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Guo R, Deng M, Xi L, Zhang S, Xu W, Liu M. Chest non‑contrasted computed tomography in detecting acute pulmonary thromboembolism: A single‑center retrospective study. Exp Ther Med 2024; 28:304. [PMID: 38873047 PMCID: PMC11170327 DOI: 10.3892/etm.2024.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
The object of the study was to evaluate comprehensively the value of chest non-contrasted CT (NC-CT) in detecting acute pulmonary thromboembolism (APE). All patients were categorized into two groups: i) With APE; and ii) without APE based on clinical diagnosis. Using the clot distribution on computed tomography pulmonary angiography (CTPA), APE was divided into central and peripheral APE. Imaging features including hyperdense lumen sign and peripheral wedge-shaped opacity on chest NC-CT were evaluated. The attenuation value of peripheral wedge-shaped opacity on NC-CT was compared between patients with and without APE. Among the 273 patients, there were 110 patients with APE, 49 patients with central APE and 61 patients with peripheral APE and 163 patients without APE. The hyperdense lumen sign had a sensitivity of 30.0% and a specificity of 97.6% in detecting APE. The sensitivity and specificity of hyperdense lumen sign in detecting central APE were 57.1 and 97.6%, respectively, while the relevant percentages in detecting peripheral APE were 8.2 and 97.6%, respectively. The mean attenuation value of peripheral wedge-shaped opacity in patients with APE was significantly lower than that in patients without APE (P<0.001). Regarding the age-adjusted D-dimer, there was a decrease of eight D-dimer positive cases for patients >50 years old without APE, confirmed by CTPA. In conclusion, chest NC-CT cannot be used as an alternative modality for CTPA in diagnosing APE, however, the hyperdense lumen sign had high specificity in the diagnosis of central APE. Patients with this symptom and increased D-dimer may not require further CTPA. The lower attenuation value of peripheral wedge-shaped opacity on NC-CT suggested APE, and CTPA confirmation was required. The age-adjusted D-dimer had higher specificity in excluding APE.
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Affiliation(s)
- Runcai Guo
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Mei Deng
- Department of Radiology, China-Japan Friendship Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100029, P.R. China
| | - Linfeng Xi
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Shuai Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Wenqing Xu
- Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, P.R. China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, P.R. China
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Eryilmaz Polat S, Akyan Soydaş ŞS, Ocak E, Gençoğlu MY, Uytun S, Özkan Tabakci S, Kürtül M, Bilgiç I, Kaşikçi M, Ademhan Tural D, Tuğcu GD, Cinel G. Has the Coronavirus Disease 2019 Pandemic Played a Role in the Early Detection of Pulmonary Embolism in Children? J Pediatr Hematol Oncol 2024; 46:e412-e418. [PMID: 38968543 DOI: 10.1097/mph.0000000000002913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/31/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Pulmonary embolism (PE) poses a significant threat to children, and nonspecific symptoms lead to delayed diagnosis. The emergence of coronavirus disease 2019 (COVID-19) has increased the complexity as it is associated with similar symptoms and increased risk of thrombotic complications. This study aimed to assess the risk factors, clinical presentations, and diagnostic features of PE in pediatric patients and to examine the impact of the COVID-19 pandemic on children with PE. MATERIALS AND METHODS We conducted a retrospective descriptive study examining the clinical and diagnostic data of 44 pediatric patients with radiologically confirmed PE. The study compared and analyzed patients diagnosed before and during the COVID-19 pandemic. RESULTS In the study, 21 of 44 pediatric patients were diagnosed in the 4 years before the COVID-19 pandemic, and 23 were diagnosed with PE during the COVID-19 pandemic. The mean time to diagnosis was 8 (2 to 14) days before the pandemic and 1 (1 to 2) days during the pandemic ( P < 0.001). The most common associated condition in both groups was infection (65.9%). Dyspnea (65.9%) and tachypnea (50.0%) were common symptoms. Except for deep vein thrombosis, there were no significant differences according to associated conditions between the groups ( P = 0.001). Pulmonary emboli were anatomically detected using computed tomography angiography, showing bilateral involvement in 45.4% of patients, segmental artery involvement in 38.6%, and main artery involvement in 15.9%. CONCLUSION The COVID-19 pandemic heightened suspicion of pediatric PE and accelerated diagnosis. Standardized diagnostic guidelines are increasingly necessary to balance accurate diagnosis with avoiding excessive imaging.
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Affiliation(s)
| | | | - Ece Ocak
- Department of Pediatric Pulmonology, Ankara City Hospital
| | | | - Salih Uytun
- Department of Pediatric Pulmonology, Ankara City Hospital
| | | | - Meltem Kürtül
- Department of Pediatric Pulmonology, Ankara City Hospital
| | - Işil Bilgiç
- Department of Pediatric Pulmonology, Ankara City Hospital
| | - Merve Kaşikçi
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | | | - Güzin Cinel
- Department of Pediatric Pulmonology, Ankara City Hospital
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3
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Romero Starke K, Kaboth P, Rath N, Reissig D, Kaempf D, Nienhaus A, Seidler A. Cardiovascular disease risk after a SARS-CoV-2 infection: A systematic review and meta-analysis. J Infect 2024; 89:106215. [PMID: 38971381 DOI: 10.1016/j.jinf.2024.106215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVES To our knowledge, there is no systematic review examining CVD risks after a SARS-CoV-2 infection over time, while also taking into account disease severity. All evidence on the risk for pulmonary embolism (PE), myocardial infarction (MI), ischaemic stroke (IS), haemorrhagic stroke (HS), and arterial thrombosis following infection was evaluated. METHODS The protocol was registered with PROSPERO. We searched Pubmed, Embase, MedRxiv and screened the titles/abstracts and full texts. We extracted the included studies, assessed their quality, and estimated pooled risks by time after infection and according to disease severity. RESULTS Risks were highest in the acute phase [PE: 27.1 (17.8-41.10); MI: 4.4 (1.6-12.4); stroke: 3.3 (2.1-5.2); IS: 5.6 (2.1-14.8); HS: 4.0 (0.1-326.2)] compared to the post-acute phase [PE: 2.9 (2.6-3.3); MI: 1.4 (1.1-1.9); stroke: 1.4 (1.0-2.0); IS: 1.6 (0.9-2.7)]. Highest risks were observed after infection confirmation, dropping during the first month post-infection (e.g. PE: RR(7 days) = 31; RR(1 month) = 8.1). A doubled risk was still observed until 4.5 months for PE, one month for MI and two months for IS. Risks decreased with decreasing disease severity. CONCLUSIONS Because of increased risk of CVD outcomes, management of persons who survived a severe SARS-CoV-2 infection is required, especially during the first nine months post-infection.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Pauline Kaboth
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Natalie Rath
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - David Reissig
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Daniel Kaempf
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre, Hamburg-Eppendorf, 20246 Hamburg, Germany; Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Magod B, Chokshi AK, Martin KA, Schimmel DR, Khan SS, Shah NS. Rural-urban differences in pulmonary embolism mortality by race-ethnicity and sex in the United States, 1999-2020. J Thromb Thrombolysis 2024; 57:337-340. [PMID: 37945938 DOI: 10.1007/s11239-023-02915-6] [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] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Racial and ethnic differences in pulmonary embolism (PE) mortality within rural and urban regions in the U.S. have not previously been described. PE mortality may vary across regions and urbanization given disparities in social and structural determinants and comorbid disease. METHODS Using surveillance data from the Centers for Disease Control and Prevention, age-adjusted mortality rates (AAMR) related to PE were calculated for rural and urban regions in the U.S., in non-Hispanic Black and White women and men, between 1999 and 2020. RESULTS Among 137,946 deaths in urban regions and 41,333 deaths in rural regions due to PE during this period, AAMR decreased 1.8% per year in urban regions from 3.1 to 100,000 in 1999 to 2.2 per 100,000 in 2020, and decreased 1% per year in rural regions from 4.3 to 100,000 in 1999 to 3.3 per 100,000 in 2020. Since 2008, AAMR from PE increased in non-Hispanic White males in rural and urban regions, decreased in non-Hispanic Black females in rural regions, and otherwise remained stagnant in all other race-sex groups. CONCLUSIONS AAMR from PE was higher in rural compared with urban individuals, with differences by race and sex. Mortality rates remained stagnant over the last decade in non-Hispanic Black adults and non-Hispanic White females and increased in non-Hispanic White males.
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Affiliation(s)
- Benjamin Magod
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Anuj K Chokshi
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Karlyn A Martin
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Daniel R Schimmel
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Sadiya S Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA
| | - Nilay S Shah
- Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Suite 680, Chicago, IL, 60611, USA.
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Sedhom R, Mohsen A, Stoletniy L, Abramov D, Elgendy IY. Characteristics and outcomes of COVID-19-associated pulmonary embolism. Eur J Intern Med 2023; 115:143-145. [PMID: 37253653 PMCID: PMC10209441 DOI: 10.1016/j.ejim.2023.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Ramy Sedhom
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Amr Mohsen
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Liset Stoletniy
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Dmitry Abramov
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Islam Y Elgendy
- Gill Heart Institute, University of Kentucky, 900 S. Limestone Street, Lexington, KY 40536, USA.
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6
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Heo MH, Choi HY, Kim JY, Kim KW, Lee SI, Kim KT, Park JS, Choe WJ, Kim JH. Anesthetic management of an elderly COVID-19 patient with pulmonary thromboembolism for hip surgery - A case report. Anesth Pain Med (Seoul) 2023; 18:290-295. [PMID: 37468206 PMCID: PMC10410544 DOI: 10.17085/apm.23009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND COVID-19 and delayed hip surgery are well-known risk factors for thromboembolism in elderly patients. CASE We report the case of an 88-year-old female patient with COVID-19 and pulmonary thromboembolism (PTE) who underwent delayed hip surgery 21 days after the injury. Heparinization and inferior vena cava filters were used to treat and prevent PTE. Transesophageal echocardiography and extracorporeal membrane oxygenation (ECMO) sheaths were inserted as a precaution in case of emergencies during surgery; the procedure was performed without any specific event. CONCLUSIONS COVID-19-infected patients suffering from a hip fracture have a high risk of thromboembolism, and therefore, require utmost attention for appropriate evaluation and prevention.
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Affiliation(s)
- Min Hee Heo
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hwan Yong Choi
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Woo Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang Il Lee
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung-Tae Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jang Su Park
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Won Joo Choe
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jun Hyun Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
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Bailey M, Linden D, Guo-Parke H, Earley O, Peto T, McAuley DF, Taggart C, Kidney J. Vascular risk factors for COVID-19 ARDS: endothelium, contact-kinin system. Front Med (Lausanne) 2023; 10:1208866. [PMID: 37448794 PMCID: PMC10336249 DOI: 10.3389/fmed.2023.1208866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023] Open
Abstract
SARS-CoV-2 binds to ACE2 receptors, expressed within the lungs. Risk factors for hospitalization include hypertension, diabetes, ischaemic heart disease and obesity-conditions linked by the presence of endothelial pathology. Viral infection in this setting causes increased conversion of circulating Factor XII to its active form (FXIIa). This is the first step in the contact-kinin pathway, leading to synchronous activation of the intrinsic coagulation cascade and the plasma Kallikrein-Kinin system, resulting in clotting and inflammatory lung disease. Temporal trends are evident from blood results of hospitalized patients. In the first week of symptoms the activated partial thromboplastin time (APTT) is prolonged. This can occur when clotting factors are consumed as part of the contact (intrinsic) pathway. Platelet counts initially fall, reflecting their consumption in coagulation. Lymphopenia occurs after approximately 1 week, reflecting the emergence of a lymphocytic pneumonitis [COVID-19 acute respiratory distress syndrome (ARDS)]. Intrinsic coagulation also induces the contact-kinin pathway of inflammation. A major product of this pathway, bradykinin causes oedema with ground glass opacities (GGO) on imaging in early COVID-19. Bradykinin also causes release of the pleiotrophic cytokine IL-6, which causes lymphocyte recruitment. Thromobosis and lymphocytic pneumonitis are hallmark features of COVID-19 ARDS. In this review we examine the literature with particular reference to the contact-kinin pathway. Measurements of platelets, lymphocytes and APTT should be undertaken in severe infections to stratify for risk of developing ARDS.
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Affiliation(s)
- Melanie Bailey
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Dermot Linden
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Hong Guo-Parke
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Olivia Earley
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Tunde Peto
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Danny F. McAuley
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Clifford Taggart
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Joseph Kidney
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
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Gryglewska-Wawrzak K, Cienkowski K, Cienkowska A, Banach M, Bielecka-Dabrowa A. The Role of Multidisciplinary Approaches in the Treatment of Patients with Heart Failure and Coagulopathy of COVID-19. J Cardiovasc Dev Dis 2023; 10:245. [PMID: 37367410 PMCID: PMC10299062 DOI: 10.3390/jcdd10060245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a severe respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Heart failure (HF) is associated with a worse prognosis for patients with this viral infection, highlighting the importance of early detection and effective treatment strategies. HF can also be a consequence of COVID-19-related myocardial damage. To optimise the treatment of these patients, one needs to understand the interactions between this disease and viruses. Until now, the validity of the screening for cardiovascular complications after COVID-19 has not been confirmed. There were also no patients in whom such diagnostics seemed appropriate. Until appropriate recommendations are made, diagnosis procedures must be individualised based on the course of the acute phase and clinical symptoms reported or submitted after COVID-19. Clinical phenomena are the criteria for determining the recommended test panel. We present a structured approach to COVID-19 patients with heart involvement.
