EVALUATION OF PULMONARY EMBOLISM IN THE PACE OF COVID-19

Canan Akkus¹, Hakan Yilmaz², Zelal Adibelli¹, Hakan Demirci¹, Melih Kartal¹,Cevdet Duran^{1, *}

¹The Department of Internal Medicine, The Medical School of Usak University, Usak, Turkey - ²The Department of Radiology, The Medical School of Usak University, Usak, Turkey

Background: To investigate the prevalence and clinical and laboratory characteristics of the cases with pulmonary embolism (PE) in the pace of coronavirus disease-2019 (COVID-19). 

Materials and methods: COVID-19 patients’ records were retrospectively scanned from the hospital’s automation system and recorded on patients’ files.

Results: Of 1452 COVID-19 patients, 17 (1.2%) were diagnosed with PE. Compared cases with PE with controls, it was seen that mean age was higher (p=0.036), male gender was prominent (p=0.016), patients presented with dyspnea symptoms further (p<0.001), while O2 saturation measured at room air on admission was lower (p=0.002). In PE patients, glucose (p=0.007), D-dimer (p<0.001), C-reactive protein (p<0.001) and ferritin levels (p=0.002) were higher than controls. In Receiver-Operator Characteristics analysis, the cut-off value of D-dimer in predicting PE was found to be 4211 ng/mL (p<0.001). COVID-19 patients were diagnosed with PE median five (min:max=0:36) days after hospitalization. Additionally, PE patients were found to have longer hospitalization time (p<0.001), the requirement for caring in the intensive care unit (p<0.001), and intubation (p=0.001), and non-invasive mechanical ventilation (p<0.001) in more patients, compared to controls. Mortality rates were similar in both groups, with three and 106 deaths in PE and control groups, respectively. Lower-extremity Doppler ultrasonography was performed in 196 patients, and thrombi were detected in the femoral vein in four patients, also presenting with PE.

Conclusions: Even if there is no embolism without any obvious clinic of PE in all cases with COVID-19, such cases should be screened for PE in the presence of significant D-dimer elevation.