram (CTPA).Methods: This retrospective, single-center cohort analysis included 130 PCR-positive patients hospitalized for COVID-19 [35 women and 95 men, median age 57 years (interquartile range 51–64)] with suspected pulmonary embolism based on clinical suspicion. The presence and extent of embolism and parenchymal abnormalities on CTPA were recorded. The severity of pulmonary parenchymal involvement was stratified by two experienced radiologists into two groups: lesions affecting ≤50% or >50% of the parenchyma. Patient characteristics, radiological aspects, laboratory parameters, and 60-day mortality data were collected.Results: Pulmonary embolism was present in 26% of the patients. Most emboli were small and peripheral. Patients with widespread parenchymal abnormalities, with or without pulmonary embolism, had increased main pulmonary artery diameter (p < 0.05) and higher C-reactive protein (p < 0.01), D-dimer (p < 0.01), and troponin T (p < 0.001) and lower hemoglobin (p < 0.001). A wider main pulmonary artery diameter correlated positively with C-reactive protein (r = 0.28, p = 0.001, and n = 130) and procalcitonin. In a multivariant analysis, D-dimer >7.2 mg/L [odds ratio (±95% confidence interval) 4.1 (1.4–12.0)] and ICU stay were significantly associated with embolism (p < 0.001). The highest 60-day mortality was found in patients with widespread parenchymal abnormalities combined with pulmonary embolism (36%), followed by patients with widespread parenchymal abnormalities without pulmonary embolism (26%). In multivariate analysis, high troponin T, D-dimer, and plasma creatinine and widespread parenchymal abnormalities on CT were associated with 60-day mortality.Conclusions: Pulmonary embolism combined with widespread parenchymal abnormalities contributed to mortality risk in COVID-19. Elevated C-reactive protein, D-dimer, troponin-T, P-creatinine, and enlarged pulmonary artery were associated with a worse outcome and may mirror a more severe systemic disease. A liberal approach to radiological investigation should be recommended at clinical deterioration, when the situation allows it. Computed tomography imaging, even without intravenous contrast to assess the severity of pulmonary infiltrates, are of value to predict outcome in COVID-19. Better radiological techniques with higher resolution could potentially improve the detection of microthromboses. This could influence anticoagulant treatment strategies, preventing clinical detoriation.

The Value of D-Dimer in Patients with Increased C-Reactive Protein Suspected of Pulmonary Embolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 5056-5056
Author(s):  
Claire Siemes ◽  
Paul Berendes ◽  
Frans van der Straaten ◽  
Ton Cleophas ◽  
Mark-David Levin
Keyword(s):  
Pulmonary Embolism ◽  
Conflicts Of Interest ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Serum Levels ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Interaction Term ◽  
Pulmonary Embolisms ◽  
D Dimer

Abstract Abstract 5056 OBJECTIVE To investigate the relation between elevated levels of C-reactive protein (CRP) and D-dimer, and to study whether D-dimer levels can be interpreted in relation to elevated levels of CRP in the prediction of a pulmonary embolism in order to increase its specificity without decline in sensitivity. METHODS Between august 2004 and april 2007 (33 months) serum levels of C-reactive protein (mmol/L) and D-dimer (mmol/L) were cross-sectionally collected and pulmonary embolisms on CT-angiograms were scored within 48 hours. The study was devided into three parts. First, characteristics of excluded persons were studied. Second, the correlation between CRP and D-dimer level was considered in those with a defined (i.e. values with < and > symbols excluded) biomarker level. Finally, the effect of CRP level on the sensitivity of D-dimer for pulmonary embolisms was examined. RESULTS CRP and D-dimer levels were positively correlated ( r = 0.37; p < 0.001), and both were increased in persons with a pulmonary embolism (CRP: p = 0.02; D-dimer: p < 0.001). 14 % of variability in D-dimer level was explained by CRP level. Median D-dimer levels were increased in the pulmonary embolism (PE) group, however, the increase in D-dimer level by CRP quartile as was found in the non-PE was not seen in de PE-group. Adding the interaction term of CRP and D-dimer to the statistical model showed some influence on the area under the curve (AUC). Nevertheless, this was not significantly different from the model with only D-dimer levels. However, when stratified for CRP quartile, ROC-curves of the predictive effect of D-dimer on pulmonary embolisms showed a decrease in AUC by increment of CRP quartile. CONCLUSION CRP and D-dimer are positively correlated, and both predictive of PE. The predictive value of D-dimer for PE declines by increment of CRP, although this seems to be safely for a broader range of accompanied CRP levels. Disclosures No relevant conflicts of interest to declare.

scholarly journals SARS‐CoV‐2 viremia is associated with inflammatory, but not cardiovascular biomarkers, in patients hospitalized for COVID‐19