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Affiliation(s)
- Katarzyna Gryglewska-Wawrzak
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93338 Lodz, Poland; (M.B.); (A.B.-D.)
| | | | - Alicja Cienkowska
- Faculty of Biology and Environmental Protection, University of Lodz, 90136 Lodz, Poland;
| | - Maciej Banach
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93338 Lodz, Poland; (M.B.); (A.B.-D.)
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90419 Lodz, Poland
| | - Agata Bielecka-Dabrowa
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93338 Lodz, Poland; (M.B.); (A.B.-D.)
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, 90419 Lodz, Poland
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9
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Vielhauer J, Benesch C, Pernpruner A, Johlke AL, Hellmuth JC, Muenchhoff M, Scherer C, Fink N, Sabel B, Schulz C, Mayerle J, Mahajan UM, Stubbe HC. How to exclude pulmonary embolism in patients hospitalized with COVID-19: a comparison of predictive scores. Thromb J 2023; 21:51. [PMID: 37131204 PMCID: PMC10153021 DOI: 10.1186/s12959-023-00492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/12/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is an important complication of Coronavirus disease 2019 (COVID-19). COVID-19 is associated with respiratory impairment and a pro-coagulative state, rendering PE more likely and difficult to recognize. Several decision algorithms relying on clinical features and D-dimer have been established. High prevalence of PE and elevated Ddimer in patients with COVID-19 might impair the performance of common decision algorithms. Here, we aimed to validate and compare five common decision algorithms implementing age adjusted Ddimer, the GENEVA, and Wells scores as well as the PEGeD- and YEARS-algorithms in patients hospitalized with COVID-19. METHODS In this single center study, we included patients who were admitted to our tertiary care hospital in the COVID-19 Registry of the LMU Munich. We retrospectively selected patients who received a computed tomography pulmonary angiogram (CTPA) or pulmonary ventilation/perfusion scintigraphy (V/Q) for suspected PE. The performances of five commonly used diagnostic algorithms (age-adjusted D-dimer, GENEVA score, PEGeD-algorithm, Wells score, and YEARS-algorithm) were compared. RESULTS We identified 413 patients with suspected PE who received a CTPA or V/Q confirming 62 PEs (15%). Among them, 358 patients with 48 PEs (13%) could be evaluated for performance of all algorithms. Patients with PE were older and their overall outcome was worse compared to patients without PE. Of the above five diagnostic algorithms, the PEGeD- and YEARS-algorithms performed best, reducing diagnostic imaging by 14% and 15% respectively with a sensitivity of 95.7% and 95.6%. The GENEVA score was able to reduce CTPA or V/Q by 32.2% but suffered from a low sensitivity (78.6%). Age-adjusted D-dimer and Wells score could not significantly reduce diagnostic imaging. CONCLUSION The PEGeD- and YEARS-algorithms outperformed other tested decision algorithms and worked well in patients admitted with COVID-19. These findings need independent validation in a prospective study.
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Affiliation(s)
- Jakob Vielhauer
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany.
- German Center for Infection Research, Partner Site Munich, Munich, Germany.
| | - Christopher Benesch
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Anna Pernpruner
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Anna-Lena Johlke
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Johannes Christian Hellmuth
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Muenchhoff
- German Center for Infection Research, Partner Site Munich, Munich, Germany
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
- Max von Pettenkofer Institute and Gene Center, National Reference Center for Retroviruses, Ludwig Maximilian University (LMU) of Munich, Virology, Munich, Germany
| | - Clemens Scherer
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital, LMU Munich, Munich, Germany
- Department of Medicine I, University Hospital LMU Munich, Munich, Germany
| | - Nicola Fink
- Department of Radiology, Hospital of the LMU Munich, Munich, Germany
| | - Bastian Sabel
- Department of Radiology, Hospital of the LMU Munich, Munich, Germany
| | - Christian Schulz
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany
| | | | - Hans Christian Stubbe
- Department of Medicine II, University Hospital LMU Munich, Munich, Germany.
- German Center for Infection Research, Partner Site Munich, Munich, Germany.
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10
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Franco-Moreno A, Brown-Lavalle D, Rodríguez-Ramírez N, Muñoz-Roldán C, Rubio-Aguilera AI, Campos-Arenas M, Muñoz-Rivas N, Moya-Mateo E, Ruiz-Giardín JM, Pardo-Guimerá V, Ulla-Anes M, Pedrero-Tomé R, Torres-Macho J, Bustamante-Fermosel A. Clinical prediction model for pulmonary thrombosis diagnosis in hospitalized patients with SARS-CoV-2 infection. J Clin Transl Res 2023; 9:59-68. [PMID: 37034002 PMCID: PMC10075091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Aim We aimed to develop a clinical prediction model for pulmonary thrombosis (PT) diagnosis in hospitalized COVID-19 patients. Methods Non-intensive care unit hospitalized COVID-19 patients who underwent a computed tomography pulmonary angiogram (CTPA) for suspected PT were included in the study. Demographic, clinical, analytical, and radiological variables as potential factors associated with the presence of PT were selected. Multivariable Cox regression analysis to develop a score for estimating the pre-test probability of PT was performed. The score was internally validated by bootstrap analysis. Results Among the 271 patients who underwent a CTPA, 132 patients (48.7%) had PT. Heart rate >100 bpm (OR = 4.63 [95% CI: 2.30-9.34]; P < 0.001), respiratory rate >22 bpm (OR = 5.21 [95% CI: 2.00-13.54]; P < 0.001), RALE score ≥4 (OR = 3.24 [95% CI: 1.66-6.32]; P < 0.001), C-reactive protein (CRP) >100 mg/L (OR = 2.10 [95% CI: 0.95-4.63]; P = 0.067), and D-dimer >3.000 ng/mL (OR = 6.86 [95% CI: 3.54-13.28]; P < 0.001) at the time of suspected PT were independent predictors of thrombosis. Using these variables, we constructed a nomogram (CRP, Heart rate, D-dimer, RALE score, and respiratory rate [CHEDDAR score]) for estimating the pre-test probability of PT. The score showed a high predictive accuracy (area under the receiver-operating characteristics curve = 0.877; 95% CI: 0.83-0.92). A score lower than 182 points on the nomogram confers a low probability for PT with a negative predictive value of 92%. Conclusions CHEDDAR score can be used to estimate the pre-test probability of PT in hospitalized COVID-19 patients outside the intensive care unit. Relevance for Patients Developing a new clinical prediction model for PT diagnosis in COVID-19 may help in the triage of patients, and limit unnecessary exposure to radiation and the risk of nephrotoxicity due to iodinated contrast.
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Affiliation(s)
- Anabel Franco-Moreno
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
- Corresponding author: Anabel Franco-Moreno Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre. Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | - David Brown-Lavalle
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
- Corresponding author: Anabel Franco-Moreno Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre. Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | | | - Candela Muñoz-Roldán
- Department of Radiology, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Ana Ignes Rubio-Aguilera
- Department of Radiology, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Maria Campos-Arenas
- Department of Radiology, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Nuria Muñoz-Rivas
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Eva Moya-Mateo
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | | | - Virginia Pardo-Guimerá
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Mariano Ulla-Anes
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Roberto Pedrero-Tomé
- EPINUT-UCM (Ref. 920325) Investigation Group, Universidad Complutense de Madrid, Madrid, Spain
- Fundación para la Investigación e Innovación Biomédica de los Hospitales Universitarios Infanta Leonor y del Sureste, Madrid, Spain
| | - Juan Torres-Macho
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
- Corresponding author: Anabel Franco-Moreno Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre. Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | - Ana Bustamante-Fermosel
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
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11
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Zuin M, Barco S, Giannakoulas G, Engelen MM, Hobohm L, Valerio L, Vandenbriele C, Verhamme P, Vanassche T, Konstantinides SV. Risk of venous thromboembolic events after COVID-19 infection: a systematic review and meta-analysis. J Thromb Thrombolysis 2023; 55:490-498. [PMID: 36652137 PMCID: PMC9845812 DOI: 10.1007/s11239-022-02766-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/19/2023]
Abstract
Data regarding the occurrence of venous thromboembolic events (VTE), including acute pulmonary embolism (PE) and deep vein thrombosis (DVT) in recovered COVID-19 patients are scant. We performed a systematic review and meta-analysis to assess the risk of acute PE and DVT in COVID-19 recovered subject. Following the PRIMSA guidelines, we searched Medline and Scopus to locate all articles published up to September 1st, 2022, reporting the risk of acute PE and/or DVT in patients recovered from COVID-19 infection compared to non-infected patients who developed VTE over the same follow-up period. PE and DVT risk were evaluated using the Mantel-Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI) while heterogeneity was assessed using Higgins I2 statistic. Overall, 29.078.950 patients (mean age 50.2 years, 63.9% males), of which 2.060.496 had COVID-19 infection, were included. Over a mean follow-up of 8.5 months, the cumulative incidence of PE and DVT in COVID-19 recovered patients were 1.2% (95% CI:0.9-1.4, I2: 99.8%) and 2.3% (95% CI:1.7-3.0, I2: 99.7%), respectively. Recovered COVID-19 patients presented a higher risk of incident PE (HR: 3.16, 95% CI: 2.63-3.79, I2 = 90.1%) and DVT (HR: 2.55, 95% CI: 2.09-3.11, I2: 92.6%) compared to non-infected patients from the general population over the same follow-up period. Meta-regression showed a higher risk of PE and DVT with age and with female gender, and lower risk with longer follow-up. Recovered COVID-19 patients have a higher risk of VTE events, which increase with aging and among females.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthias M Engelen
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
| | | | - Peter Verhamme
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Thrace, Greece
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12
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De Michieli L, Jaffe AS, Sandoval Y. Use and Prognostic Implications of Cardiac Troponin in COVID-19. Heart Fail Clin 2023; 19:163-176. [PMID: 36863808 PMCID: PMC9973555 DOI: 10.1016/j.hfc.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Myocardial injury is common in patients with COVID-19 and is associated with an adverse prognosis. Cardiac troponin (cTn) is used to detect myocardial injury and assist with risk stratification in this population. SARS-CoV-2 infection can play a role in the pathogenesis of acute myocardial injury due to both direct and indirect damage to the cardiovascular system. Despite the initial concerns about an increased incidence of acute myocardial infarction (MI), most cTn increases are related to chronic myocardial injury due to comorbidities and/or acute nonischemic myocardial injury. This review will discuss the latest findings on this topic.
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Affiliation(s)
- Laura De Michieli
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA,Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova 35128, Italy
| | - Allan S. Jaffe
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA,Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Yader Sandoval
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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13
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Labbé V, Contou D, Heming N, Megarbane B, Razazi K, Boissier F, Ait-Oufella H, Turpin M, Carreira S, Robert A, Monchi M, Souweine B, Preau S, Doyen D, Vivier E, Zucman N, Dres M, Fejjal M, Noel-Savina E, Bachir M, Jaffal K, Timsit JF, Picos SA, Mariotte E, Martis N, Juguet W, Melica G, Rondeau P, Audureau E, Mekontso Dessap A. Effects of Standard-Dose Prophylactic, High-Dose Prophylactic, and Therapeutic Anticoagulation in Patients With Hypoxemic COVID-19 Pneumonia: The ANTICOVID Randomized Clinical Trial. JAMA Intern Med 2023:2802821. [PMID: 36946232 PMCID: PMC10034664 DOI: 10.1001/jamainternmed.2023.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Importance Given the high risk of thrombosis and anticoagulation-related bleeding in patients with hypoxemic COVID-19 pneumonia, identifying the lowest effective dose of anticoagulation therapy for these patients is imperative. Objectives To determine whether therapeutic anticoagulation (TA) or high-dose prophylactic anticoagulation (HD-PA) decreases mortality and/or disease duration compared with standard-dose prophylactic anticoagulation (SD-PA), and whether TA outperforms HD-PA; and to compare the net clinical outcomes among the 3 strategies. Design, Settings, and Participants The ANTICOVID randomized clinical open-label trial included patients with hypoxemic COVID-19 pneumonia requiring supplemental oxygen and having no initial thrombosis on chest computer tomography with pulmonary angiogram at 23 health centers in France from April 14 to December 13, 2021. Of 339 patients randomized, 334 were included in the primary analysis-114 patients in the SD-PA group, 110 in the HD-PA, and 110 in the TA. At randomization, 90% of the patients were in the intensive care unit. Data analyses were performed from April 13, 2022, to January 3, 2023. Interventions Patients were randomly assigned (1:1:1) to receive either SD-PA, HD-PA, or TA with low-molecular-weight or unfractionated heparin for 14 days. Main Outcomes and Measures A hierarchical criterion of all-cause mortality followed by time to clinical improvement at day 28. Main secondary outcome was net clinical outcome at day 28 (composite of thrombosis, major bleeding, and all-cause death). Results Among the study population of 334 individuals (mean [SD] age, 58.3 [13.0] years; 226 [67.7%] men and 108 [32.3%] women), use of HD-PA and SD-PA had similar probabilities of favorable outcome (47.3% [95% CI, 39.9% to 54.8%] vs 52.7% [95% CI, 45.2% to 60.1%]; P = .48), as did TA compared with SD-PA (50.9% [95% CI, 43.4% to 58.3%] vs 49.1% [95% CI, 41.7% to 56.6%]; P = .82) and TA compared with HD-PA (53.5% [95% CI 45.8% to 60.9%] vs 46.5% [95% CI, 39.1% to 54.2%]; P = .37). Net clinical outcome was met in 29.8% of patients receiving SD-PA (20.2% thrombosis, 2.6% bleeding, 14.0% death), 16.4% receiving HD-PA (5.5% thrombosis, 3.6% bleeding, 11.8% death), and 20.0% receiving TA (5.5% thrombosis, 3.6% bleeding, 12.7% death). Moreover, HD-PA and TA use significantly reduced thrombosis compared with SD-PA (absolute difference, -14.7 [95% CI -6.2 to -23.2] and -14.7 [95% CI -6.2 to -23.2], respectively). Use of HD-PA significantly reduced net clinical outcome compared with SD-PA (absolute difference, -13.5; 95% CI -2.6 to -24.3). Conclusions and Relevance This randomized clinical trial found that compared with SD-PA, neither HD-PA nor TA use improved the primary hierarchical outcome of all-cause mortality or time to clinical improvement in patients with hypoxemic COVID-19 pneumonia; however, HD-PA resulted in significantly better net clinical outcome by decreasing the risk of de novo thrombosis. Trial Registration ClinicalTrials.gov Identifier: NCT04808882.
