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Suárez-Castillejo C, Calvo N, Preda L, Toledo-Pons N, Millán-Pons AR, Martínez J, Ramón L, Iglesias A, Morell-García D, Bauça JM, Núñez B, Sauleda J, Sala-Llinas E, Alonso-Fernández A. Pulmonary thrombosis associated with COVID-19 pneumonia: Beyond classical pulmonary thromboembolism. Eur J Clin Invest 2024; 54:e14176. [PMID: 38339827 DOI: 10.1111/eci.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Classical pulmonary thromboembolism (TE) and local pulmonary thrombosis (PT) have been suggested as mechanisms of thrombosis in COVID-19. However, robust evidence is still lacking because this was mainly based on retrospective studies, in which patients were included when TE was suspected. METHODS All patients with COVID-19 pneumonia underwent computed tomography and pulmonary angiography in a prospective study. The main objective was to determine the number and percentage of thrombi surrounded by lung opacification (TSO) in each patient, as well as their relationship with percentage of lung involvement (TLI), to distinguish classical TE (with a random location of thrombi that should correspond to a percentage of TSO equivalent to the TLI) from PT. We determined TLI by artificial intelligence. Analyses at patient level (TLI and percentage of TSO) and at thrombi level (TLI and TSO) were performed. RESULTS We diagnosed TE in 70 out of 184 patients. Three (2-8) thrombi/patient were detected. The percentage of TSO was 100% (75-100) per patient, and TLI was 19.9% (4.6-35.2). Sixty-five patients (92.9%) were above the random scenario with higher percentage of TSO than TLI. Most thrombi were TSO (n = 299, 75.1%). When evaluating by TLI (<10%, 10%-20%, 20%-30% and >30%), percentage of TSO was higher in most groups. Thrombi were mainly in subsegmental/segmental arteries, and percentage of TSO was higher in all locations. CONCLUSIONS Thrombi in COVID-19 were found within lung opacities in a higher percentage than lung involvement, regardless of TLI and clot location, supporting the hypothesis of local PT rather than "classic TE".
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Affiliation(s)
- Carla Suárez-Castillejo
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Néstor Calvo
- Servicio de Radiodiagnostico, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Luminita Preda
- Servicio de Radiodiagnostico, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nuria Toledo-Pons
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | | | - Joaquín Martínez
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Luisa Ramón
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Amanda Iglesias
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
- CIBER Enfermedades Respiratorias, Madrid, Spain
| | - Daniel Morell-García
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Josep Miquel Bauça
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Belén Núñez
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Jaume Sauleda
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
- CIBER Enfermedades Respiratorias, Madrid, Spain
- Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Spain
| | - Ernest Sala-Llinas
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
- CIBER Enfermedades Respiratorias, Madrid, Spain
- Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Spain
| | - Alberto Alonso-Fernández
- Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
- Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
- CIBER Enfermedades Respiratorias, Madrid, Spain
- Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Spain
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Lippi G, Favaloro EJ. What We Know (and Do not Know) Regarding the Pathogenesis of Pulmonary Thrombosis in COVID-19. Semin Thromb Hemost 2023; 49:27-33. [PMID: 35021250 DOI: 10.1055/s-0041-1742091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The clinical course of coronavirus disease 2019 (COVID-19) is often complicated by the onset of venous thrombosis and thromboembolism (VTE), encompassing also pulmonary thrombosis. Recent statistics attests that the cumulative frequency of VTE can be as high as 30% in COVID-19 hospitalized patients, increasing to nearly 40 to 70% (depending on systematic screening) in those with severe illness, mechanical ventilation, or intensive care unit admission. The risk of venous thrombosis seems mostly limited to the active phase of disease, and is directly associated with some genetic (i.e., inherited prothrombotic predisposition) and demographical factors (male sex, overweight/obesity), disease severity (risk increasing progressively from hospitalization to development of severe illness, being the highest in patients needing mechanical ventilation and/or intensive care), presence and extent of pulmonary disease, coexistence of multiple risk factors (immobilization, mechanical ventilation, co- or superinfections), along with increased values of inflammatory and thrombotic biomarkers. At least three different phenotypes of pulmonary thrombosis may develop in COVID-19 patients, one caused by typical embolization from peripheral venous thrombosis (e.g., deep vein thrombosis), a second type triggered by local inflammation of nearby pulmonary tissue, and a third one mostly attributable to the prothrombotic state consequent to the pronounced systemic inflammatory response (i.e., the so-called cytokine storm) that is frequently observed in COVID-19. Although the pathogenesis of these three conditions has different features, their discrimination is essential for diagnostic and therapeutic purposes. The prognosis of COVID-19 patients who develop pulmonary thrombosis is also considerably worse than those who do not, thus probably needing frequent monitoring and more aggressive therapeutic management.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, NSW, Australia.,Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, Australia
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Lippi G, Favaloro EJ. Strength of Anticoagulation in Moderate to Severe COVID-19 Illness: In Medio Stat Virtus? Semin Thromb Hemost 2023; 49:81-84. [PMID: 36055257 DOI: 10.1055/s-0042-1756186] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy
| | - Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia.,Sydney Centres for Thrombosis and Haemostasis, Westmead, New South Wales, Australia.,Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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Sherif F, Elmokadem AH, Abdel Razek A, Kamal E, Abdou EHE, Salem MA, Ghoneim MM. DTI of the Olfactory Bulb in COVID-19-Related Anosmia: A Pilot Study. AJNR Am J Neuroradiol 2022; 43:1180-1183. [PMID: 36920776 PMCID: PMC9575417 DOI: 10.3174/ajnr.a7590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/22/2022] [Indexed: 11/07/2022]
Abstract
This study aimed to assess the utility of DTI in the detection of olfactory bulb dysfunction in COVID-19-related anosmia. It was performed in 62 patients with COVID-19-related anosmia and 23 controls. The mean diffusivity and fractional anisotropy were calculated by 2 readers. The difference between the fractional anisotropy and mean diffusivity values of anosmic and control olfactory bulbs was statistically significant (P = .001). The threshold of fractional anisotropy and mean diffusivity to differentiate a diseased from normal olfactory bulb were 0.22 and 1.5, with sensitivities of 84.4% and 96.8%, respectively, and a specificity of 100%.
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Affiliation(s)
- F Sherif
- From the Departments of Radiology (F.S., A.H.E., A.A.R., M.M.G.)
| | - A H Elmokadem
- From the Departments of Radiology (F.S., A.H.E., A.A.R., M.M.G.)
| | - A Abdel Razek
- From the Departments of Radiology (F.S., A.H.E., A.A.R., M.M.G.)
| | - E Kamal
- Otorhinolaryngology (E.K., E.H.E.A., M.A.S.), Mansoura University, Mansoura City, Egypt
| | - E H E Abdou
- Otorhinolaryngology (E.K., E.H.E.A., M.A.S.), Mansoura University, Mansoura City, Egypt
| | - M A Salem
- Otorhinolaryngology (E.K., E.H.E.A., M.A.S.), Mansoura University, Mansoura City, Egypt
| | - M M Ghoneim
- From the Departments of Radiology (F.S., A.H.E., A.A.R., M.M.G.)
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