Research Article
Acil Servise Başvuran COVID-19 Hastalarında Toraks BT ile Ölçülen Pulmoner Arter Çapı ile D Dimer Arasındaki İlişki
Abstract
Amaç: Coronavirüs hastalığı 2019 (COVID-19) salgını, dünya çapında hızla yayılması nedeniyle küresel bir sağlık acil durumu haline geldi. Çalışmamız COVID-19 hastalarında pulmoner arter çapı ile d-dimer arasındaki ilişkiyi değerlendirmiştir.
Gereç ve Yöntemler: Çalışmamıza 15 Mart 2020 ile 31 Kasım 2020 tarihleri arasında acil servisimize başvuran, Uluslararası Hastalık Sınıflandırması 10’a göre tanı kodu U07.3 olan 18 yaş ve üzeri hastalar dahil edildi. Hastaların demografik verileri (yaş, cinsiyet), laboratuvar testleri (polimeraz zincir reaksiyon testi, ddimer düzeyi) ve görüntüleme sonuçları (bilgisayarlı göğüs tomografisi, pulmoner anjiyografi bilgisayarlı tomografisi) tıbbi kayıtları ve hastane elektronik kayıt sistemi kullanılarak retrospektif olarak analiz edildi.
Bulgular: Çalışmaya toplam 1654 hasta dahil edildi. 30 günlük mortalite oranı %13,7 (n=227) idi. 30 günlük mortalite üzerinde en etkili bağımsız değişken 44 yaş ve üstünde olmaktı. Pulmoner arter çapı ve d-dimer düzeyleri hem tipik COVID-19 toraks bilgisayarlı tomografi bulguları olan grupta hem de 30 gün içinde ölen hastalarda daha yüksek bulundu. Ancak literatürden farklı olarak pulmoner embolisi olan ve olmayan hastalar arasında pulmoner arter çapı ve d-dimer düzeyleri açısından anlamlı fark bulunmadı.
Sonuç: Sonuç olarak, COVID-19 hastalarında d-dimer ile pulmoner arter çapı arasında zayıf pozitif bir korelasyon bulundu.
Keywords
References
- Singh R, Kang A, Luo X, et al. COVID-19: Current knowledge in clinical features, immunological responses, and vaccine development. The FASEB Journal. 2021;35(3):e21409. doi:10.1096/fj.202002662R.
- CDC. COVID-19 and Your Health. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed January 11, 2022. https://www.cdc.gov/coronavirus/2019-ncov/need-extraprecautions/people-with-medical-conditions.html
- Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585.
- Jackson SP, Darbousset R, Schoenwaelder SM. Thromboinflammation: challenges of therapeutically targeting coagulation and other host defense mechanisms. Blood. 2019;133(9):906-918. doi:10.1182/blood 2018-11-882993.
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 6736(20)30566-3. 2020;395(10229):1054-1062. doi:10.1016/S0140
- Altuntaş G, Timurkaan M, Kalayci M, Ayyildiz H, Timurkaan E. Early warning triad for pulmonary microemboli in COVID-19 pneumonia: Pulmonary artery diameter, D-dimer and NT-proBNP. Medicine Science. 2022;11(2):775-779. doi:10.5455/medscience.2022.01.025.
- Tastemur M, Olcucuoğlu E, Arik G, Ates I, Silay K. Pulmonary artery diameter and NT-proBNP in patients with Covid-19: Predicting prognosis and mortality. Afr Health Sci. 2023;23(2):553-564. doi:10.4314/ahs.v23i2.64.
- Öcal M, Evrin T, Çetin İ. Prognostic Utility of the Ratio of Pulmonary Artery Diameter to Ascending Aorta Diameter in COVID-19 Patients. Eurasian Journal of Emergency Medicine. 2023;22(4).
- Beiderlinden M, Kuehl H, Boes T, Peters J. Prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome: predictive value of computed tomography. Intensive Care Med. 2006;32(6):852-857. doi:10.1007/s00134-006-0122-9.