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Affiliation(s)
- Vincent Labbé
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- Service des Soins Intensifs, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium
- Université Paris Est Créteil, Institut Mondor de Recherche Biomédicale, Groupe de Recherche Clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Créteil, France
| | - Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Nicholas Heming
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Université Versailles Saint Quentin-Université Paris Saclay, Garches, France
- Laboratoire d'infection et inflammation, Unité 1173, Faculté de Médecine Simone Veil, Institut national de la santé et de la recherche médicale, Université Versailles Saint Quentin - Université Paris Saclay, Garches, France
| | - Bruno Megarbane
- Service de Réanimation Médicale et Toxicologique, Centre Hospitalier Universitaire Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Unité Mixte de Recherche en Santé 1144, Institut national de la santé et de la recherche médicale, Université Paris Cité, Paris, France
| | - Keyvan Razazi
- Université Paris Est Créteil, Institut Mondor de Recherche Biomédicale, Groupe de Recherche Clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Créteil, France
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Florence Boissier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Université de Poitiers, Poitiers, France
- Centre d'Investigation Clinique 1402 (Investigations of Sleep, Acute Lung Injury, & Ventilation group), Institut national de la santé et de la recherche médicale, Université de Poitiers, Poitiers, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive Réanimation, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Matthieu Turpin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Serge Carreira
- Service d'Anesthésie-Réanimation polyvalente, Hôpital Saint Camille, Bry-sur-Marne, France
| | - Alexandre Robert
- Service de Médecine Intensive Réanimation, Hôpital Simone Veil, Centre Hospitalier de Cannes, Cannes, France
- Centre Méditerranéen de Médecine Moléculaire, Institut national de la santé et de la recherche médicale, Université Côte d'Azur, Nice, France
| | - Mehran Monchi
- Service de Médecine Intensive Réanimation, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Bertrand Souweine
- Service de Médecine Intensive Réanimation, Hôpital Universitaire Gabriel-Montpied, Clermont-Ferrand, France
| | - Sebastien Preau
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Lille, Université de Lille, Lille, France
- Unité 1167, Institut Pasteur de Lille, Institut national de la santé et de la recherche médicale, Université de Lille, Lille, France
| | - Denis Doyen
- Service de Médecine Intensive Réanimation, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Emmanuel Vivier
- Service de Réanimation Polyvalente, Centre Hospitalier Saint Joseph-Saint Luc, Lyon, France
| | - Noémie Zucman
- Service de Médecine Intensive Réanimation, Departement Médico-Universitaire ESPRIT, Centre Hospitalier Universitaire Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France
- Unité de Formation et de Recherche de Médecine, Université Paris Cité, Paris, France
| | - Martin Dres
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Mohamed Fejjal
- Service de Médecine Intensive Réanimation, Centre Hospitalier Léon Binet, Provins, France
| | - Elise Noel-Savina
- Service de Pneumologie et de Soins Intensifs Respiratoires, Hôpital Larrey, Toulouse, France
| | - Marwa Bachir
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Karim Jaffal
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Jean-François Timsit
- Service de Médecine Intensive et Réanimation Infectieuse, Centre Hospitalier Universitaire Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris-Cité, Paris, France
- Infection, Anti-microbien, Modélisation, Evolution, Institut National de la Santé et de la Recherche Médicale, Unité 1137, Université de Paris-Cité, Paris, France
| | - Santiago Alberto Picos
- Service de Médecine Intensive Réanimation, Centre Hospitalier La Dracénie De Draguignan, Draguignan, France
| | - Eric Mariotte
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nihal Martis
- Service de Médecine Interne, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France
| | - William Juguet
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, Université Sorbonne Paris Nord, Bobigny, France
| | - Giovanna Melica
- Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Paul Rondeau
- Service de Médecine Interne, Hôpital Saint Camille, Bry-sur-Marne, France
| | - Etienne Audureau
- Unité de Recherche Clinique Henri Mondor, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
- Institut Mondor de Recherche Biomédicale, Unité 955, Institut National de la Santé et de la Recherche Médicale, Université Paris Est Créteil, Créteil, France
| | - Armand Mekontso Dessap
- Université Paris Est Créteil, Institut Mondor de Recherche Biomédicale, Groupe de Recherche Clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Créteil, France
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
- Université Paris Est Créteil, Institut Mondor de recherche biomédicale, Institut national de la santé et de la recherche médicale, Créteil, France
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14
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Fahrni G, Rocha AC, Gudmundsson L, Pozzessere C, Qanadli SD, Rotzinger DC. Impact of COVID-19 pneumonia on pulmonary vascular volume. Front Med (Lausanne) 2023; 10:1117151. [PMID: 37035332 PMCID: PMC10073514 DOI: 10.3389/fmed.2023.1117151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/24/2023] [Indexed: 04/11/2023] Open
Abstract
Background Pulmonary manifestations of COVID-19 pneumonia are well known. However, COVID-19 is also associated with a range of vascular manifestations such as embolism, congestion, and perfusion changes. Regarding congestion, research from different groups has suggested arteriovenous anastomosis dysregulation as a contributing factor. In this study, we aim to better describe the changes in vascular volume in affected lung zones and to relate them to pathophysiological hypotheses. Methods We performed automatic vascular volume extraction in 10 chest CTs of patients, including 2 female and 8 male with a mean age of 63.5 ± 9.3 years, diagnosed with COVID-19 pneumonia. We compared the proportion of vascular volumes between manually segmented regions of lung parenchyma with and without signs of pneumonia. Results The proportion of vascular volume was significantly higher in COVID (CVasc) compared to non-COVID (NCVasc) areas. We found a mean difference (DVasc) of 5% and a mean ratio (RVasc) of 3.7 between the two compartments (p < 0.01). Conclusion Vascular volume in COVID-19 affected lung parenchyma is augmented relative to normal lung parenchyma, indicating venous congestion and supporting the hypothesis of pre-existing intra-pulmonary arteriovenous shunts.
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Affiliation(s)
- Guillaume Fahrni
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ana-Carolina Rocha
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Louis Gudmundsson
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chiara Pozzessere
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Riviera Chablais Hospital and University of Lausanne, Lausanne, Switzerland
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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15
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Quintal Martínez JP, Segura Campos MR. Flavonoids as a therapeutical option for the treatment of thrombotic complications associated with COVID-19. Phytother Res 2023; 37:1092-1114. [PMID: 36480428 PMCID: PMC9878134 DOI: 10.1002/ptr.7700] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/18/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022]
Abstract
The SARS-CoV-2 outbreak has been one of the largest public health crises globally, while thrombotic complications have emerged as an important factor contributing to mortality. Therefore, compounds that regulate the processes involved in thrombosis could represent a dietary strategy to prevent thrombotic complications involved in COVID-19. In August 2022, various databases were consulted using the keywords "flavonoids", "antiplatelet", "anticoagulant", "fibrinolytic", and "nitric oxide". Studies conducted between 2019 and 2022 were chosen. Flavonoids, at concentrations mainly between 2 and 300 μM, are capable of regulating platelet aggregation, blood coagulation, fibrinolysis, and nitric oxide production due to their action on multiple receptors and enzymes. Most of the studies have been carried out through in vitro and in silico models, and limited studies have reported the in vivo and clinical effect of flavonoids. Currently, quercetin has been the only flavonoid evaluated clinically in patients with COVID-19 for its effect on D-dimer levels. Therefore, clinical studies in COVID-19 patients analyzing the effect on platelet, coagulant, fibrinolytic, and nitric oxide parameters are required. In addition, further high-quality studies that consider cytotoxic safety and bioavailability are required to firmly propose flavonoids as a treatment for the thrombotic complications implicated in COVID-19.
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16
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Safiriyu I, Fatuyi M, Mehta A, Naseer A, Alexander E, Vovan H, Shamaki GR, Bob-Manuel T. Impact of COVID-19 Infection on the Clinical Outcomes of Pulmonary Embolism Hospitalizations : A Nationwide Analysis. Curr Probl Cardiol 2023; 48:101669. [PMID: 36841316 PMCID: PMC9946871 DOI: 10.1016/j.cpcardiol.2023.101669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND There is an increased risk of venous thromboembolism among patients with COVID-19 infection, with the risk being higher among those needing intensive level of care. Existing data is, however limited regarding the outcomes of patients admitted with concurrent COVID-19 infection and pulmonary embolism (PE). METHODS All acute PE admissions were identified from the National Inpatient Sample database during 2020 using ICD-10 codes. Patients were subsequently classified into those with and without COVID-19 infection. The primary outcome of interest was in-hospital mortality. Using multivariate logistic regression, the predictors of mortality were assessed for patients with concurrent acute PE and COVID-19. RESULTS The database query generated 278,840 adult patients with a primary diagnosis of PE. Of these, 4580 patients had concurrent PE and COVID-19 infection. The concurrent PE and COVID-19 infection group had a higher proportion of Black-American and Hispanic patients, and those living in the zip codes associated with lowest annualized income compared to the PE alone group. Furthermore, patients in the concurrent PE and COVID-19 infection group had an increased risk of in-hospital mortality (adjusted odds ratio [aOR]:1.62; 95% CI: 1.17 - 2.24; p = 0.004), septic shock (aOR: 1.66; 95% CI 1.10-2.52; p = 0.016), respiratory failure (aOR: 1.78; 95% CI 1.53-2.06; p = 0.001), and a longer hospital stay [5.5 days vs 4.59 days; p = 0.001). CONCLUSION Concurrent COVID-19 and PE admissions is associated with an increased in-hospital mortality, risk of septic shock and respiratory failure, and a longer length of hospital stay.
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Affiliation(s)
- Israel Safiriyu
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Michael Fatuyi
- Department of Medicine, TriHealth Good Samaritan Hospital Program, Cincinnati Ohio, USA
| | - Adhya Mehta
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ahmad Naseer
- Department of Medicine, Jacobi Medical Center, Bronx, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ebere Alexander
- Department of Medicine, Mt Carmel East Hospital, Colombus, Ohio, USA
| | - Houston Vovan
- Department of Medicine, TriHealth Good Samaritan Hospital Program, Cincinnati Ohio, USA
| | - Garba Rimamskep Shamaki
- Department of Internal medicine Unity Hospital, Rochester Regional Health Rochester, NY, USA
| | - Tamunoinemi Bob-Manuel
- Department of Interventional and Endovascular Cardiology, Stern Cardiovascular Foundation, Memphis, TN, USA
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17
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Pilia E, Belletti A, Fresilli S, Lee TC, Zangrillo A, Finco G, Landoni G. The Effect of Heparin Full-Dose Anticoagulation on Survival of Hospitalized, Non-critically Ill COVID-19 Patients: A Meta-analysis of High Quality Studies. Lung 2023; 201:135-147. [PMID: 36738324 PMCID: PMC9899107 DOI: 10.1007/s00408-023-00599-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND International COVID-19 guidelines recommend thromboprophylaxis for non-critically ill inpatients to prevent thrombotic complications. It is still debated whether full-dose thromboprophylaxis reduces all-cause mortality. The main aim of this updated systematic review and meta-analysis is to evaluate the effect of full-dose heparin-based thromboprophylaxis on survival in hospitalized non-critically ill COVID-19 patients. METHODS A systematic review was performed across Pubmed/Medline, EMBASE, Cochrane Central Register of clinical trials, Clinicaltrials.gov, and medRxiv.org from inception to November 2022. We conducted a meta-analysis of randomized clinical trials (RCTs) comparing full-dose heparin-based anticoagulation to prophylactic or intermediate dose anticoagulation or standard treatment in hospitalized non-critically ill COVID-19 patients. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials and Grading of Recommendations Assessment, Development and Evaluation was applied. The primary outcome was all-cause mortality at the longest follow-up available. RESULTS We identified 6 multicenter RCTs involving 3297 patients from 13 countries across 4 continents. The rate of all-cause mortality was 6.2% (103/1662) in the full-dose group vs 7.7% (126/1635) in the prophylactic or intermediate dose group (Risk Ratio [RR] = 0.76; 95% confidence interval [CI] = 0.59-0.98; P = 0.037). The probabilities of any mortality difference and of NNT ≤ 100 were estimated at 98.2% and 84.5%, respectively. The risk of bias was low for all included RCTs and the strength of the evidence was "moderate." CONCLUSION Our meta-analysis of high-quality multicenter RCTs suggests that full-dose anticoagulation with heparin or low molecular weight heparin reduces all-cause mortality in hospitalized non-critically ill COVID-19 patients. STUDY REGISTRATION PROSPERO, review no. CRD42022348993.
