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Dumea E, Lazar M, Chitu-Tisu CE, Barbu EC, Ion DA. COVID-19 associated pulmonary embolism: clinical, biochemical and CT imaging findings. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 62:307-322. [PMID: 38641909 DOI: 10.2478/rjim-2024-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection represented a disruptive pathology that emerged in late 2019 with profound implications ranging from individual health to health systems and world economy. Our study aimed to evaluate clinical, biochemical and computerized tomography (CT) parameters values in determining the severity of pulmonary embolism (PE) associated with COVID-19. METHODS We performed an observational cohort study evaluating demographic, clinical, biochemical, coagulation markers, as well as CT imaging parameters. RESULTS In our study on 186 patients with COVID-19, we found that 31 patients (16,66%) had pulmonary embolism. Significant correlations for the patients with PE were detected in C-reactive protein, lactate dehydrogenase, serum ferritin, IL-6, serum myoglobin, NT-proBNP, D-dimers, serum proteins, transaminases as well as white cell blood counts. Patients with pulmonary embolism had a more severe lung involvement, with thrombi distribution mainly involving the lower lobes. CONCLUSION Early identification of PE is an important step for timely and efficient treatment in the intensive care management of COVID-19 patients. Our study showed that high plasmatic values of lactate dehydrogenase, ferritin, IL-6, white blood cells and D-dimers and low proteins serum levels are strongly linked with COVID-19-associated pulmonary embolism.
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Affiliation(s)
- Eduard Dumea
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
| | - Mihai Lazar
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
- 2"Prof. Dr. Matei Bals" National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, Sector 2, 021105 Bucharest, Romania
| | - Cristina Emilia Chitu-Tisu
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
| | - Ecaterina Constanta Barbu
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
| | - Daniela Adriana Ion
- 1Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania
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2
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Baykara N. Clinical Characteristics, Outcomes, and Risk Factors for Mortality in Pregnant/Puerperal Women with COVID-19 Admitted to ICU in Turkey: A Multicenter, Retrospective Study from a Middle-Income Country. J Intensive Care Med 2024; 39:577-594. [PMID: 38320979 DOI: 10.1177/08850666231222838] [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: 02/08/2024]
Abstract
BACKGROUND Coronaviruses have been the cause of 3 major outbreaks during the last 2 decades. Information on coronavirus diseases in pregnant women is limited, and even less is known about seriously ill pregnant women. Data are also lacking regarding the real burden of coronavirus disease 2019 (COVID-19) infection in pregnant women from low/middle-income countries. The aim of this study was to determine the characteristics and clinical course of COVID-19 in pregnant/puerperal women admitted to ICUs in Turkey. METHODS This was a national, multicenter, retrospective study. The study population comprised all SARS-CoV-2-infected pregnant/puerperal women admitted to participating ICUs between 1 March 2020 and 1 January 2022. Data regarding demographics, comorbidities, illness severity, therapies, extrapulmonary organ injuries, non-COVID-19 infections, and maternal and fetal/neonatal outcomes were recorded. LASSO logistic regression and multiple logistic regression analyses were used to identify predictive variables in terms of ICU mortality. RESULTS A total of 597 patients (341 pregnant women, 255 puerperal women) from 59 ICUs in 44 hospitals were included and of these patients, 87.1% were unvaccinated. The primary reason for ICU admission was acute hypoxemic respiratory failure in 522 (87.4%), acute hypoxemic respiratory failure plus shock in 14 (2.3%), ischemic cerebrovascular accident (CVA) in 5 (0.8%), preeclampsia/eclampsia/HELLP syndrome in 6 (1.0%), and post-caesarean follow-up in 36 (6.0%). Nonsurvivors were sicker than survivors upon ICU admission, with higher APACHE II (p < 0.001) and SOFA scores (p < 0.001). A total of 181 (30.3%) women died and 280 (46.6%) had received invasive mechanical ventilation (IMV). Myocardial injury, the highest SOFA score during ICU stay, LDH levels on admission, the highest levels of AST during ICU stay, average daily dose of corticosteroids, IMV, prophylactic dose anticoagulation (compared with therapeutic dose anticoagulation), PaO2/FiO2 ratio <100, pulmonary embolism, and shock were identified as predictors of mortality. Rates of premature birth (46.4%), cesarean section (53.7%), fetal distress (15.3%), stillbirth (6.5%), and low birth weight (19.4%) were high. Rates of neonatal death (8%) and respiratory distress syndrome (21%) were also high among live-born infants. CONCLUSIONS Severe/critical COVID-19 infection during the pregnancy/puerperal period was associated with high maternal mortality and fetal/neonatal complication rates in Turkey.
