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Computed tomography characterization and outcome evaluation of COVID-19 pneumonia complicated by venous thromboembolism.
PLoS One. 2020; 15(11):e0242475.Plos

Abstract

BACKGROUND

COVID-19 is frequently complicated by venous thromboembolism (VTE). Computed tomography (CT) of the chest-primarily usually conducted as low-dose, non-contrast enhanced CT-plays an important role in the diagnosis and follow-up of COVID-19 pneumonia. Performed as contrast-enhanced CT pulmonary angiography, it can reliably detect or rule-out pulmonary embolism (PE). Several imaging characteristics of COVID-19 pneumonia have been described for chest CT, but no study evaluated CT findings in the context of VTE/PE.

PURPOSE

In our retrospective study, we analyzed clinical, laboratory and CT imaging characteristics of 50 consecutive patients with RT-PCR proven COVID-19 pneumonia who underwent contrast-enhanced chest CT at two tertiary care medical centers.

MATERIAL AND METHODS

All patients with RT-PCR proven COVID-19 pneumonia and contrast-enhanced chest CT performed at two tertiary care hospitals between March 1st and April 20th 2020 were retrospectively identified. Patient characteristics (age, gender, comorbidities), symptoms, date of symptom onset, RT-PCR results, imaging results of CT and leg ultrasound, laboratory findings (C-reactive protein, differential blood count, troponine, N-terminal pro-B-type natriuretic peptide (NT-proBNP), fibrinogen, interleukin-6, D-dimer, lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase muscle-brain (CKmb) and lactate,) and patient outcome (positive: discharge or treatment on normal ward; negative: treatment on intensive care unit (ICU), need for mechanical ventilation, extracorporeal membrane oxygenation (ECMO), or death) were analyzed. Follow-up was performed until May 10th. Patients were assigned to two groups according to two endpoints: venous thromboembolism (VTE) or no VTE. For statistical analysis, univariate logistic regression models were calculated.

RESULTS

This study includes 50 patients. In 14 out of 50 patients (28%), pulmonary embolism was detected at contrast-enhanced chest CT. The majority of PE was detected on CTs performed on day 11-20 after symptom onset. Two patients (14%) with PE simultaneously had evidence of deep vein thrombosis. 15 patients (30%) had a negative outcome (need for intensive care, mechanical ventilation, extracorporeal membrane oxygenation, or death), and 35 patients (70%) had a positive outcome (transfer to regular ward, or discharge). Patients suffering VTE had a statistically significant higher risk of an unfavorable outcome (p = 0.028). In univariate analysis, two imaging characteristics on chest CT were associated with VTE: crazy paving pattern (p = 0.024) and air bronchogram (n = 0.021). Also, elevated levels of NT-pro BNP (p = 0.043), CK (p = 0.023) and D-dimers (p = 0.035) were significantly correlated with VTE.

CONCLUSION

COVID-19 pneumonia is frequently complicated by pulmonary embolism (incidence of 28% in our cohort), remarkably with lacking evidence of deep vein thrombosis in nearly all thus affected patients of our cohort. As patients suffering VTE had an adverse outcome, we call for a high level of alertness for PE and advocate a lower threshold for contrast-enhanced CT in COVID-19 pneumonia. According to our observations, this might be particularly justified in the second week of disease and if a crazy paving pattern and / or air bronchogram is present on previous non-enhanced CT.

Authors+Show Affiliations

Department of Radiology, Regensburg University Medical Center, Regensburg, Germany.Department of Radiology, Regensburg University Medical Center, Regensburg, Germany. Department of Radiology, Hospital Donaustauf, Donaustauf, Germany.Department of Radiology, Regensburg University Medical Center, Regensburg, Germany.Center for Clinical Studies, Regensburg University Medical Center, Regensburg, Germany.Department of Radiology, Hospital Barmherzige Brueder, Regensburg, Germany.Department of Pneumology, Hospital Barmherzige Brueder, Regensburg, Germany.Department of Radiology, Regensburg University Medical Center, Regensburg, Germany.Department of Radiology, Regensburg University Medical Center, Regensburg, Germany.Department of Radiology, Regensburg University Medical Center, Regensburg, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33211737