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Affiliation(s)
- Eros Pilia
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy ,Department of Anesthesia, Resuscitation and Pain Therapy, University of Cagliari, Cagliari, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Stefano Fresilli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Todd C. Lee
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, QC Canada
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy ,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Finco
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy ,Department of Anesthesia, Resuscitation and Pain Therapy, University of Cagliari, Cagliari, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy ,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Nasab EM, Aghajani H, Makoei RH, Athari SS. COVID-19's immuno-pathology and cardiovascular diseases. J Investig Med 2023; 71:71-80. [PMID: 36647329 PMCID: PMC9850087 DOI: 10.1177/10815589221141841] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The pandemic of COVID-19 in worldwide causes recent millions of morbidity and mortality in all countries and is the most important challenge in the world in recent years. Coronavirus is a single-stranded RNA virus and infection with COVID-19 leads to acute respiratory distress syndrome, lung inflammation, cytokine storm, and death. The other complications include endothelial dysfunction, activation of coagulation, thromboembolic events, and vascular disease. Cardiovascular complications such as myocardial and stroke ischemia, pulmonary thromboembolism, systemic arterial, and deep vein thrombosis were reported. In this review, we presented immuno-pathological mechanisms and the effects of COVID-19 on the cardiovascular system, heart, vessels, coagulation system, and molecular glance of immuno-inflammation to the COVID-19's pathology on the cardiovascular system.
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Affiliation(s)
- Entezar Mehrabi Nasab
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran,Department of Cardiology, School of Medicine, Valiasr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hassan Aghajani
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hassanzadeh Makoei
- Department of Cardiology, School of Medicine, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Seyyed Shamsadin Athari
- Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran,Seyyed Shamsadin Athari, Department of Immunology, School of Medicine, Zanjan University of Medical Sciences, Gavazang Road, Zanjan PG36+6RX, Iran. Emails: and
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Camerlo S, Ligato J, Rosati G, Carrà G, Russo I, De Gobbi M, Morotti A. Shedding Light on the Pathogenesis of Splanchnic Vein Thrombosis. Int J Mol Sci 2023; 24:ijms24032262. [PMID: 36768584 PMCID: PMC9916478 DOI: 10.3390/ijms24032262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Splanchnic vein thrombosis is a rare but potentially life-threatening manifestation of venous thromboembolism, with challenging implications both at the pathological and therapeutic level. It is frequently associated with liver cirrhosis, but it could also be provoked by myeloproliferative disorders, cancer of various gastroenterological origin, abdominal infections and thrombophilia. A portion of splanchnic vein thrombosis is still classified as idiopathic. Here, we review the mechanisms of splanchnic vein thrombosis, including new insights on the role of clonal hematopoiesis in idiopathic SVT pathogenesis, with important implications from the therapeutic standpoint.
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20
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Acute phase characteristics and long-term complications of pulmonary embolism in COVID-19 compared to non-COVID-19 cohort: a large single-centre study. BMC Pulm Med 2023; 23:25. [PMID: 36653788 PMCID: PMC9846660 DOI: 10.1186/s12890-023-02323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To compare the severity of pulmonary embolism (PE) and the long-term complications between patients with and without COVID-19, and to investigate whether the tools for risk stratification of death are valid in this population. METHODS We retrospectively included hospitalized patients with PE from 1 January 2016 to 31 December 2022. Comparisons for acute episode characteristics, risk stratification of the PE, outcomes, and long-term complications were made between COVID and non-COVID patients. RESULTS We analyzed 116 (27.5%) COVID patients and 305 (72.4%) non-COVID patients. In patients with COVID-19, the traditional risk factors for PE were absent, and the incidence of deep vein thrombosis was lower. COVID patients showed significantly higher lymphocyte count, lactate dehydrogenase, lactic acid, and D-dimer levels. COVID patients had PE of smaller size (12.3% vs. 25.5% main pulmonary artery, 29.8% vs. 37.1% lobar, 44.7% vs. 29.5% segmental and 13.2% vs. 7.9% subsegmental, respectively; p < 0.001), less right ventricular dysfunction (7.7% vs. 17.7%; p = 0.007) and higher sPESI score (1.66 vs. 1.11; p < 0.001). The need for mechanical ventilation was significantly higher in COVID patients (8.6% vs. 1.3%; p < 0.001); However, the in-hospital death was less (5.2% vs. 10.8%; p = 0.074). The incidence of long-term complications was lower in COVID cohort (p < 0.001). PE severity assessed by high sPESI and intermediate and high-risk categories were independently associated with in-hospital mortality in COVID patients. CONCLUSION The risk of in-hospital mortality and the incidence of long-term complications were lower in COVID-19. The usual tools for risk stratification of PE are valid in COVID patients.
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21
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Abstract
Electrical impedance tomography (EIT) has been shown to be of value in evaluating the distribution of ventilation. In addition, several studies, particularly case reports, have demonstrated the use of EIT in the assessment of lung perfusion. EIT may be a potential diagnostic bedside tool in the diagnosis and follow-up of acute pulmonary embolism. CASE SUMMARY We present one case of a patient with COVID-19 who likely had pulmonary thromboembolism where perfusion scans were made before and after thrombolytic therapy. Perfusion scans showed improvement after thrombolytic therapy. This article should therefore be seen as a first step in proving the validity of EIT-derived perfusion scans as a diagnostic for pulmonary embolism. CONCLUSION The hypertonic saline bolus EIT method as a diagnostic tool for pulmonary embolism is a promising new technique, which can be particularly meaningful for critically ill patients. Further study is required to evaluate the sensitivity and specificity of this technique and the impact on decision-making and outcomes of critically ill patients.
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22
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Watson O, Zaldua JC, Pillai S, Whitley J, Howard M, Lawrence M, Hawkins K, Morris K, Evans PA. The efficacy of low molecular weight heparin is reduced in COVID-19. Clin Hemorheol Microcirc 2023; 84:333-344. [PMID: 36442189 DOI: 10.3233/ch-221635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A significant degree of mortality and morbidity in COVID-19 is through thromboembolic complications, only partially mitigated by anticoagulant therapy. Reliable markers of infection severity are not fully established. OBJECTIVES This study investigated whether visco-elastic biomarkers predict disease severity on presentation to the Emergency Department (ED) and how they measure response to anticoagulationMETHODS:Patients testing positive for COVID-19 at a large University Teaching Hospital ED were recruited at presentation. Multiple blood samples were taken throughout hospital admission to monitor disease progression with end outcome recorded. Visco-elastic markers, fractal dimension (df) and Time to Gel Point (TGP) which measure the properties of the incipient clot were compared in patients with and without anticoagulation by Low Molecular Weight Heparin (LMWH). RESULTS TGP and df did not predict severity of infection with COVID-19. Although LMWH prolonged TGP, there was no change in df indicating LMWH did not change clot microstructure. CONCLUSIONS Therapeutic efficacy of LMWH appears blunted in COVID-19 infection. This may be due to the inflammatory state creating a resistance to LMWH activity, which may explain why LMWH appears less effective in COVID-19 compared to other disease states. COVID-19 was not predicted by visco-elastic testing at the time of ED presentation.
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Affiliation(s)
- Oliver Watson
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
- Swansea University Medical School Swansea University, Singleton Park, Swansea, UK
| | - Jun-Cezar Zaldua
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
- Swansea University Medical School Swansea University, Singleton Park, Swansea, UK
| | - Suresh Pillai
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
- Swansea University Medical School Swansea University, Singleton Park, Swansea, UK
| | - Janet Whitley
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
- Swansea University Medical School Swansea University, Singleton Park, Swansea, UK
| | - Matthew Howard
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
- Swansea University Medical School Swansea University, Singleton Park, Swansea, UK
| | - Matthew Lawrence
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Karl Hawkins
- Swansea University Medical School Swansea University, Singleton Park, Swansea, UK
| | - Keith Morris
- Cardiff Metropolitan University, Llandaff Campus Western Avenue, Cardiff, UK
| | - Phillip Adrian Evans
- Welsh Centre for Emergency Medicine Research, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
- Swansea University Medical School Swansea University, Singleton Park, Swansea, UK
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23
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Hobohm L, Sagoschen I, Barco S, Farmakis IT, Fedeli U, Koelmel S, Gori T, Espinola-Klein C, Münzel T, Konstantinides S, Keller K. COVID-19 infection and its impact on case fatality in patients with pulmonary embolism. Eur Respir J 2023; 61:13993003.00619-2022. [PMID: 35981745 PMCID: PMC9411730 DOI: 10.1183/13993003.00619-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although a high prevalence of pulmonary embolism (PE) has been reported in association with coronavirus disease 2019 (COVID-19) in critically ill patients, nationwide data on the outcome of hospitalised patients with COVID-19 and PE are still limited. Thus, we investigated seasonal trends and predictors of in-hospital death in patients with COVID-19 and PE in Germany. METHODS We used a German nationwide inpatient sample to analyse data on hospitalisations among COVID-19 patients with and without PE during 2020, and to detect changes in PE prevalence and case fatality in comparison with 2019. RESULTS We analysed 176 137 COVID-19 hospitalisations in 2020; PE was recorded in 1.9% (n=3362) of discharge certificates. Almost one-third of patients with COVID-19 and PE died during the in-hospital course (28.7%) compared with COVID-19 patients without PE (17.7%). Between 2019 and 2020, numbers of PE-related hospitalisations were largely unchanged (98 485 versus 97 718), whereas the case fatality rate of PE increased slightly in 2020 (from 12.7% to 13.1%; p<0.001). Differences in case fatality were found between PE patients with and without COVID-19 in 2020 (28.7% versus 12.5%; p<0.001), corresponding to a 3.1-fold increased risk of PE-related death (OR 3.16, 95% CI 2.91-3.42; p<0.001) in the presence of COVID-19. CONCLUSIONS In Germany, the prevalence of PE events during hospitalisations was similar in 2019 and 2020. However, the fatality rate among patients with both COVID-19 and PE was substantially higher than that in those with only one of these diseases, suggesting a life-threatening additive prognostic impact of the COVID-19-PE combination.
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Affiliation(s)
- Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- L. Hobohm and I. Sagoschen contributed equally and share first authorship
| | - Ingo Sagoschen
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- L. Hobohm and I. Sagoschen contributed equally and share first authorship
| | - Stefano Barco
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Ioannis T Farmakis
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Padova, Italy
| | - Sebastian Koelmel
- Department of Internal Medicine, Triemli Hospital Zurich, Zurich, Switzerland
| | - Tommaso Gori
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Karsten Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
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24
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Eroume À Egom E, Shiwani HA, Nouthe B. From acute SARS-CoV-2 infection to pulmonary hypertension. Front Physiol 2022; 13:1023758. [PMID: 36601347 PMCID: PMC9806360 DOI: 10.3389/fphys.2022.1023758] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
As the world progressively recovers from the acute stages of the coronavirus disease 2019 (COVID-19) pandemic, we may be facing new challenges regarding the long-term consequences of COVID-19. Accumulating evidence suggests that pulmonary vascular thickening may be specifically associated with COVID-19, implying a potential tropism of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus for the pulmonary vasculature. Genetic alterations that may influence the severity of COVID-19 are similar to genetic drivers of pulmonary arterial hypertension. The pathobiology of the COVID-19-induced pulmonary vasculopathy shares many features (such as medial hypertrophy and smooth muscle cell proliferation) with that of pulmonary arterial hypertension. In addition, the presence of microthrombi in the lung vessels of individuals with COVID-19 during the acute phase, may predispose these subjects to the development of chronic thromboembolic pulmonary hypertension. These similarities raise the intriguing question of whether pulmonary hypertension (PH) may be a long-term sequela of SARS-COV-2 infection. Accumulating evidence indeed support the notion that SARS-COV-2 infection is indeed a risk factor for persistent pulmonary vascular defects and subsequent PH development, and this could become a major public health issue in the future given the large number of individuals infected by SARS-COV-2 worldwide. Long-term studies assessing the risk of developing chronic pulmonary vascular lesions following COVID-19 infection is of great interest for both basic and clinical research and may inform on the best long-term management of survivors.
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Affiliation(s)
- Emmanuel Eroume À Egom
- Institut du Savoir Montfort (ISM), University of Ottawa, Ottawa, ON, Canada,CIEL, Centre d’Innovation et de Commercialisation en Recherche Clinique et Bio-Médicale Immânow’EL, Béatitude/Nkolbisson, Yaoundé, Cameroon,Laboratory of Endocrinology and Radioisotopes, Institute of Medical Research and Medicinal Plants Studies (IMPM), Yaoundé, Cameroon,*Correspondence: Emmanuel Eroume À Egom,
| | - Haaris A. Shiwani
- Burnley General Hospital, East Lancashire Hospitals NHS Trust, Burnley, United Kingdom
| | - Brice Nouthe
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
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25
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Nasrullah A, Gangu K, Shumway NB, Cannon HR, Garg I, Shuja H, Bobba A, Chourasia P, Sheikh AB, Shekhar R. COVID-19 and Pulmonary Embolism Outcomes among Hospitalized Patients in the United States: A Propensity-Matched Analysis of National Inpatient Sample. Vaccines (Basel) 2022; 10:2104. [PMID: 36560514 PMCID: PMC9784895 DOI: 10.3390/vaccines10122104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/03/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Venous thromboembolism, in particular, pulmonary embolism (PE), is a significant contributor to the morbidity and mortality associated with COVID-19. In this study, we utilized the National Inpatient Sample (NIS) database 2020 to evaluate and compare clinical outcomes in patients with COVID-19 with and without PE. Our sample includes 1,659,040 patients hospitalized with COVID-19 pneumonia between January 2020 and December 2020. We performed propensity-matched analysis for patient characteristics and in-hospital outcomes, including the patient’s age, race, sex, insurance status, median income, length of stay, mortality, hospitalization cost, comorbidities, mechanical ventilation, and vasopressor support. Patients with COVID-19 with PE had a higher need for mechanical ventilation (25.7% vs. 15.6%, adjusted odds ratio 1.4, 95% CI 1.4−1.5, p < 0.001), the vasopressor requirement (5.4% vs. 2.6%, adjusted OR 1.6, 95% CI 1.4−1.8, p < 0.001), longer hospital stays (10.8 vs. 7.9 days, p < 0.001), and overall higher in-hospital mortality (19.1 vs. 13.9%, adjusted OR of 1.3, 95% CI 1.1−1.5, p < 0.001). This study highlights the need for more aggressive management of PE in COVID-19-positive patients with the aim to improve early diagnosis and treatment to reduce morbidity, mortality, and healthcare costs seen in the synchronous COVID-19 and PE-positive patients.
