COVID-19 and Pulmonary Thrombosis—An Unresolved Clinical Puzzle: A Single-Center Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Patients and Data Collection
2.2. CTPA Protocol
2.3. Statistical Analysis
3. Results
3.1. Baseline Patients’ Characteristics
3.2. Association of Pulmonary Thrombosis with COVID-19 Severity
3.3. Factors Associated with Pulmonary Thrombosis
3.4. Factors Associated with Mortality
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Pulmonary Thrombosis (n = 178) | No Pulmonary Thrombosis (n = 397) | p-Value a | |
---|---|---|---|
Age, median (IQR) b | 61 (50–69) | 62 (51–70) | 0.6400 |
Male, No. (%) b | 124 (69.7) | 258 (65.0) | 0.2941 |
Comorbidities | |||
Diabetes Mellitus | 37 (20.8) | 66 (16.6) | 0.2406 |
Arterial Hypertension | 83 (46.6) | 185 (46.6) | >0.9999 |
Gastritis/GERD | 8 (4.5) | 20 (5.0) | >0.9999 |
Cardiovascular Disease | 37 (20.8) | 107 (27.0) | 0.1197 |
Clinical findings on admission | |||
Duration of illness on admission, days | 10 (8–13) | 10 (8–12) | 0.1906 |
Peripheral oxygen saturation (spO2) | 91 (88–94) | 92 (88–94) | 0.1384 |
MAP | 97 (90–106) | 97 (88–102) | 0.0549 |
CHOD score | 5 (3–7) | 5 (3–5) | 0.0031 |
Laboratory findings on admission | |||
C-reactive Protein, mg/L | 107 (54–177) | 83 (47–148) | 0.0128 |
Procalcitonin, µg/L | 0.15 (0.082–0.32) | 0.13 (0.084–0.27) | 0.6218 |
Interleukin 6, ng/L | 66 (31–108) | 59 (32–121) | 0.8638 |
Ferritin, µg/L | 884 (536–1511) | 1042 (564–2018) | 0.3808 |
White Blood Cells Count, ×109/L | 7.8 (5.3–11.0) | 6.8 (5.2–9.8) | 0.0517 |
Lymphocyte count, 109/L | 0.5 (0.1–0.7) | 0.7 (0.5–0.9) | 0.1559 |
Neutrophil/lymphocyte ratio | 8.8 (4.9–13.0) | 7.9 (5.1–13) | 0.8200 |
Hemoglobin, g/L | 137 (129–145) | 137 (128–147) | 0.4048 |
Platelets, ×109/L | 201 (149–274) | 181 (141–245) | 0.0131 |
Platelets/lymphocyte ratio | 283 (187–424) | 260 (180–425) | 0.5877 |
Aspartate Aminotransferase, IU/L | 52 (36–75) | 52 (38–80) | 0.4993 |
Alanine Aminotransferase, IU/L | 45 (28–66) | 44 (27–72) | 0.8851 |
Gamma-glutamyl transferase, IU/L | 55 (34–94) | 52 (32–99) | 0.7702 |
Lactate dehydrogenase, IU/L | 410 (324–519) | 380 (294–478) | 0.0266 |
Prothrombin time | 1.1 (0.96–1.2) | 1.1 (1.0–1.2) | 0.0030 |
International normalized ratio | 0.97 (0.93–1.1) | 0.95 (0.91–1.0) | 0.0026 |
Fibrinogen, g/L | 6 (5.1–7.2) | 5.9 (5.2–7.1) | 0.9713 |
D-dimer, mg/L | 1.2 (0.74–3) | 0.94 (0.59–1.5) | <0.0001 |
Oxygen Supplementation | Number of Patients | Subsegmental PT | Segmental, Lobar, or Central PT | No PT |
---|---|---|---|---|
No oxygen | 44 | 6 (13.6%) | 8 (18.2%) | 30 (68.2%) |
1–4 L O2/min | 128 | 17 (13.3%) | 23 (18.0%) | 88 (68.8%) |
5–8 L O2/min | 65 | 5 (7.7%) | 11 (16.9%) | 49 (75.4%) |
9–11 L O2/min | 38 | 1 (2.6%) | 4 (10.5%) | 33 (86.8%) |
12–15 L O2/min | 69 | 6 (8.7%) | 5 (7.2%) | 58 (84.1%) |
≥15 L O2/min | 77 | 10 (13.0%) | 24 (31.2%) | 43 (55.8%) |
HFNC | 92 | 13 (14.1%) | 21 (22.8%) | 58 (63.0%) |
NIV | 24 | 4 (16.7%) | 7 (29.2%) | 13 (54.2%) |
IMV and ECMO | 44 | 3 (6.8%) | 12 (27.3%) | 29 (65.9%) |
Univariable Analysis | Multivariable Analysis | |||
---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
Age | 0.89 (0.62–1.28) | 0.5804 | ||
Male sex | 1.24 (0.84–1.79) | 0.2941 | ||
CHOD ≥ 5 | 1.64 (1.14–2.38) | 0.0085 | ||
Plt ≥ 185 ×109/L | 1.46 (1.02–2.09) | 0.0381 | ||
CRP ≥ 85 mg/L | 1.52 (1.06–2.17) | 0.0240 | ||
D-dimer ≥ 1.0 mg/L | 1.87 (1.29–2.69) | 0.0006 | 1.78 (1.12–2.75) | 0.0082 |
O2 ≥ 15 L | 2.03 (1.43–2.89) | 0.0001 | 1.89 (1.26–2.84) | 0.0021 |
ICU admission | 1.81 (1.07–3.09) | 0.0320 |
Low-Flow Oxygen Supplementation (<15 L/min) | High-Flow Oxygen Supplementation (≥15 L/min) | |||
---|---|---|---|---|
D-dimer < 1.0 mg/L (n = 167) | D-dimer ≥ 1.0 mg/L (n = 179) | D-dimer < 1.0 mg/L (n = 114) | D-dimer ≥ 1.0 mg/L (n = 115) | |
PT incidence | 32 (19.1%) | 54 (30.2%) | 36 (31.6%) | 56 (48.7%) |
Subsegmental PT | 17 (10.2%) | 18 (10.1%) | 12 (10.5%) | 17 (14.8%) |
Segmental PT | 11 (6.6%) | 26 (14.5%) | 19 (16.7%) | 28 (24.3%) |
Lobar PT | 3 (1.8%) | 7 (3.9%) | 5 (4.4%) | 7 (6.1%) |
Central PT | 1 (0.6%) | 3 (1.7%) | 0 | 4 (3.5%) |
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Močibob, L.; Šušak, F.; Šitum, M.; Višković, K.; Papić, N.; Vince, A. COVID-19 and Pulmonary Thrombosis—An Unresolved Clinical Puzzle: A Single-Center Cohort Study. J. Clin. Med. 2022, 11, 7049. https://doi.org/10.3390/jcm11237049
Močibob L, Šušak F, Šitum M, Višković K, Papić N, Vince A. COVID-19 and Pulmonary Thrombosis—An Unresolved Clinical Puzzle: A Single-Center Cohort Study. Journal of Clinical Medicine. 2022; 11(23):7049. https://doi.org/10.3390/jcm11237049
Chicago/Turabian StyleMočibob, Loris, Frano Šušak, Maja Šitum, Klaudija Višković, Neven Papić, and Adriana Vince. 2022. "COVID-19 and Pulmonary Thrombosis—An Unresolved Clinical Puzzle: A Single-Center Cohort Study" Journal of Clinical Medicine 11, no. 23: 7049. https://doi.org/10.3390/jcm11237049