2021 ◽  
Author(s):  
Peder L. Myhre ◽  
Christian Prebensen ◽  
Christine Monceyron Jonassen ◽  
Jan Erik Berdal ◽  
Torbjørn Omland
Keyword(s):  
Myocardial Injury ◽  
Prospective Observational Study ◽  
Cardiac Tissue ◽  
Troponin T ◽  
Myocardial Dysfunction ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Lower Oxygen ◽  
Cardiovascular Biomarkers ◽  
D Dimer

Abstract Background COVID‐19 may present with a variety of cardiovascular manifestations, and elevations of biomarkers reflecting myocardial injury and stress are prevalent. SARS‐CoV‐2 has been found in cardiac tissue, and myocardial dysfunction post‐COVID‐19 may occur. However, the association between SARS‐CoV‐2 RNA in plasma and cardiovascular biomarkers remains unknown. Methods and Results COVID MECH was a prospective, observational study enrolling consecutive, hospitalized patients with laboratory‐confirmed infection with SARS‐CoV‐2 and symptoms of COVID‐19. Biobank plasma samples used to measure SARS‐CoV‐2 RNA and cardiovascular and inflammatory biomarkers were collected in 123 patients at baseline, and in 96 (78%) at day 3. Patients were aged 60±15 years, 71 (58%) male, 68 (55%) Caucasian and 31 (25%) received mechanical ventilation during hospitalization. SARS‐CoV‐2 RNA was detected in plasma from 48 (39%) patients at baseline. Patients with viremia were more frequently male, had more diabetes mellitus and lower oxygen saturation. Patients with viremia had higher concentrations of interleukin‐6, C‐reactive protein, procalcitonin and ferritin (all <0.001), but comparable levels of cardiac troponin T (cTnT; p=0.09), N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP; p=0.27) and D‐dimer (p=0.67) to patients without viremia. SARS‐CoV‐2 RNA was present in plasma at either baseline or day 3 in 50 (52%) patients, and these patients experienced increase from baseline to day 3 in NT‐proBNP and D‐dimer concentrations, while there was no change in cTnT. Conclusions SARS‐CoV‐2 viremia was associated with increased concentrations of inflammatory, but not cardiovascular biomarkers. NT‐proBNP and D‐dimer, but not cTnT, increased from baseline to day 3 in patients with viremia.

Exclusion of pulmonary embolism using C-reactive protein and D-dimer

2003 ◽  
Vol 90 (12) ◽  
pp. 1198-1203 ◽  
Author(s):  
Daniel Hayoz ◽  
Bertrand Yersin ◽  
Arnaud Perrier ◽  
Ghassan Barghouth ◽  
Pierre Schnyder ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Judgment ◽  
Prediction Rule ◽  
Pulmonary Angiography ◽  
Enzyme Linked Immunosorbent Assay ◽  
Probability Assessment ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Clinical Probability ◽  
D Dimer

SummaryOur goal was to evaluate the diagnostic utility of C-reactive protein (CRP) alone or combined with clinical probability assessment in patients with suspected pulmonary embolism (PE), and to compare its performance to a D-dimer assay. We conducted a prospective study in which we performed a common immuno-turbidimetric CRP test and a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer test in 259 consecutive outpatients with suspected PE at the emergency department of a teaching hospital. We assessed clinical probability of PE by a validated prediction rule overridden by clinical judgment. Patients with D-dimer levels ≥ 500 µg/l underwent a work-up consisting of lower-limb venous ultrasound, spiral computer-ized tomography, ventilation-perfusion scan, or pulmonary angiography. Patients were followed up for three months. Seventy-seven (30%) of the patients had PE.The CRP alone had a sensitivity of 84% (95% confidence interval [CI).: 74 to 92%) and a negative predictive value (NPV) of 87% (95% CI: 78 to 93%) at a cutpoint of 5 mg/l. Overall, 61 (24%) patients with a low clinical probability of PE had a CRP < 5 mg/l. Due to the low prevalence of PE (9%) in this subgroup, the NPV increased to 97% (95% CI: 89 to 100%). The D-dimer (cutpoint 500 µg/l) showed a sensitivity of 100% (95% CI: 95 to 100%) and a NPV of 100% (95% CI: 94 to 100%) irrespective of clinical probability and accurately rule out PE in 56 (22%) patients. Standard CRP tests alone or combined with clinical probability assessment cannot safely exclude PE.

Clinical characteristics of COVID-19 patients (Latvia, Spring 2020)

2020 ◽  
Author(s):  
Ludmila Viksna ◽  
◽  
Oksana Kolesova ◽  
Aleksandrs Kolesovs ◽  
Ieva Vanaga ◽  
...  
Keyword(s):  
Blood Cells ◽  
Troponin T ◽  
Sodium Concentration ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Coagulation Tests ◽  
Damage Indicators ◽  
Prothrombin Index ◽  
D Dimer

Data include following variables: Demographics, epidemiological history, comorbidities, diagnosis, complications, and symptoms on admission to the hospital. Also, body’s temperature and SpO2. Blood cells: white cells count (WBC), neutrophils (Neu), lymphocytes (Ly), eosinophils (Eo) and monocytes (Mo), percentages of segmented and banded neutrophils, erythrocytes (RBC), platelet count (PLT), hemoglobin (Hb), and hematocrit (HCT); Inflammatory indicators: erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); Tissue damage indicators: alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and troponin T (TnT); Electrolytes: potassium and sodium concentration; Renal function indicators: creatinine and glomerular filtration rate (GFR); Coagulation tests: D-dimer, prothrombin time, and prothrombin index on admission to the hospital.