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Affiliation(s)
- Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Nichole B. Shumway
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Harmon R. Cannon
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Ishan Garg
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Hina Shuja
- Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Pakistan
| | - Aniesh Bobba
- Department of Medicine, John H Stronger Hospital, Cook County, Chicago, IL 60612, USA
| | - Prabal Chourasia
- Department of Medicine, Mary Washington Hospital, Fredericksburg, VA 22401, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
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Huang RC, Chiu CH, Shang HS, Perng CL, Chiang TT, Tsai CC, Wang CH. Clinical characteristics analysis of COVID-19 patients from the first significant community outbreak by SARS-CoV-2 variant B.1.1.7 in Taiwan as experienced from a single northern medical center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1036-1043. [PMID: 36057491 PMCID: PMC9381423 DOI: 10.1016/j.jmii.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/11/2022] [Accepted: 08/01/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND/PURPOSE Clinical characteristics of patients in the first community outbreak of coronavirus disease 2019 (COVID-19) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant B.1.1.7 in Taiwan have not been characterized. METHODS SARS-CoV-2 positive specimens from inpatients between May 7 and June 15 in 2021were screen for SARS-CoV-2 B.1.1.7 lineage by VirSNiP assay. Clinical characteristics were reviewed and compared with those from Feb 1 to April 30, 2020 and from Jan 1 to March 31, 2022. RESULTS One hundred forty-one inpatients from May 7 to June 15, 2021 infected with SARS-CoV-2 B.1.1.7 lineage were included. The major presenting symptoms were fever (88.7%) and cough (59.6%). Incidence of relevant complications including pulmonary embolism, simultaneous infections with bacteria, virus, and fungi were 0.7%, 12.8%, 13.5%, and 2.1%, respectively. Old age, high Charlson comorbidity index, short of breath, and initial critical illness were independently associated with 28-day mortality (all p < 0.05). In comparison to COVID-19 inpatients from Feb 1 to April 30, 2020, patients from the outbreak by SARS-CoV-2 B.1.1.7 lineage were older, more severe in disease condition, higher mortality but less obvious initial presenting symptoms. After implementation of nationwide vaccination campaign in the next half year of 2021, COVID-19 inpatients from Jan 1 to March 31 in 2022 indicated less severe diseases than those infected with SARS-CoV-2 B.1.1.7 lineage. CONCLUSION COVID-19 inpatients by SARS-CoV-2 variant B.1.1.7 with old age, multiple comorbidities, and more severe disease conditions were associated with increased mortality. Vaccination for this vulnerable populations may be helpful.
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Affiliation(s)
- Ruei-Chang Huang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hung-Sheng Shang
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cherng-Lih Perng
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tsung-Ta Chiang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chun-Chou Tsai
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ching-Hsun Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC,Corresponding author. Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. Fax: +886-2-87927258
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27
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Valenzuela ED, Mercado P, Pairumani R, Medel JN, Petruska E, Ugalde D, Morales F, Eisen D, Araya C, Montoya J, Gonzalez A, Rovegno M, Ramirez J, Aguilera J, Hernández G, Bruhn A, Slama M, Bakker J. Cardiac function in critically ill patients with severe COVID: A prospective cross-sectional study in mechanically ventilated patients. J Crit Care 2022; 72:154166. [PMID: 36244256 PMCID: PMC9557772 DOI: 10.1016/j.jcrc.2022.154166] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/29/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate cardiac function in mechanically ventilated patients with COVID-19. MATERIALS AND METHODS Prospective, cross-sectional multicenter study in four university-affiliated hospitals in Chile. All consecutive patients with COVID-19 ARDS requiring mechanical ventilation admitted between April and July 2020 were included. We performed systematic transthoracic echocardiography assessing right and left ventricular function within 24 h of intubation. RESULTS 140 patients aged 57 ± 11, 29% female were included. Cardiac output was 5.1 L/min [IQR 4.5-6.2] and 86% of the patients required norepinephrine. ICU mortality was 29% (40 patients). Fifty-four patients (39%) exhibited right ventricle dilation out of whom 20 patients (14%) exhibited acute cor pulmonale (ACP). Eight out of the twenty patients with ACP exhibited pulmonary embolism (40%). Thirteen patients (9%) exhibited left ventricular systolic dysfunction (ejection fraction <45%). In the multivariate analysis acute cor pulmonale and PaO2/FiO2 ratio were independent predictors of ICU mortality. CONCLUSIONS Right ventricular dilation is highly prevalent in mechanically ventilated patients with COVID-19 ARDS. Acute cor pulmonale was associated with reduced pulmonary function and, in only 40% of patients, with co-existing pulmonary embolism. Acute cor pulmonale is an independent risk factor for ICU mortality.
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Affiliation(s)
- Emilio Daniel Valenzuela
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Pablo Mercado
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Ronald Pairumani
- Unidad de Cuidados Intensivos, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Juan Nicolás Medel
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Edward Petruska
- Unidad de Cuidados Intensivos, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Diego Ugalde
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Felipe Morales
- Unidad de Cuidados Intensivos, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Daniela Eisen
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carla Araya
- Unidad de Cuidados Intensivos, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Jorge Montoya
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Alejandra Gonzalez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maximiliano Rovegno
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Ramirez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Aguilera
- Departamento de Paciente Crítico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michel Slama
- Medical Intensive Care Unit, CHU Sud Amiens, Amiens, France
| | - Jan Bakker
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile,Department of intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, Netherlands,Department of Pulmonary and Critical Care, New York University, NYU Langone Health, New York, USA,Department of Pulmonary and Critical Care, Columbia University Medical Center, New York, USA
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28
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Zuin M, Rigatelli G, Bilato C, Quadretti L, Roncon L, Zuliani G. COVID-19 patients with acute pulmonary embolism have a higher mortality risk: systematic review and meta-analysis based on Italian cohorts. J Cardiovasc Med (Hagerstown) 2022; 23:773-778. [PMID: 36166326 PMCID: PMC9671546 DOI: 10.2459/jcm.0000000000001354] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 06/03/2022] [Accepted: 07/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acute pulmonary embolism has been recognized as a frequent complication of COVID-19 infection influencing the clinical course and outcomes of these patients. OBJECTIVES We performed a systematic review and meta-analysis to evaluate the mortality risk in COVID-19 Italian patients complicated by acute pulmonary embolism in the short-term period. METHODS The study was performed in accordance with the Preferred Report Items for Systematic Reviews and Meta-analyses guidelines. PubMed-MEDLINE and Scopus databases were systematically searched for articles, published in the English language and enrolling Italian cohorts with confirmed COVID-19 infection from inception through 20 October 2021. Mortality risk data were pooled using the Mantel-Haenszel random effects models with odds ratio as the effect measure with 95% confidence interval. Heterogeneity among studies was assessed using Higgins and Thomson I2 statistic. RESULTS Eight investigations enrolling 1.681 patients (mean age 64.9 years, 1125 males) met the inclusion criteria and were considered for the analysis. A random-effect model showed that acute pulmonary embolism was present in 19.0% of Italian patients with COVID-19 infection. Moreover, these patients were at higher mortality risk compared with those without (odds ratio: 1.76, 95% confidence interval: 1.26-2.47, P = 0.001, I2 = 0%). Sensitivity analysis confirmed yielded results. CONCLUSION In Italian patients with COVID-19 infection, acute pulmonary embolism was present in about one out of five and significantly associated with a higher mortality risk in the short-term period. The identification of acute pulmonary embolism in these patients remains critical to promptly identify vulnerable populations who would require prioritization in treatment and prevention and close monitoring.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano
| | | | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Rovigo
| | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara
- Department of Medicine, Porto Viro General Hospital, Rovigo, Italy
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29
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Fu Z, Bai G, Song B, Wang Y, Song H, Ma M, Zhu J, Zhang Z, Kang Q. Risk factors and mortality of pulmonary embolism in COVID-19 patients: Evidence based on fifty observational studies. Medicine (Baltimore) 2022; 101:e29895. [PMID: 36397410 PMCID: PMC9665895 DOI: 10.1097/md.0000000000029895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND At present, many studies have described acute pulmonary embolism (PE) as a frequent and prognostically relevant complication of coronavirus disease 2019 (COVID-19) infection. Thus we performed the present analysis of 50 studies to evaluate the risk factors and mortality of PE in COVID-19 patients. METHOD Databases including PubMed, Embase, Cochrane Library and Web of Science were searched to October, 2021. Odds ratio (OR), mean difference (MD) or standard MD was used to evaluate the outcomes. The primary outcomes were the difference of mortality between PE and non-PE COVID-19 patients as well as relevant risk factors of PE in COVID-19 patients. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. RESULT A total of 50 studies including 10053 patients were included in this meta-analysis. Our results indicated that COVID-19 patients with PE experienced significantly higher mortality than non-PE patients (21.9% vs. 10.7%), with a pooled OR of 2.21 (95% CI 1.30 - 3.76; P = .003). In addition, COVID-19 patients with PE also experienced more mechanical ventilation (MV) (OR 2.21; 95% CI 1.30 - 3.75; P = .003) and invasive mechanical ventilation (IMV) (OR 3.58; 95% CI 2.47 - 5.20; P < .0001) respectively. Univariate analysis (UVA) results indicated the Sequential Organ Failure Assessment (SOFA) score, time to deep venous thrombosis (DVT), nonintensive care unit (non-ICU) patients and no anticoagulation as risk factors of PE for COVID-19 patients. In addition, multivariate analysis also found that SOFA score, D-dimer, BMI > 30 kg/m2 and history of PE were risk factors of PE for COVID-19 patients. CONCLUSION The present analysis indicated that PE increased the mortality of COVID-19 patients. Mechanical ventilation, especially invasive mechanical ventilation, is correlated with an increased incidence of PE in patients with COVID-19. The incidence of PE for COVID-19 patients may be multifactorial and further researches focused on risk factors were needed in the future.
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Affiliation(s)
- Zhaoliang Fu
- Department of lnterventional, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Gengshen Bai
- Department of General Surgery, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Bingsheng Song
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Yongbing Wang
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Hui Song
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Ming Ma
- Department of lnterventional, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Junqiang Zhu
- Department of Radiology, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Zejun Zhang
- Department of Radiology, The Second People’s Hospital of Baiyin City, Baiyin, China
| | - Qinghong Kang
- Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, Baiyin, China
- *Correspondence: Qinghong Kang, Department of Respiratory Disease, The Second People’s Hospital of Baiyin City, No. 509, Park Road, Baiyin District, Baiyin City 730900, China (e-mail: )
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30
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de Cossio S, Paredes-Ruiz D, Gómez-Cuervo C, González-Olmedo J, Lalueza A, Revilla Y, Lumbreras C, Díaz-Pedroche C. Clinical Differences and Outcomes of COVID-19 Associated Pulmonary Thromboembolism in Comparison with Non-COVID-19 Pulmonary Thromboembolism. J Clin Med 2022; 11:jcm11206011. [PMID: 36294331 PMCID: PMC9605135 DOI: 10.3390/jcm11206011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been reported to increase the risk of pulmonary thromboembolism (PTE). The aim of this study is to elucidate whether Coronavirus disease COVID-19-associated PTE has a different clinical expression than non-COVID-19 PTE due to a different pathophysiology. (2) Methods: retrospective study of PTE episodes conducted at our hospital between January 2019 and December 2020, comparing the group of COVID-19-associated PTE patients with a control group of non-COVID-19 PTE patients. (3) Results: A total of 229 patients with PTE were registered, 79 of whom had COVID-19. Cancer (15.2% vs. 39.3%; p < 0.001), previous surgery (0% vs. 8%; p = 0.01), previous VTE (2.5% vs. 15.3%; p = 0.003), signs and/or symptoms of deep venous thrombosis (DVT) (7.6% vs. 22.7%; p = 0.004) and syncope (1.3% vs. 8.1%; p = 0.035) were less frequent in the COVID-19 group. Central thrombosis was more frequent in the control group (35.3% vs. 13.9%; p = 0.001). No VTE recurrent episodes were observed in the COVID-19 group, whereas four (2.7%) episodes were recorded for the control group. One-month bleeding rate was higher in the COVID-19 group (10.1% vs. 1.3%; p = 0.004). (4) Conclusion: COVID-19-associated PTE has clinical characteristics that differ from those of PTE without COVID-19, including inferior severity and a lower rate of VTE recurrence. Physicians should be aware of the high risk of bleeding in the first month of COVID-19-associated PTE.