- Matsushita S, Matsuoka S, Yamashiro T, et al. Pulmonary arterial enlargement in patients with acute exacerbation of interstitial pneumonia. Clin Imaging. 2014;38(4):454-457.doi:10.1016/j.clinimag.2014.02.004.
- Vlachou M, Drebes A, Candilio L, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-984. doi:10.1007/s11239-020-02370-7.
- Lewis G, Hoey ETD, Reynolds JH, Ganeshan A, Ment J. Multi-detector CT assessment in pulmonary hypertension: techniques, systematic approach to interpretation and key findings. Quant Imaging Med Surg. 2015;5(3):423-432. doi:10.3978/j.issn.2223-4292.2015.01.05.
- Shen Y, Wan C, Tian P, et al. CT-base pulmonary artery measurement in the detection of pulmonary hypertension: a meta-analysis and systematic review. Medicine (Baltimore). 2014;93(27):e256. doi:10.1097/MD.0000000000000256.
- Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014;311(11):1117-1124. doi:10.1001/jama.2014.2135.
- Covid19. Accessed August 20, 2022. https://covid19.saglik.gov.tr/
- Truong QA, Massaro JM, Rogers IS, et al. Reference Values for Normal Pulmonary Artery Dimensions by Noncontrast Cardiac Computed Tomography. Circulation: Cardiovascular Imaging. 2012;5(1):147-154. doi:10.1161/CIRCIMAGING.111.968610.
- D’Souza D. Pulmonary embolism | Radiology Reference Article | Radiopaedia.org. Radiopaedia. doi:10.53347/rID-1937.
- Al-Ani F, Chehade S, Lazo-Langner A. Thrombosis risk associated with COVID-19 infection. A scoping review. Thromb Res. 2020;192:152-160. doi:10.1016/j.thromres.2020.05.039.
- 19. Elberts SJ, Bateman R, Koutsoubis A, London KS, White JL, Fields JM. The impact of COVID‐19 on the sensitivity of D‐dimer for pulmonary embolism. Acad Emerg Med. 2021;28(10):1142-114doi:10.1111/acem.14348.
- lok FA, Kruip MJHA, Meer NJM van der, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research. 2020;191:145-147. doi:10.1016/j.thromres.2020.04.013
- Zhang H, Zhou P, Wei Y, et al. Histopathologic Changes and SARS–CoV2 Immunostaining in the Lung of a Patient With COVID-19. Ann Intern Med. Published online doi:10.7326/M20-0533.
- Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict inhospital mortality in patients with COVID-19. J Thromb Haemost. 2020;18(6):1324-1329. doi:10.1111/jth.14859.
- Esposito A, Palmisano A, Toselli M, et al. Chest CT-derived pulmonary artery enlargement at the admission predicts overall survival in COVID19 patients: insight from 1461 consecutive patients in Italy. Eur Radiol. 2021;31(6):4031-4041. doi:10.1007/s00330-020-07622-x.
- Ippolito D, Giandola T, Maino C, et al. Acute pulmonary embolism in hospitalized patients with SARS-CoV2-related pneumonia: multicentric experience from Italian endemic area. Radiol Med. 2021;126(5):669 678. doi:10.1007/s11547-020-01328-2.
- Espallargas I, Rodríguez Sevilla JJ, Rodríguez Chiaradía DA, et al. CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis. Eur Radiol. 2021;31(4):1915-1922. doi:10.1007/s00330-020-07300-y.
- Spagnolo P, Cozzi A, Foà RA, et al. CT-derived pulmonary vascular metrics and clinical outcome in COVID-19 patients. Quantitative Imaging in Medicine and Surgery. 2020;10(6):1325333-1321333. doi:10.21037/aims-20-546.
- Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med. 2020;382(17):e38. doi:10.1056/NEJMc2007575.
- Han H, Yang L, Liu R, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-1120. doi:10.1515/cclm-2020-0188.
- Xiong M, Liang X, Wei YD. Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Br J Haematol. 2020;189(6):1050-1052. doi:10.1111/bjh.16725.