Citation

Meiler, Stefanie, et al. "Computed Tomography Characterization and Outcome Evaluation of COVID-19 Pneumonia Complicated By Venous Thromboembolism." PloS One, vol. 15, no. 11, 2020, pp. e0242475.
Meiler S, Hamer OW, Schaible J, et al. Computed tomography characterization and outcome evaluation of COVID-19 pneumonia complicated by venous thromboembolism. PLoS One. 2020;15(11):e0242475.
Meiler, S., Hamer, O. W., Schaible, J., Zeman, F., Zorger, N., Kleine, H., Rennert, J., Stroszczynski, C., & Poschenrieder, F. (2020). Computed tomography characterization and outcome evaluation of COVID-19 pneumonia complicated by venous thromboembolism. PloS One, 15(11), e0242475. https://doi.org/10.1371/journal.pone.0242475
Meiler S, et al. Computed Tomography Characterization and Outcome Evaluation of COVID-19 Pneumonia Complicated By Venous Thromboembolism. PLoS One. 2020;15(11):e0242475. PubMed PMID: 33211737.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Computed tomography characterization and outcome evaluation of COVID-19 pneumonia complicated by venous thromboembolism. AU - Meiler,Stefanie, AU - Hamer,Okka Wilkea, AU - Schaible,Jan, AU - Zeman,Florian, AU - Zorger,Niels, AU - Kleine,Henning, AU - Rennert,Janine, AU - Stroszczynski,Christian, AU - Poschenrieder,Florian, Y1 - 2020/11/19/ PY - 2020/07/22/received PY - 2020/11/03/accepted PY - 2020/11/19/entrez PY - 2020/11/20/pubmed PY - 2020/12/2/medline SP - e0242475 EP - e0242475 JF - PloS one JO - PLoS One VL - 15 IS - 11 N2 - BACKGROUND: COVID-19 is frequently complicated by venous thromboembolism (VTE). Computed tomography (CT) of the chest-primarily usually conducted as low-dose, non-contrast enhanced CT-plays an important role in the diagnosis and follow-up of COVID-19 pneumonia. Performed as contrast-enhanced CT pulmonary angiography, it can reliably detect or rule-out pulmonary embolism (PE). Several imaging characteristics of COVID-19 pneumonia have been described for chest CT, but no study evaluated CT findings in the context of VTE/PE. PURPOSE: In our retrospective study, we analyzed clinical, laboratory and CT imaging characteristics of 50 consecutive patients with RT-PCR proven COVID-19 pneumonia who underwent contrast-enhanced chest CT at two tertiary care medical centers. MATERIAL AND METHODS: All patients with RT-PCR proven COVID-19 pneumonia and contrast-enhanced chest CT performed at two tertiary care hospitals between March 1st and April 20th 2020 were retrospectively identified. Patient characteristics (age, gender, comorbidities), symptoms, date of symptom onset, RT-PCR results, imaging results of CT and leg ultrasound, laboratory findings (C-reactive protein, differential blood count, troponine, N-terminal pro-B-type natriuretic peptide (NT-proBNP), fibrinogen, interleukin-6, D-dimer, lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase muscle-brain (CKmb) and lactate,) and patient outcome (positive: discharge or treatment on normal ward; negative: treatment on intensive care unit (ICU), need for mechanical ventilation, extracorporeal membrane oxygenation (ECMO), or death) were analyzed. Follow-up was performed until May 10th. Patients were assigned to two groups according to two endpoints: venous thromboembolism (VTE) or no VTE. For statistical analysis, univariate logistic regression models were calculated. RESULTS: This study includes 50 patients. In 14 out of 50 patients (28%), pulmonary embolism was detected at contrast-enhanced chest CT. The majority of PE was detected on CTs performed on day 11-20 after symptom onset. Two patients (14%) with PE simultaneously had evidence of deep vein thrombosis. 15 patients (30%) had a negative outcome (need for intensive care, mechanical ventilation, extracorporeal membrane oxygenation, or death), and 35 patients (70%) had a positive outcome (transfer to regular ward, or discharge). Patients suffering VTE had a statistically significant higher risk of an unfavorable outcome (p = 0.028). In univariate analysis, two imaging characteristics on chest CT were associated with VTE: crazy paving pattern (p = 0.024) and air bronchogram (n = 0.021). Also, elevated levels of NT-pro BNP (p = 0.043), CK (p = 0.023) and D-dimers (p = 0.035) were significantly correlated with VTE. CONCLUSION: COVID-19 pneumonia is frequently complicated by pulmonary embolism (incidence of 28% in our cohort), remarkably with lacking evidence of deep vein thrombosis in nearly all thus affected patients of our cohort. As patients suffering VTE had an adverse outcome, we call for a high level of alertness for PE and advocate a lower threshold for contrast-enhanced CT in COVID-19 pneumonia. According to our observations, this might be particularly justified in the second week of disease and if a crazy paving pattern and / or air bronchogram is present on previous non-enhanced CT. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/33211737/Computed_tomography_characterization_and_outcome_evaluation_of_COVID_19_pneumonia_complicated_by_venous_thromboembolism_ L2 - https://dx.plos.org/10.1371/journal.pone.0242475 DB - PRIME DP - Unbound Medicine ER -