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Affiliation(s)
- Nur Baykara
- Department of Anesthesiology, Division of Critical Care, School of Medicine, Kocaeli University, Kocaeli, Turkey
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3
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Franco-Moreno A, Palma-Huerta E, Fernández-Vidal E, Madroñal-Cerezo E, Marco-Martínez J, Romero-Pareja R, Izquierdo-Martínez A, Carpintero-García L, Ruiz-Giardín JM, Torres-Macho J, de Ancos-Aracil CL. External validation of the CHEDDAR score for suspected pulmonary embolism in patients with SARS-CoV-2 infection in an independent cohort. J Thromb Thrombolysis 2024; 57:352-357. [PMID: 38095742 DOI: 10.1007/s11239-023-02918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 03/26/2024]
Abstract
The accuracy of the classic scores that help stratify the pretest clinical probability of pulmonary embolism (PE) in SARS-CoV-2 infection (COVID-19) is low. Therefore, to estimate the risk of PE in these patients, a new set of guidelines must be established. The recently published CHEDDAR score proposes a new diagnostic strategy to reduce the use of computed tomography pulmonary angiography (CTPA) in non-critically ill SARS-COV-2 patients with suspected PE. According to the nomogram, patients are segregated into low-risk (< 182 points) or high-risk (≥ 182 points) based on the best cut-off value to discard PE in the original cohort. We aimed to externally validate this diagnostic strategy in an independent cohort. We analyzed data from two retrospective cohorts of hospitalized non-critically ill COVID-19 patients who underwent a CTPA due to suspicion for PE. CHEDDAR score was applied. As per the CHEDDAR nomogram, patients were classified as having a low or high clinical pre-test probability. Of the 270 patients included, 69 (25.5%) had PE. Applying the CHEDDAR score, 182 (67.4%) patients could have had PE excluded without imaging. Among 58 patients classified as having high clinical pre-test probability, 39 (67.2%) had PE. Sensitivity, specificity, positive and negative predictive values, and AUC were 56%, 90%, 67%, 85%, and 0.783 (95% CI 0.71-0.85), respectively. We provide external validation of the CHEDDAR score in an independent cohort. Even though the CHEDDAR score showed good discrimination capacity, caution is required in patients classified as having low clinical pre-test probability with a D-dimer value > 3000 ng/mL, and a RALE score ≥ 4.
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Affiliation(s)
- Anabel Franco-Moreno
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | - Elena Palma-Huerta
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Gran Via del Este Avenue, 80, 28031, Madrid, Spain
| | - Elisa Fernández-Vidal
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Gran Via del Este Avenue, 80, 28031, Madrid, Spain
| | | | | | | | | | | | - José Manuel Ruiz-Giardín
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
- Internal Medicine Department, Hospital Universitario de Fuenlabrada, CiberInfect, Madrid, Spain
| | - Juan Torres-Macho
- Internal Medicine Department, Hospital Universitario Infanta Leonor-Virgen de la Torre, Gran Via del Este Avenue, 80, 28031, Madrid, Spain
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Dar MS, Kumar S, Samiullah F. Comment on: Impact of COVID-19 Infection on the Clinical Outcomes of Pulmonary Embolism Hospitalizations: A Nationwide Analysis. Curr Probl Cardiol 2024; 49:101944. [PMID: 37422045 DOI: 10.1016/j.cpcardiol.2023.101944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/10/2023]
Affiliation(s)
| | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari Karachi, Karachi, Pakistan
| | - Fnu Samiullah
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari Karachi, Karachi, Pakistan
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5
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Zhu H, Li Y, Su H, Yan C, Xin W, Ying K. What Is the Impact of Baseline Inflammatory and Hemostatic Indicators with the Risk of Mortality in Severe Inpatients with COVID-19: A Retrospective Study. Clin Appl Thromb Hemost 2024; 30:10760296241255959. [PMID: 38831596 DOI: 10.1177/10760296241255959] [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: 06/05/2024] Open
Abstract
The purpose of the study was to investigate baseline inflammatory, hemostatic indicators and new-onset deep vein thrombosis (DVT) with the risk of mortality in COVID-19 inpatients. In this single-center study, a total of 401 COVID-19 patients hospitalized in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were enrolled from December 1, 2022 to January 31, 2023. The basic information, first laboratory examination results, imaging examination, and outcome-related indicators were compared between patients in the moderate and severe subgroups. We found that baseline D-dimer and baseline absolute neutrophil count (ANC) levels were associated with new-onset DVT and death in severe hospitalized patients with COVID-19. The odds ratio (OR) of baseline D-dimer and baseline ANC with mortality was 1.18 (95% confidence interval [CI], 1.08-1.28; P < .001) and 1.13 (95% CI, 1.06-1.21; P < .001). Baseline ANC was associated with the risk of death in severe hospitalized COVID-19 patients, irrespective of the DVT status. In addition, a significantly higher serum neutrophil activity was observed in severe COVID-19 inpatients with DVT or those deceased during hospital stay. New-onset DVT partially mediated the association between baseline D-dimer (indirect effect: 0.011, estimated mediating proportion: 67.0%), baseline ANC (indirect effect: 0.006, estimated mediating proportion: 48.7%), and mortality in severe hospitalized patients with COVID-19. In summary, baseline D-dimer and baseline absolute neutrophil count (ANC) levels were associated with the mortality in severe hospitalized patients with COVID-19, especially DVT inpatients. New-onset DVT partially mediated the association between baseline D-dimer, baseline ANC, and mortality in severe hospitalized patients with COVID-19.