The Relationship Between Pulmonary Artery Diameter Measured by Chest CT and D-Dimer in COVID-19 Patients Admitted to the Emergency Department
Abstract
Aim: The coronavirus disease 2019 (COVID-19) pandemic has become a global health emergency due to its rapid spread worldwide. Our study evaluated the relationship between pulmonary artery diameter and d-dimer in COVID-19 patients.
Material and Methods: Patients aged 18 years and older with International Classification of Diseases 10 diagnosis code U07.3 who were admitted to our emergency department between March 15, 2020, and November 31, 2020, were included in our study. Demographic data (age, sex), laboratory tests (polymerase chain reaction test, d-dimer level), and imaging results (chest computed tomography, computed tomography pulmonary angiography) of the patients were retrospectively analyzed using medical records and the hospital electronic record system.
Results: A total of 1654 patients were included in the study. The 30-day mortality rate was 13.7% (n=227). The most effective independent variable on 30-day mortality was 44 years of age or older. Pulmonary artery diameter and d-dimer levels were found to be higher in both the group with typical COVID-19 chest computed tomography findings and in patients who died within 30 days. However, unlike the literature, there was no significant difference in pulmonary artery diameter and d-dimer levels between patients with and without pulmonary embolism.
Conclusion: In conclusion, we found a weak positive correlation between d-dimer and pulmonary artery diameter in COVID-19 patients.
Ethical Statement
The study was approved by the Ethics Committee of the University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey. (Approval number 2020/13-42).
References
- Singh R, Kang A, Luo X, et al. COVID-19: Current knowledge in clinical features, immunological responses, and vaccine development. The FASEB Journal. 2021;35(3):e21409. doi:10.1096/fj.202002662R.
- CDC. COVID-19 and Your Health. Centers for Disease Control and Prevention. Published February 11, 2020. Accessed January 11, 2022. https://www.cdc.gov/coronavirus/2019-ncov/need-extraprecautions/people-with-medical-conditions.html
- Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585.
- Jackson SP, Darbousset R, Schoenwaelder SM. Thromboinflammation: challenges of therapeutically targeting coagulation and other host defense mechanisms. Blood. 2019;133(9):906-918. doi:10.1182/blood 2018-11-882993.
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 6736(20)30566-3. 2020;395(10229):1054-1062. doi:10.1016/S0140
- Altuntaş G, Timurkaan M, Kalayci M, Ayyildiz H, Timurkaan E. Early warning triad for pulmonary microemboli in COVID-19 pneumonia: Pulmonary artery diameter, D-dimer and NT-proBNP. Medicine Science. 2022;11(2):775-779. doi:10.5455/medscience.2022.01.025.
- Tastemur M, Olcucuoğlu E, Arik G, Ates I, Silay K. Pulmonary artery diameter and NT-proBNP in patients with Covid-19: Predicting prognosis and mortality. Afr Health Sci. 2023;23(2):553-564. doi:10.4314/ahs.v23i2.64.
- Öcal M, Evrin T, Çetin İ. Prognostic Utility of the Ratio of Pulmonary Artery Diameter to Ascending Aorta Diameter in COVID-19 Patients. Eurasian Journal of Emergency Medicine. 2023;22(4).
- Beiderlinden M, Kuehl H, Boes T, Peters J. Prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome: predictive value of computed tomography. Intensive Care Med. 2006;32(6):852-857. doi:10.1007/s00134-006-0122-9.
- Matsushita S, Matsuoka S, Yamashiro T, et al. Pulmonary arterial enlargement in patients with acute exacerbation of interstitial pneumonia. Clin Imaging. 2014;38(4):454-457.doi:10.1016/j.clinimag.2014.02.004.
- Vlachou M, Drebes A, Candilio L, et al. Pulmonary thrombosis in Covid-19: before, during and after hospital admission. J Thromb Thrombolysis. 2021;51(4):978-984. doi:10.1007/s11239-020-02370-7.