Lung Ultrasound in COVID-19: Clinical Correlates and Comparison With Chest Computed Tomography

2021 ◽  
Author(s):  
Grazia Portale ◽  
Federica Ciolina ◽  
Luca Arcari ◽  
Gianluca Di Lazzaro Giraldi ◽  
Massimiliano Danti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Ultrasound ◽  
Comprehensive Evaluation ◽  
Troponin T ◽  
Scoring Systems ◽  
Chest Ct ◽  
C Reactive Protein ◽  
Chest Computed Tomography ◽  
Reactive Protein ◽  
Quantitative Scoring

Abstract Background: lung ultrasound (LUS) and chest computed tomography (chest-CT) are largely employed to evaluate coronavirus-disease-19 (COVID-19) pneumonia. We investigated semi-quantitative LUS and CT scoring in hospitalized COVID-19 patients.Methods: LUS and chest-CT were performed within 24 hours upon admission. Both were analyzed according to semi-quantitative scoring systems. Subgroups were identified according to median LUS score.Results: patients within higher LUS-score group were older (79 vs 60 years, p<0.001), had higher C-reactive protein (CRP) (7.2 vs 1.3 mg/dl, p<0.001) and chest-CT score (10 vs 4, p=0.027) as well as lower PaO2/FiO2 (286 vs 356, p=0.029) as compared to patients within lower scores. We found a significant correlation between scores (r=0.390, p=0.023). Both LUS and CT scores correlated directly with patients age (r=0.586, p<0.001 and r=0.399, p=0.021 respectively) and CRP (r=0.472, p=0.002 and r=0.518, p=0.002 respectively), inversely with PaO2/FiO2 (r=-0.485, p=0.003 and r=-0.440, p=0.017 respectively). LUS-score only showed significant correlation with hs-Troponin T, NT-pro-BNP and creatinine (r=0.433, p=0.019; r=0.411, p=0.027 and r=0.497, p=0.001 respectively).Conclusions: semi-quantitative bedside LUS related to the severity of COVID-19 pneumonia similarly to chest-CT. Correlation of LUS-score with markers of cardiac and renal injury suggests that LUS might contribute to a more comprehensive evaluation of this heterogeneous population.

scholarly journals Risk management in acute pulmonary embolism: correlation between right heart dysfunction, pulmonary clots distribution, biomarkers and prognosis

2013 ◽  
pp. 23-29
Author(s):  
Luca Masotti ◽  
Fabio Antonelli ◽  
Elio Venturini ◽  
Giancarlo Landini
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Troponin I ◽  
Main Pulmonary Artery ◽  
Shock Index ◽  
Right Heart ◽  
Heart Dysfunction ◽  
Right Heart Dysfunction ◽  
D Dimer

BACKGROUND Right heart dysfunction (RHD) is related to adverse outcomes in acute pulmonary embolism (PE). AIM OF THE STUDY To evaluate the relation between RHD, pulmonary clots distribution and biomarkers and prognosis of patients with PE. METHODS We analysed echocardiographic data of 70 patients with diagnosis of PE confirmed by pulmonary computer tomography, hCT. We considered the enddiastolic right/left ventricles ratio > 1 as index of RHD; echocardiographic data were compared with clots distribution in pulmonary vascular tree such as hCT findings and biomarkers. For each patient we calculated the shock index (heart rate/systolic blood pressure ratio, shock defined as ratio ≥ 1). RESULTS Hospital mortality was 8.5%. Mean age of dead patients was significantly higher compared to alive (85.67 vs 71.57 years, p < 0.05). 41% of patients revealed unilateral PE, 59% had bilateral. In 10% of patients main pulmonary artery was interested by clot, 48% of patients had involved one of the main branches, 90% had involved at least one of the lobar branches, 59% one of segmental branches of pulmonary arteries. 52% of patients had RHD. Mortality in RHD patients was 14.8% vs 8% in no RHD, p < 0.05. Mean values of troponin I and D-dimer were significantly higher in RHD patients. Shock index was ≥ 1 in 37.5% of RHD and 20% in no RHD. RHD patients showed significantly higher involvement of main pulmonary artery and its branches and higher bilateral involvement. CONCLUSIONS RHD is related to proximal and bilateral pulmonary clots distribution and troponin I and D-dimer values and poorer prognosis.

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