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Affiliation(s)
- Huiqi Zhu
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Yeping Li
- Department of Respiratory and Critical Medicine, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Hua Su
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Chao Yan
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Wanghao Xin
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Kejing Ying
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
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Tateishi K, Hmoud H, De Gregorio L, De Gregorio I, Asselin CY, De Gregorio J. Impact of Cardiac and Cerebrovascular Complications During Hospitalization on Long-Term Prognosis in Patients With COVID-19. Am J Cardiol 2023; 209:114-119. [PMID: 37839464 DOI: 10.1016/j.amjcard.2023.09.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
The impact of cardiac and cerebrovascular events during COVID-19 hospitalization on long-term prognosis remains uncertain. We aimed to evaluate the effect of myocardial infarction (MI), cerebrovascular accident (CVA), and pulmonary embolism (PE) during hospitalization on the long-term prognosis in patients who survived COVID-19 hospitalization. A retrospective observational analysis was performed on a cohort of 2,389 patients who survived COVID-19 hospitalization in our institution between January and June 2020. The patients were divided into MI (n = 111) and non-MI (n = 2,278) groups according to the presence of MI during hospitalization. As a subanalysis, the patients were assigned to CVA (n = 97) and non-CVA (n = 2,292) and PE (n = 54) and non-PE (n = 2,335) groups. The primary outcome was long-term survival after discharge. During a median follow-up period of 2.4 years after discharge, 30 patients (27.0%) in the MI group and 140 patients (6.2%) in the non-MI group died (p <0.001). The Kaplan-Meier survival curve analysis demonstrated that the MI group was significantly associated with an increased incidence of all-cause death after discharge (log-rank p <0.001), as supported by the multivariate Cox proportional hazards model analysis (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.61 to 3.74, p <0.001). However, the presence of CVA (HR 1.46, 95% CI 0.91 to 2.34, p = 0.113) or PE (HR 0.94, 95% CI 0.23 to 3.84, p = 0.937) were not associated with an increased incidence of all-cause death after discharge. In conclusion, among the cardiovascular and cerebrovascular complications associated with COVID-19 hospitalization, the presence of MI during hospitalization was proved to be a significant independent predictor of long-term mortality in patients who survived COVID-19 hospitalization.
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Affiliation(s)
- Kazuya Tateishi
- Department of Cardiovascular Services, Englewood Hospital and Medical Center, Englewood, New Jersey.
| | - Hosam Hmoud
- Department of Cardiology, Lenox Hill Hospital Northwell Health, New York, New York
| | | | | | - Chantal Y Asselin
- Department of Internal Medicine, Morristown Medical Center, Morristown, New Jersey
| | - Joseph De Gregorio
- Department of Cardiovascular Services, Englewood Hospital and Medical Center, Englewood, New Jersey
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7
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Bosek M, Wybranowski T, Napiórkowska-Mastalerz M, Pyskir J, Cyrankiewicz M, Pyskir M, Pilaczyńska-Cemel M, Szołna-Chodór A, Wrembel M, Kruszewski S, Przybylski G. The Impact of COVID-19 on Cellular Factors Influencing Red Blood Cell Aggregation Examined in Dextran: Possible Causes and Consequences. Int J Mol Sci 2023; 24:14952. [PMID: 37834401 PMCID: PMC10573242 DOI: 10.3390/ijms241914952] [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] [Received: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Several studies have indicated that COVID-19 can lead to alterations in blood rheology, including an increase in red blood cell aggregation. The precise mechanisms behind this phenomenon are not yet fully comprehended. The latest findings suggest that erythrocyte aggregation significantly influences microcirculation, causes the formation of blood clots in blood vessels, and even damages the endothelial glycocalyx, leading to endothelial dysfunction. The focus of this research lies in investigating the cellular factors influencing these changes in aggregation and discussing potential causes and implications in the context of COVID-19 pathophysiology. For this purpose, the aggregation of erythrocytes in a group of 52 patients with COVID-19 pneumonia was examined in a 70 kDa Dextran solution, which eliminates the influence of plasma factors. Using image analysis, the velocities and sizes of the formed aggregates were investigated, determining their porosity. This study showed that the process of erythrocyte aggregation in COVID-19 patients, independent of plasma factors, leads to the formation of more compact, denser, three-dimensional aggregates. These aggregates may be less likely to disperse under circulatory shear stress, increasing the risk of thrombotic events. This study also suggests that cellular aggregation factors can be responsible for the thrombotic disorders observed long after infection, even when plasma factors have normalized. The results and subsequent broad discussion presented in this study can contribute to a better understanding of the potential complications associated with increased erythrocyte aggregation.