- Lewis G, Hoey ETD, Reynolds JH, Ganeshan A, Ment J. Multi-detector CT assessment in pulmonary hypertension: techniques, systematic approach to interpretation and key findings. Quant Imaging Med Surg. 2015;5(3):423-432. doi:10.3978/j.issn.2223-4292.2015.01.05.
- Shen Y, Wan C, Tian P, et al. CT-base pulmonary artery measurement in the detection of pulmonary hypertension: a meta-analysis and systematic review. Medicine (Baltimore). 2014;93(27):e256. doi:10.1097/MD.0000000000000256.
- Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014;311(11):1117-1124. doi:10.1001/jama.2014.2135.
- Covid19. Accessed August 20, 2022. https://covid19.saglik.gov.tr/
- Truong QA, Massaro JM, Rogers IS, et al. Reference Values for Normal Pulmonary Artery Dimensions by Noncontrast Cardiac Computed Tomography. Circulation: Cardiovascular Imaging. 2012;5(1):147-154. doi:10.1161/CIRCIMAGING.111.968610.
- D’Souza D. Pulmonary embolism | Radiology Reference Article | Radiopaedia.org. Radiopaedia. doi:10.53347/rID-1937.
- Al-Ani F, Chehade S, Lazo-Langner A. Thrombosis risk associated with COVID-19 infection. A scoping review. Thromb Res. 2020;192:152-160. doi:10.1016/j.thromres.2020.05.039.
- 19. Elberts SJ, Bateman R, Koutsoubis A, London KS, White JL, Fields JM. The impact of COVID‐19 on the sensitivity of D‐dimer for pulmonary embolism. Acad Emerg Med. 2021;28(10):1142-114doi:10.1111/acem.14348.
- lok FA, Kruip MJHA, Meer NJM van der, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research. 2020;191:145-147. doi:10.1016/j.thromres.2020.04.013
- Zhang H, Zhou P, Wei Y, et al. Histopathologic Changes and SARS–CoV2 Immunostaining in the Lung of a Patient With COVID-19. Ann Intern Med. Published online doi:10.7326/M20-0533.
- Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict inhospital mortality in patients with COVID-19. J Thromb Haemost. 2020;18(6):1324-1329. doi:10.1111/jth.14859.
- Esposito A, Palmisano A, Toselli M, et al. Chest CT-derived pulmonary artery enlargement at the admission predicts overall survival in COVID19 patients: insight from 1461 consecutive patients in Italy. Eur Radiol. 2021;31(6):4031-4041. doi:10.1007/s00330-020-07622-x.
- Ippolito D, Giandola T, Maino C, et al. Acute pulmonary embolism in hospitalized patients with SARS-CoV2-related pneumonia: multicentric experience from Italian endemic area. Radiol Med. 2021;126(5):669 678. doi:10.1007/s11547-020-01328-2.
- Espallargas I, Rodríguez Sevilla JJ, Rodríguez Chiaradía DA, et al. CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis. Eur Radiol. 2021;31(4):1915-1922. doi:10.1007/s00330-020-07300-y.
- Spagnolo P, Cozzi A, Foà RA, et al. CT-derived pulmonary vascular metrics and clinical outcome in COVID-19 patients. Quantitative Imaging in Medicine and Surgery. 2020;10(6):1325333-1321333. doi:10.21037/aims-20-546.
- Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med. 2020;382(17):e38. doi:10.1056/NEJMc2007575.
- Han H, Yang L, Liu R, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-1120. doi:10.1515/cclm-2020-0188.
- Xiong M, Liang X, Wei YD. Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Br J Haematol. 2020;189(6):1050-1052. doi:10.1111/bjh.16725.
There are 29 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Emergency Medicine |
| Journal Section | Original Articles |
| Authors | |
| Early Pub Date | April 3, 2024 |
| Publication Date | March 31, 2024 |
| Submission Date | December 25, 2023 |
| Acceptance Date | March 11, 2024 |
| Published in Issue | Year 2024 Volume: 7 Issue: 1 |