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Affiliation(s)
- Santiago de Cossio
- Department of Internal Medicine, 12 de Octubre University Hospital, 28041 Madrid, Spain
- Correspondence:
| | - Diana Paredes-Ruiz
- Department of Internal Medicine, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | | | - Jesús González-Olmedo
- Department of Internal Medicine, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Antonio Lalueza
- Department of Internal Medicine, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Yolanda Revilla
- Radiology Department, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carlos Lumbreras
- Department of Internal Medicine, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carmen Díaz-Pedroche
- Department of Internal Medicine, 12 de Octubre University Hospital, 28041 Madrid, Spain
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31
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Brem FL, Tayef TAA, Rasras H, Mahi OE, Ouafi NE, Zakaria B. Concomitant renal and splenic infarctions in a COVID-19-patient with a catastrophic thrombotic syndrome. Radiol Case Rep 2022; 17:4030-4033. [PMID: 35999857 PMCID: PMC9389916 DOI: 10.1016/j.radcr.2022.06.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Since the outbreak of the COVID-19 pandemic, thrombotic events have been accurately described in patients infected by the SARS-CoV-2, especially venous thromboembolism. However, the mystery of arterial thrombosis is still unclear. Here, we report the case of a 59-year-old man with diabetes mellitus, admitted for COVID-19-pneumonia complicated by pulmonary embolism, a thrombus in the aortic isthmus, the descending thoracic aorta associated with splenic and left renal infarctions, and an acute right limb ischemia. The etiological assessment of this catastrophic thrombotic syndrome showed no evidence for preexisting inherited or acquired thrombophilia. Our case emphasizes the hypercoagulability state in COVID-19-patient leading to both arterial and venous thromboembolisms and the need to establish adequate strategies for the diagnosis and management of thrombo-embolisms to prevent these potentially fatal complications.
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Affiliation(s)
- Falmata Laouan Brem
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Corresponding author.
| | - Taha Abu Al Tayef
- Department of Vascular surgery, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Hammam Rasras
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Omar El Mahi
- Department of Vascular surgery, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Bazid Zakaria
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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32
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Alessandro B, Wilma B, Bruno F. Pulmonary embolism in a patient with eltrombopag-treated aplastic anaemia and paroxysmal nocturnal haemoglobinuria clone during COVID-19 pneumonia. Thromb J 2022; 20:46. [PMID: 35999631 PMCID: PMC9398496 DOI: 10.1186/s12959-022-00407-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/26/2022] [Indexed: 12/22/2022] Open
Abstract
Thrombosis in patients with thrombocytopenia has several risk factors, both disease-related and treatment-associated. Recently, COVID-19 infection was recognized as an additional risk factor, further complicating the delicate balance between thrombosis and bleeding in these patients. Here we describe the case of a patient with aplastic anaemia on eltrombopag who developed pulmonary embolism during COVID-19 pneumonia, despite receiving oral anticoagulation with edoxaban. Notably, he was also carrying a large paroxysmal nocturnal haemoglobinuria clone, although without evidence of haemolysis. The presented case recapitulates some of the open questions in thrombotic risk management of cytopenic patients, such as the management of thrombopoietin receptor agonists and the choice of anticoagulation in PNH, while also accounting for the additional thrombotic risk linked to COVID-19.
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Affiliation(s)
- Bosi Alessandro
- Haematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100, Milan, Italy.,Department of Oncology and Haemato-oncology, University of Milan, Milan, Italy
| | - Barcellini Wilma
- Haematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100, Milan, Italy
| | - Fattizzo Bruno
- Haematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100, Milan, Italy. .,Department of Oncology and Haemato-oncology, University of Milan, Milan, Italy.
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33
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Pilia E, Belletti A, Fresilli S, Finco G, Landoni G. Efficacy and safety of heparin full-dose anticoagulation in hospitalized non-critically ill COVID-19 patients: a meta-analysis of multicenter randomized controlled trials. J Thromb Thrombolysis 2022; 54:420-430. [PMID: 35922578 PMCID: PMC9362611 DOI: 10.1007/s11239-022-02681-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 12/24/2022]
Abstract
Arterial and venous thrombotic events in COVID-19 cause significant morbidity and mortality among patients. Although international guidelines agree on the need for anticoagulation, it is unclear whether full-dose heparin anticoagulation confers additional benefits over prophylactic-dose anticoagulation. This systematic review and meta-analysis aimed to investigate the efficacy and safety of heparin full-dose anticoagulation in hospitalized non-critically ill COVID-19 patients. We searched Pubmed/Medline, EMBASE, Clinicaltrials.gov, medRxiv.org and Cochrane Central Register of clinical trials dated up to April 2022. Randomized controlled trials (RCTs) comparing full-dose heparin anticoagulation to prophylactic-dose anticoagulation or standard treatment in hospitalized non-critically ill COVID-19 patients were included in our pooled analysis. The primary endpoint was the rate of major thrombotic events and the co-primary endpoint was the rate of major bleeding events. We identified 4 studies, all of them multicenter, randomizing 2926 patients. Major thrombotic events were 23/1524 (1.5%) in full-dose heparin anticoagulation versus 57/1402 (4.0%) in prophylactic-dose [relative risk (RR) 0.39; 95% confidence interval (CI) 0.25–0.62; p˂0.01; I2 = 0%]. Clinical relevant bleeding events occurred in 1.7% (26/1524) among patients treated with heparin full anticoagulation dose compared to 1.1% (15/1403) in prophylactic-dose group (RR 1.60; 95% CI 0.85–3.03; p = 0.15; I2 = 20%). Mortality was 6.6% (101/1524) versus 8.6% (121/1402) (RR 0.63; 95% CI 0.33–1.19; p = 0.15). In this meta-analysis of high quality multicenter randomized trials, full-dose anticoagulation with heparin was associated with lower rate of major thrombotic events without differences in bleeding risk and mortality in hospitalized non critically ill COVID-19 patients. Study registration PROSPERO, review no. CRD42022301874.
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Affiliation(s)
- Eros Pilia
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.,Department of Anesthesia, Resuscitation and Pain Therapy, University of Cagliari, Cagliari, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Stefano Fresilli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gabriele Finco
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.,Department of Anesthesia, Resuscitation and Pain Therapy, University of Cagliari, Cagliari, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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34
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Barco S, Voci D, Held U, Sebastian T, Bingisser R, Colucci G, Duerschmied D, Frenk A, Gerber B, Götschi A, Konstantinides SV, Mach F, Robert-Ebadi H, Rosemann T, Simon NR, Spechbach H, Spirk D, Stortecky S, Vaisnora L, Righini M, Kucher N. Enoxaparin for primary thromboprophylaxis in symptomatic outpatients with COVID-19 (OVID): a randomised, open-label, parallel-group, multicentre, phase 3 trial. Lancet Haematol 2022; 9:e585-e593. [PMID: 35779558 PMCID: PMC9243568 DOI: 10.1016/s2352-3026(22)00175-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/26/2022]
Abstract
Background COVID-19 is a viral prothrombotic respiratory infection. Heparins exert antithrombotic and anti-inflammatory effects, and might have antiviral properties. We aimed to investigate whether thromboprophylaxis with enoxaparin would prevent untoward hospitalisation and death in symptomatic, but clinically stable outpatients with COVID-19. Methods OVID was a randomised, open-label, parallel-group, investigator-initiated, phase 3 trial and was done at eight centres in Switzerland and Germany. Outpatients aged 50 years or older with acute COVID-19 were eligible if they presented with respiratory symptoms or body temperature higher than 37·5°C. Eligible participants underwent block-stratified randomisation (by age group 50–70 vs >70 years and by study centre) in a 1:1 ratio to receive either subcutaneous enoxaparin 40 mg once daily for 14 days versus standard of care (no thromboprophylaxis). The primary outcome was a composite of any untoward hospitalisation and all-cause death within 30 days of randomisation. Analysis of the efficacy outcomes was done in the intention-to-treat population. The primary safety outcome was major bleeding. The study was registered in ClinicalTrials.gov (NCT04400799) and has been completed. Findings At the predefined formal interim analysis for efficacy (50% of total study population), the independent Data Safety Monitoring Board recommended early termination of the trial on the basis of predefined statistical criteria having considered the very low probability of showing superiority of thromboprophylaxis with enoxaparin for the primary outcome under the initial study design assumptions. Between Aug 15, 2020, and Jan 14, 2022, from 3319 participants prescreened, 472 were included in the intention-to-treat population and randomly assigned to receive enoxaparin (n=234) or standard of care (n=238). The median age was 57 years (IQR 53–62) and 217 (46%) were women. The 30-day risk of the primary outcome was similar in participants allocated to receive enoxaparin and in controls (8 [3%] of 234 vs 8 [3%] of 238; adjusted relative risk 0·98; 95% CI 0·37–2·56; p=0·96). All hospitalisations were related to COVID-19. No deaths were reported during the study. No major bleeding events were recorded. Eight serious adverse events were recorded in the enoxaparin group versus nine in the control group. Interpretation These findings suggest thromboprophylaxis with enoxaparin does not reduce early hospitalisations and deaths among outpatients with symptomatic COVID-19. Futility of the treatment under the initial study design assumptions could not be conclusively assessed owing to under-representation of older patients and consequent low event rates. Funding SNSF (National Research Programme COVID-19 NRP78: 198352), University Hospital Zurich, University of Zurich, Dr-Ing Georg Pollert (Berlin), Johanna Dürmüller-Bol Foundation.
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Affiliation(s)
- Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Tim Sebastian
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Giuseppe Colucci
- Service of Hematology, Clinica Luganese Moncucco, Lugano, Switzerland; Department of Hematology, University of Basel, Basel, Switzerland; Clinica Sant'Anna, Sorengo, Switzerland
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg-Mannheim, Mannheim, Germany; Department of Cardiology and Angiology I, Heart CenterFreiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - André Frenk
- Department of Cardiology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Bernhard Gerber
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; University of Zurich, Zurich, Switzerland
| | - Andrea Götschi
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Komotini, Greece
| | - François Mach
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Switzerland
| | | | - Noemi R Simon
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Hervé Spechbach
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Spirk
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Lukas Vaisnora
- Department of Cardiology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Marc Righini
- Division of Angiology and Hemostasis, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Switzerland
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
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35
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COVID-19 and Pulmonary Tuberculosis Coinfection in a Moroccan Patient with Pulmonary Embolism: A Case Report and Literature Review. Case Rep Infect Dis 2022; 2022:1522876. [PMID: 35941998 PMCID: PMC9356796 DOI: 10.1155/2022/1522876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Emerging cases of coinfection of coronavirus disease 2019 (COVID-19) and tuberculosis (TB), although rare, have attracted the attention of health systems around the world and have arisen many concerns about the diagnosis, treatment, and prognosis of this coinfection especially in high TB burden countries. Here, we report a rare case and, to the best of our knowledge, the first reported case in Morocco of simultaneous diagnosis of an active pulmonary TB infection and a COVID-19 pneumonia. We present a case of a sixty-seven-year-old male patient who was admitted to our COVID-19 emergency department with a diagnosis of COVID-19 pneumonia, confirmed by nasopharyngeal swab's polymerase chain reaction (PCR) for detection of SARS-CoV-2. The atypical radiological findings suggested a TB coinfection which was later confirmed by sputum cultures and Xpert MTB/Rif assay. The patient also presented some complications including thrombosis of the left leg, pulmonary embolism and inaugural ketosis. Treatment was administered as per local protocols: broad spectrum antibiotics, corticosteroids, fixed dose-combination of antituberculosis treatment along with hydration and insulin therapy for ketosis treatment and anticoagulation. The patient was discharged after twenty-three days of hospitalization. Due to the currently limited data, further studies are necessary to establish any possible correlation between COVID-19 infection and the progression of a latent and/or the severity of an active TB infection.
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36
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Fixed-Dose Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Pulmonary Embolism Associated with COVID-19. Viruses 2022; 14:v14081606. [PMID: 35893672 PMCID: PMC9394471 DOI: 10.3390/v14081606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/20/2022] [Indexed: 12/07/2022] Open
Abstract
Background. Fixed-dose ultrasound-assisted catheter-directed thrombolysis (USAT) rapidly improves hemodynamic parameters and reverses right ventricular dysfunction caused by acute pulmonary embolism (PE). The effectiveness of USAT for acute PE associated with coronavirus disease 2019 (COVID-19) is unknown. Methods and results. The study population of this cohort study consisted of 36 patients with an intermediate-high- or high-risk acute PE treated with a fixed low-dose USAT protocol (r-tPA 10–20 mg/15 h). Of these, 9 patients tested positive for COVID-19 and were age–sex-matched to 27 patients without COVID-19. The USAT protocol included, beyond the infusion of recombinant tissue plasminogen activator, anti-Xa-activity-adjusted unfractionated heparin therapy (target 0.3–0.7 U/mL). The study outcomes were the invasively measured mean pulmonary arterial pressure (mPAP) before and at completion of USAT, and the National Early Warning Score (NEWS), according to which more points indicate more severe hemodynamic impairment. Twenty-four (66.7%) patients were men; the mean age was 67 ± 14 years. Mean ± standard deviation mPAP decreased from 32.3 ± 8.3 to 22.4 ± 7.0 mmHg among COVID-19 patients and from 35.4 ± 9.7 to 24.6 ± 7.0 mmHg among unexposed, with no difference in the relative improvement between groups (p = 0.84). Within 12 h of USAT start, the median NEWS decreased from six (Q1–Q3: 4–8) to three (Q1–Q3: 2–4) points among COVID-19 patients and from four (Q1–Q3: 2–6) to two (Q1–Q3: 2–3) points among unexposed (p = 0.29). One COVID-19 patient died due to COVID-19-related complications 14 days after acute PE. No major bleeding events occurred. Conclusions. Among patients with COVID-19-associated acute PE, mPAP rapidly decreased during USAT with a concomitant progressive improvement of the NEWS. The magnitude of mPAP reduction was similar in patients with and without COVID-19.
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37
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Harpaz R, DuMouchel W, Van Manen R, Nip A, Bright S, Szarfman A, Tonning J, Lerch M. Signaling COVID-19 Vaccine Adverse Events. Drug Saf 2022; 45:765-780. [PMID: 35737293 PMCID: PMC9219360 DOI: 10.1007/s40264-022-01186-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Statistical signal detection is a crucial tool for rapidly identifying potential risks associated with pharmaceutical products. The unprecedented environment created by the coronavirus disease 2019 (COVID-19) pandemic for vaccine surveillance predisposes commonly applied signal detection methodologies to a statistical issue called the masking effect, in which signals for a vaccine of interest are hidden by the presence of other reported vaccines. This masking effect may in turn limit or delay our understanding of the risks associated with new and established vaccines. OBJECTIVE The aim is to investigate the problem of masking in the context of COVID-19 vaccine signal detection, assessing its impact, extent, and root causes. METHODS Based on data underlying the Vaccine Adverse Event Reporting System, three commonly applied statistical signal detection methodologies, and a more advanced regression-based methodology, we investigate the temporal evolution of signals corresponding to five largely recognized adverse events and two potentially new adverse events. RESULTS The results demonstrate that signals of adverse events related to COVID-19 vaccines may be undetected or delayed due to masking when generated by methodologies currently utilized by pharmacovigilance organizations, and that a class of advanced methodologies can partially alleviate the problem. The results indicate that while masking is rare relative to all possible statistical associations, it is much more likely to occur in COVID-19 vaccine signaling, and that its extent, direction, impact, and roots are not static, but rather changing in accordance with the changing nature of data. CONCLUSIONS Masking is an addressable problem that merits careful consideration, especially in situations such as COVID-19 vaccine safety surveillance and other emergency use authorization products.
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Affiliation(s)
- Rave Harpaz
- Oracle Health Sciences, Burlington, MA, USA.
| | | | | | | | | | | | - Joseph Tonning
- U.S. Public Health Service/U.S. FDA retired, Silver Spring, MD, USA
| | - Magnus Lerch
- Oracle Health Sciences, Burlington, MA, USA
- Lenolution GmbH, Berlin, Germany
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Watson O, Pillai S, Howard M, Cezar-Zaldua J, Whitley J, Burgess B, Lawrence M, Hawkins K, Morris K, Evans PA. Impaired fibrinolysis in severe Covid-19 infection is detectable in early stages of the disease. Clin Hemorheol Microcirc 2022; 82:183-191. [PMID: 35694917 DOI: 10.3233/ch-221491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A significant degree of mortality and morbidity in Covid-19 is due to thromboembolic disease. Coagulopathy has been well described in critically unwell patients on ICU. There is less clear evidence regarding these changes at the time of presentation to the Emergency Department and the progression of disease over time. OBJECTIVE We sought to investigate whether coagulation markers can predict severity and how they change over the disease course. METHODS Patients presenting to a single University Teaching Hospital were recruited and followed up if PCR was positive. Alongside routine blood testing, Rotational Thromboelastometry (ROTEM) was performed. Outcome data was recorded for all patients, and ROTEM values were compared across outcome groups. RESULTS Extem and Intem Maximum Lysis were significantly reduced in those who died or required an ICU admission, indicating a reduced ability to break down clot mass in the most critically unwell patients. CONCLUSION Comparisons between groups demonstrated that one distinguishing feature between those who require ICU admission or die of Covid-19 compared with those who survive a hospital stay to discharge was the extent to which fibrinolysis could occur. Mortality and morbidity in Covid-19 infection appears in part driven by an inability to break down clot mass.
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Affiliation(s)
- O Watson
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board.,Swansea University, UK
| | - S Pillai
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board.,Swansea University, UK
| | - M Howard
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board.,Swansea University, UK
| | - J Cezar-Zaldua
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board.,Swansea University, UK
| | - J Whitley
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board.,Swansea University, UK
| | - B Burgess
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board
| | - M Lawrence
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board
| | | | - K Morris
- Cardiff Metropolitan University, UK
| | - P A Evans
- Welsh Centre for Emergency Medicine Research, Swansea Bay University Health Board.,Swansea University, UK
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Satta S, Shahabipour F, Gao W, Lentz SR, Perlman S, Ashammakhi N, Hsiai T. Engineering viral genomics and nano-liposomes in microfluidic platforms for patient-specific analysis of SARS-CoV-2 variants. Theranostics 2022; 12:4779-4790. [PMID: 35832078 PMCID: PMC9254234 DOI: 10.7150/thno.72339] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/21/2022] [Indexed: 11/15/2022] Open
Abstract
New variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are continuing to spread globally, contributing to the persistence of the COVID-19 pandemic. Increasing resources have been focused on developing vaccines and therapeutics that target the Spike glycoprotein of SARS-CoV-2. Recent advances in microfluidics have the potential to recapitulate viral infection in the organ-specific platforms, known as organ-on-a-chip (OoC), in which binding of SARS-CoV-2 Spike protein to the angiotensin-converting enzyme 2 (ACE2) of the host cells occurs. As the COVID-19 pandemic lingers, there remains an unmet need to screen emerging mutations, to predict viral transmissibility and pathogenicity, and to assess the strength of neutralizing antibodies following vaccination or reinfection. Conventional detection of SARS-CoV-2 variants relies on two-dimensional (2-D) cell culture methods, whereas simulating the micro-environment requires three-dimensional (3-D) systems. To this end, analyzing SARS-CoV-2-mediated pathogenicity via microfluidic platforms minimizes the experimental cost, duration, and optimization needed for animal studies, and obviates the ethical concerns associated with the use of primates. In this context, this review highlights the state-of-the-art strategy to engineer the nano-liposomes that can be conjugated with SARS-CoV-2 Spike mutations or genomic sequences in the microfluidic platforms; thereby, allowing for screening the rising SARS-CoV-2 variants and predicting COVID-19-associated coagulation. Furthermore, introducing viral genomics to the patient-specific blood accelerates the discovery of therapeutic targets in the face of evolving viral variants, including B1.1.7 (Alpha), B.1.351 (Beta), B.1.617.2 (Delta), c.37 (Lambda), and B.1.1.529 (Omicron). Thus, engineering nano-liposomes to encapsulate SARS-CoV-2 viral genomic sequences enables rapid detection of SARS-CoV-2 variants in the long COVID-19 era.
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Affiliation(s)
- Sandro Satta
- Department of Bioengineering, School of Engineering, University of California, Los Angeles, California, USA
- Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, California, USA
| | - Fahimeh Shahabipour
- Skin Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Wei Gao
- Medical Engineering, California Institute of Technology, California, Pasadena, USA
| | - Steven R. Lentz
- Section of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Medicine, College of Medicine, University of Iowa, Iowa, USA
| | - Stanley Perlman
- Department of Microbiology and Immunology, College of Medicine, University of Iowa, USA
| | - Nureddin Ashammakhi
- Department of Bioengineering, Henry Samueli School of Engineering & Applied Science, University of California, CA, USA
- Institute for Quantitative Health Science & Engineering and Department of Biomedical Engineering, College of Engineering, Michigan State University, MI, USA
| | - Tzung Hsiai
- Department of Bioengineering, School of Engineering, University of California, Los Angeles, California, USA
- Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, California, USA
- Division of Cardiology, Department of Medicine, School of Medicine, University of California, Los Angeles, California, USA
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Sofia R, Carbone M, Landoni G, Zangrillo A, Dagna L. Anticoagulation as secondary prevention of massive lung thromboses in hospitalized patients with COVID-19. Eur J Intern Med 2022; 100:21-24. [PMID: 35487806 PMCID: PMC9005384 DOI: 10.1016/j.ejim.2022.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Rosaria Sofia
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mattias Carbone
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
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Noll J, Reichert M, Dietrich M, Riedel JG, Hecker M, Padberg W, Weigand MA, Hecker A. When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA. Langenbecks Arch Surg 2022; 407:1315-1332. [PMID: 35307746 PMCID: PMC8934603 DOI: 10.1007/s00423-022-02495-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
Since the eruption of the worldwide SARS-CoV-2 pandemic in late 2019/early 2020, multiple elective surgical interventions were postponed. Through pandemic measures, elective operation capacities were reduced in favour of intensive care treatment for critically ill SARS-CoV-2 patients. Although intermittent low-incidence infection rates allowed an increase in elective surgery, surgeons have to include long-term pulmonary and extrapulmonary complications of SARS-CoV-2 infections (especially "Long Covid") in their perioperative management considerations and risk assessment procedures. This review summarizes recent consensus statements and recommendations regarding the timepoint for surgical intervention after SARS-CoV-2 infection released by respective German societies and professional representatives including DGC/BDC (Germany Society of Surgery/Professional Association of German Surgeons e.V.) and DGAI/BDA (Germany Society of Anesthesiology and Intensive Care Medicine/Professional Association of German Anesthesiologists e.V.) within the scope of the recent literature. The current literature reveals that patients with pre- and perioperative SARS-CoV-2 infection have a dramatically deteriorated postoperative outcome. Thereby, perioperative mortality is mainly caused by pulmonary and thromboembolic complications. Notably, perioperative mortality decreases to normal values over time depending on the duration of SARS-CoV-2 infection.
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Affiliation(s)
- J Noll
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Reichert
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Dietrich
- Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - J G Riedel
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M Hecker
- Medical Clinic II, University Hospital of Giessen, Giessen, Germany
| | - W Padberg
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany
| | - M A Weigand
- Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - A Hecker
- Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany.
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Muñoz OM, Ruiz-Talero P, Hernández-Florez C, Lombo-Moreno CE, Casallas-Rivera MA, Mayorga-Hernández CA. Validation of the PESI Scale to Predict in-Hospital Mortality in Patients with Pulmonary Thromboembolism Secondary to SARS CoV - 2 Infection. Clin Appl Thromb Hemost 2022; 28:10760296221102940. [PMID: 35593084 PMCID: PMC9125100 DOI: 10.1177/10760296221102940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate the discriminative ability and the calibration of the Pulmonary Embolism Severity Index (PESI) to predict in-hospital mortality in patients with Pulmonary Embolism (PE) secondary to COVID 19 in two hospitals in Bogotá. METHODS External validation study of a prediction model based on a retrospective cohort of patients with PE secondary to COVID-19 treated at Hospital Universitario San Ignacio and Hospital universitario La Samaritana, between March 2020 and August 2021. Calibration of the scale was evaluated using the Hosmer-Lemeshow test and a calibration belt diagram. Discrimination ability was evaluated using a ROC curve. RESULTS 272 patients were included (median age 61.5 years, male 58.8%). PE was diagnosed in 45.6% of the patients at the time of admission. Of the remaining 54.4%, 95.9% received thromboprophylaxis until the time of diagnosis.17.6% of the patients died. Regarding calibration, the scale systematically underestimates risk in all classes of PESI. For class I, the ratio of observed/expected events was 4.4 vs 0.8%, class II 4.8 vs 1.8%, class III 15.2 vs 4.2%, class IV 14.3 vs 5.9% and class V 46.7 vs 5.8%. The calibration test rejected the adequate calibration hypothesis (p < 0.001). The discriminatory ability was adequate (AUC = 0.7128, 95% CI 0.63-0.79). CONCLUSIONS The PESI scale in patients with PE secondary to COVID 19 underestimates the risk of in-hospital mortality, while maintaining adequate discrimination. It is suggested not to use the PESI scale until it is recalibrated in this context.
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Affiliation(s)
- Oscar M Muñoz
- Internal Medicine Department, Pontificia Universidad Javeriana, Bogota, Colombia,Hospital Universitario San Ignacio, Bogota, Colombia
| | - Paula Ruiz-Talero
- Internal Medicine Department, Pontificia Universidad Javeriana, Bogota, Colombia,Hospital Universitario San Ignacio, Bogota, Colombia
| | - Catalina Hernández-Florez
- Internal Medicine Department, Pontificia Universidad Javeriana, Bogota, Colombia,Hospital Universitario San Ignacio, Bogota, Colombia
| | - Carlos Ernesto Lombo-Moreno
- Internal Medicine Department, Pontificia Universidad Javeriana, Bogota, Colombia,Carlos Ernesto Lombo-Moreno, Internal Medicine, Pontificia Universidad Javeriana, Cra 7 # 40-62. Piso 7, Bogotá, Colombia.
| | - Martha Alejandra Casallas-Rivera
- RICAVTA investigation group, Bogota, Colombia,Internal Medicine Department, Hospital Universitario La Samaritana, Bogota, Colombia,Universidad de La Sabana, Chia, Colombia
| | - Carol Anne Mayorga-Hernández
- Internal Medicine Department, Hospital Universitario La Samaritana, Bogota, Colombia,Universidad de La Sabana, Chia, Colombia
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Zuin M, Engelen MM, Bilato C, Vanassche T, Rigatelli G, Verhamme P, Vandenbriele C, Zuliani G, Roncon L. Prevalence of Acute Pulmonary Embolism at Autopsy in Patients With COVID-19. Am J Cardiol 2022; 171:159-164. [PMID: 35277253 PMCID: PMC8902912 DOI: 10.1016/j.amjcard.2022.01.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 12/25/2022]
Abstract
To date, the actual prevalence of acute pulmonary embolism (PE) in patients with SARS-CoV-2 infection remains unknown, as systematic screening for PE is cumbersome. We performed a systematic review and meta-analysis on autoptic data to estimate the prevalence of histopathologic findings of acute PE and its relevance as a cause of death on patients with COVID-19. We searched MEDLINE-PubMed and Scopus to locate all articles published in the English language, up to August 10, 2021, reporting the autoptic prevalence of acute PE and evaluating PE as the underlying cause of death in patients with COVID-19. The pooled prevalence for both outcomes was calculated using a random-effects model and presenting the related 95% confidence interval (CI). Statistical heterogeneity was measured using the Higgins I2 statistic. We analyzed autoptic data of 749 patients with COVID-19 (mean age 63.4 years) included in 14 studies. In 10 studies, based on 526 subjects (mean age 63.8 years), a random-effect model revealed that autoptic acute PE findings were present in 27.5% of cases (95% CI 15.0 to 45.0%, I2 89.9%). Conversely, in 429 COVID-19 subjects (mean age 64.0 years) enrolled in 9 studies, acute PE was the underlying cause of death in 19.9% of cases (95% CI 11.0 to 33.3%, I2 83.3%). Autoptic findings of acute PE in patients with COVID-19 are present in about 30% of subjects, whereas a venous thromboembolic event represents the underlying cause of death in about 1 of 4 patients.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, Ferrara, Italy.
| | - Matthias M Engelen
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Thomas Vanassche
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Peter Verhamme
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | | | - Giovanni Zuliani
- Department of Translational Medicine, Section of Internal and Cardio-Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
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Holmqvist J, Beck‐Friis J, Jensen C, Dalla K, Mårdstam S, Christensen J, Nordén N, Widing H, Rosén‐Wetterholm E, Cavefors O, Yilmaz A, Cronhjort M, Redfors B, Oras J. Cardiac dysfunction and mortality in critically ill patients with COVID-19: A Swedish multicentre observational study. Acta Anaesthesiol Scand 2022; 66:606-614. [PMID: 35122232 PMCID: PMC9111275 DOI: 10.1111/aas.14039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/03/2022] [Accepted: 01/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence and importance of cardiac dysfunction in critically ill patients with COVID-19 in Sweden is not yet established. The aim of the study was to assess the prevalence of cardiac dysfunction and elevated pulmonary artery pressure (PAP), and its influence on mortality in patients with COVID-19 in intensive care in Sweden. METHODS This was a multicentre observational study performed in five intensive care units (ICUs) in Sweden. Patients admitted to participating ICU with COVID-19 were examined with echocardiography within 72 h from admission and again after 4 to 7 days. Cardiac dysfunction was defined as left ventricular (LV) dysfunction (ejection fraction <50% and/or regional hypokinesia) or right ventricular (RV) dysfunction (defined as TAPSE <17 mm or visually assessed moderate/severe RV dysfunction). RESULTS We included 132 patients, of whom 127 (96%) were intubated. Cardiac dysfunction was found in 42 (32%) patients. Most patients had cardiac dysfunction at the first assessment (n = 35) while a few developed cardiac dysfunction later (n = 7) and some changed type of dysfunction (n = 3). LV dysfunction was found in 21 and RV dysfunction in 19 patients, while 5 patients had combined dysfunction. Elevated PAP was found in 34 patients (26%) and was more common in patients with RV dysfunction. RV dysfunction and elevated PAP were independently associated with an increased risk of death (OR 3.98, p = .013 and OR 3.88, p = .007, respectively). CONCLUSIONS Cardiac dysfunction occurs commonly in critically ill patients with COVID-19 in Sweden. RV dysfunction and elevated PAP are associated with an increased risk of death.
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Affiliation(s)
- Jacob Holmqvist
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Sahlgrenska Gothenburg Sweden
| | - Josefine Beck‐Friis
- Department of Infectious Diseases Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Infectious Diseases Sahlgrenska University Hospital Gothenburg Sweden
| | - Carl Jensen
- Department of Anesthesiology and Intensive Care Medicine NU Hospital Group Trollhättan Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Mölndal Gothenburg Sweden
| | - Simon Mårdstam
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Jens Christensen
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Nina Nordén
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Mölndal Gothenburg Sweden
| | - Hannes Widing
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Östra Gothenburg Sweden
| | - Elin Rosén‐Wetterholm
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Oscar Cavefors
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Sahlgrenska Gothenburg Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Infectious Diseases Sahlgrenska University Hospital Gothenburg Sweden
| | - Maria Cronhjort
- Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
- Department of Anaesthesia and Intensive Care Södersjukhuset Stockholm Sweden
| | - Björn Redfors
- Department of Cardiology Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Jonatan Oras
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska University Hospital/Sahlgrenska Gothenburg Sweden
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Intensive-Dose Tinzaparin in Hospitalized COVID-19 Patients: The INTERACT Study. Viruses 2022; 14:v14040767. [PMID: 35458497 PMCID: PMC9027745 DOI: 10.3390/v14040767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 01/08/2023] Open
Abstract
(1) Background: It is well-established that coronavirus disease-2019 (COVID-19) is highly pro-inflammatory, leading to activation of the coagulation cascade. COVID-19-induced hypercoagulability is associated with adverse outcomes and mortality. Current guidelines recommend that hospitalized COVID-19 patients should receive pharmacological prophylaxis against venous thromboembolism (VTE). (2) INTERACT is a retrospective, phase IV, observational cohort study aiming to evaluate the overall clinical effectiveness and safety of a higher than conventionally used prophylactic dose of anticoagulation with tinzaparin administered for VTE prevention in non-critically ill COVID-19 patients with moderate disease severity. (3) Results: A total of 705 patients from 13 hospitals in Greece participated in the study (55% men, median age 62 years). Anticoagulation with tinzaparin was initiated immediately after admission. A full therapeutic dose was received by 36.3% of the participants (mean ± SD 166 ± 33 IU/Kgr/day) and the remaining patients (63.9%) received an intermediate dose (mean ± SD 114 ± 22 IU/Kgr/day). The median treatment duration was 13 days (Q1−Q3: 8−20 days). During the study (April 2020 to November 2021), 14 thrombotic events (2.0%) were diagnosed (i.e., three cases of pulmonary embolism (PE) and 11 cases of deep venous thrombosis, DVT). Four bleeding events were recorded (0.6%). In-hospital death occurred in 12 patients (1.7%). Thrombosis was associated with increasing age (median: 74.5 years, Q1−Q3: 62−79, for patients with thrombosis vs. 61.9 years, Q1−Q3: 49−72, p = 0.0149), increased D-dimer levels for all three evaluation time points (at admission: 2490, Q1−Q3: 1580−6480 vs. 700, Q1−Q3: 400−1475, p < 0.0001), one week ± two days after admission (3510, Q1−Q3: 1458−9500 vs. 619, Q1−Q3: 352−1054.5, p < 0.0001), as well as upon discharge (1618.5, Q1−Q3: 1010−2255 vs. 500, Q1−Q3: 294−918, p < 0.0001). Clinical and laboratory improvement was affirmed by decreasing D-dimer and CRP levels, increasing platelet numbers and oxygen saturation measurements, and a drop in the World Health Organization (WHO) progression scale. (4) Conclusions: The findings of our study are in favor of prophylactic anticoagulation with an intermediate to full therapeutic dose of tinzaparin among non-critically ill patients hospitalized with COVID-19.
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Incidence and prognostic value of pulmonary embolism in COVID-19: A systematic review and meta-analysis. PLoS One 2022; 17:e0263580. [PMID: 35286316 PMCID: PMC8920268 DOI: 10.1371/journal.pone.0263580] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background Pulmonary embolisms are frequently and prognostically in individuals infected by coronavirus disease 2019 (COVID-19); the incidence of pulmonary embolisms is varied across numerous studies. This study aimed to assess the pooled incidence of pulmonary embolic events and the prognostic value of such events in intensive care unit (ICU) admissions of patients with COVID-19. Methods The Cochrane Library, PubMed, and EmBase were systematically searched for eligible studies published on or before October 20, 2021. The pooled incidence of pulmonary embolism was calculated using the random-effects model. Moreover, the prognostic value was assessed by measuring the sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Results Thirty-six studies involving 10,367 COVID-19 patients were selected for the final meta-analysis. The cumulative incidence of pulmonary embolism in patients with COVID-19 was 21% (95% confidence interval [95%CI]: 18−24%; P<0.001), and the incidence of pulmonary embolism in ICU and non-ICU patients was 26% (95%CI: 22−31%; P<0.001) and 17% (95%CI: 14−20%; P<0.001), respectively. The predictive role of pulmonary embolism in ICU admission was also assessed, and the sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.31 (95%CI: 0.21−0.42), 0.84 (95%CI: 0.75−0.90), 1.88 (95%CI: 1.45−2.45), 0.83 (95%CI: 0.75−0.91), 2.25 (95%CI: 1.64−3.08), and 0.61 (95%CI: 0.57−0.65), respectively. Conclusion This study found that the incidence of pulmonary embolism was relatively high in COVID-19 patients, and the incidence of pulmonary embolism in ICU patients was higher than that in non-ICU patients.
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Patel S. Letter to the Editor: The Role of D-Dimers in the Initial Evaluation of COVID-19 [Letter]. Ther Clin Risk Manag 2022; 18:511-512. [PMID: 35510217 PMCID: PMC9059871 DOI: 10.2147/tcrm.s369820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Sachin Patel
- Emergency Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
- Correspondence: Sachin Patel, Emergency Department, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK, Email
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Voci D, Fedeli U, Farmakis IT, Hobohm L, Keller K, Valerio L, Schievano E, Barbiellini Amidei C, Konstantinides SV, Kucher N, Barco S. Deaths related to pulmonary embolism and cardiovascular events before and during the 2020 COVID-19 pandemic: An epidemiological analysis of data from an Italian high-risk area. Thromb Res 2022; 212:44-50. [PMID: 35219931 PMCID: PMC8858636 DOI: 10.1016/j.thromres.2022.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pulmonary embolism is a known complication of coronavirus disease 2019 (COVID-19). Epidemiological population data focusing on pulmonary embolism-related mortality is limited. METHODS Veneto is a region in Northern Italy counting 4,879,133 inhabitants in 2020. All ICD-10 codes from death certificates (1st January 2018 to 31st December 2020) were examined. Comparisons were made between 2020 (COVID-19 outbreak) and the average of the two-year period 2018-2019. All-cause, COVID-19-related and the following cardiovascular deaths have been studied: pulmonary embolism, hypertensive disease, ischemic heart disease, atrial fibrillation/flutter, and cerebrovascular diseases. RESULTS In 2020, a total of 56,412 deaths were recorded, corresponding to a 16% (n = 7806) increase compared to the period 2018-2019. The relative percentage increase during the so-called first and second waves was 19% and 44%, respectively. Of 7806 excess deaths, COVID-19 codes were reported in 90% of death certificates. The percentage increase in pulmonary embolism-related deaths was 27% (95%CI 19-35%), 1018 deaths during the year 2020, compared to 804 mean annual deaths in the period 2018-2019. This was more evident among men, who experience an absolute increase of 147 deaths (+45%), than in women (+67 deaths; +14%). The increase was primarily driven by deaths recorded during the second wave (+91% in October-December). An excess of deaths, particularly among men and during the second wave, was also observed for other cardiovascular diseases, notably hypertensive disease, atrial fibrillation, cerebrovascular disease, and ischemic heart disease. CONCLUSIONS We observed a considerable increase of all-cause mortality during the year 2020. This was mainly driven by COVID-19 and its complications. The relative increase in the number of pulmonary embolism-related deaths was more prominent during the second wave, suggesting a possible underdiagnosis during the first wave.
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Affiliation(s)
- Davide Voci
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Ioannis T. Farmakis
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Cardiology I, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karsten Keller
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Cardiology I, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Luca Valerio
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elena Schievano
- Epidemiological Department, Azienda Zero, Veneto Region, Padua, Italy
| | - Claudio Barbiellini Amidei
- Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Stavros V. Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Department of Cardiology, Democritus University of Thrace, Greece
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Zurich, Switzerland,Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany,Corresponding author at: Department of Angiology, University Hospital Zurich, Raemistrasse 100, RAE C 19, 8091 Zurich, Switzerland
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Abstract
Coronavirus disease 2019 (COVID-19) is the third deadly coronavirus infection of the 21st century that has proven to be significantly more lethal than its predecessors, with the number of infected patients and deaths still increasing daily. From December 2019 to July 2021, this virus has infected nearly 200 million people and led to more than 4 million deaths. Our understanding of COVID-19 is constantly progressing, giving better insight into the heterogeneous nature of its acute and long-term effects. Recent literature on the long-term health consequences of COVID-19 discusses the need for a comprehensive understanding of the multisystemic pathophysiology, clinical predictors, and epidemiology to develop and inform an evidence-based, multidisciplinary management approach. A PubMed search was completed using variations on the term post-acute COVID-19. Only peer-reviewed studies in English published by July 17, 2021 were considered for inclusion. All studies discussed in this text are from adult populations unless specified (as with multisystem inflammatory syndrome in children). The preliminary evidence on the pulmonary, cardiovascular, neurological, hematological, multisystem inflammatory, renal, endocrine, gastrointestinal, and integumentary sequelae show that COVID-19 continues after acute infection. Interdisciplinary monitoring with holistic management that considers nutrition, physical therapy, psychological management, meditation, and mindfulness in addition to medication will allow for the early detection of post-acute COVID-19 sequelae symptoms and prevent long-term systemic damage. This review serves as a guideline for effective management based on current evidence, but clinicians should modify recommendations to reflect each patient's unique needs and the most up-to-date evidence. The presence of long-term effects presents another reason for vaccination against COVID-19.
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Affiliation(s)
- Shreeya Joshee
- University of Nevada-Reno, School of Medicine, Reno, NV, USA
| | - Nikhil Vatti
- Department of Family Medicine, Southern Illinois University School of Medicine, Decatur, IL, USA
| | - Christopher Chang
- Division of Immunology, Allergy and Rheumatology, Memorial Healthcare System, Hollywood, FL, USA; Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, CA, USA.
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Affiliation(s)
- Laura De Michieli
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, Padova 35128, Italy
| | - Allan S Jaffe
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Yader Sandoval
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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