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Affiliation(s)
- Maciej Bosek
- Department of Biophysics, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.B.)
| | - Tomasz Wybranowski
- Department of Biophysics, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.B.)
| | - Marta Napiórkowska-Mastalerz
- Department of Biophysics, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.B.)
| | - Jerzy Pyskir
- Department of Biophysics, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.B.)
| | - Michał Cyrankiewicz
- Department of Biophysics, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.B.)
| | - Małgorzata Pyskir
- Department of Rehabilitation, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland;
| | - Marta Pilaczyńska-Cemel
- Department of Lung Diseases, Neoplasms and Tuberculosis, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland
| | - Alicja Szołna-Chodór
- Department of Biophysics, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.B.)
| | - Mateusz Wrembel
- Department of Lung Diseases, Neoplasms and Tuberculosis, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland
| | - Stefan Kruszewski
- Department of Biophysics, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.B.)
| | - Grzegorz Przybylski
- Department of Lung Diseases, Neoplasms and Tuberculosis, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland
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Singh SJ, Baldwin MM, Daynes E, Evans RA, Greening NJ, Jenkins RG, Lone NI, McAuley H, Mehta P, Newman J, Novotny P, Smith DJF, Stanel S, Toshner M, Brightling CE. Respiratory sequelae of COVID-19: pulmonary and extrapulmonary origins, and approaches to clinical care and rehabilitation. THE LANCET. RESPIRATORY MEDICINE 2023; 11:709-725. [PMID: 37216955 PMCID: PMC10198676 DOI: 10.1016/s2213-2600(23)00159-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023]
Abstract
Although the exact prevalence of post-COVID-19 condition (also known as long COVID) is unknown, more than a third of patients with COVID-19 develop symptoms that persist for more than 3 months after SARS-CoV-2 infection. These sequelae are highly heterogeneous in nature and adversely affect multiple biological systems, although breathlessness is a frequently cited symptom. Specific pulmonary sequelae, including pulmonary fibrosis and thromboembolic disease, need careful assessment and might require particular investigations and treatments. COVID-19 outcomes in people with pre-existing respiratory conditions vary according to the nature and severity of the respiratory disease and how well it is controlled. Extrapulmonary complications such as reduced exercise tolerance and frailty might contribute to breathlessness in post-COVID-19 condition. Non-pharmacological therapeutic options, including adapted pulmonary rehabilitation programmes and physiotherapy techniques for breathing management, might help to attenuate breathlessness in people with post-COVID-19 condition. Further research is needed to understand the origins and course of respiratory symptoms and to develop effective therapeutic and rehabilitative strategies.
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Affiliation(s)
- Sally J Singh
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK.
| | - Molly M Baldwin
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Enya Daynes
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Rachael A Evans
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Neil J Greening
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - R Gisli Jenkins
- Imperial College London National Heart and Lung Institute, London, UK
| | - Nazir I Lone
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hamish McAuley
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, UK
| | - Joseph Newman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Petr Novotny
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | | | - Stefan Stanel
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Mark Toshner
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Christopher E Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 DOI: 10.3390/tomography9030095] [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: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
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Dubar V, Pascreau T, Dupont A, Dubucquoi S, Dautigny AL, Ghozlan B, Zuber B, Mellot F, Vasse M, Susen S, Poissy J, Gaudet A. Development of a Decision Support Tool for Anticoagulation in Critically Ill Patients Admitted for SARS-CoV-2 Infection: The CALT Protocol. Biomedicines 2023; 11:1504. [PMID: 37371599 DOI: 10.3390/biomedicines11061504] [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: 03/30/2023] [Revised: 05/14/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Severe COVID-19 infections are at high risk of causing thromboembolic events (TEEs). However, the usual exams may be unavailable or unreliable in predicting the risk of TEEs at admission or during hospitalization. We performed a retrospective analysis of two centers (n = 124 patients) including severe COVID-19 patients to determine the specific risk factors of TEEs in SARS-CoV-2 infection at admission and during stays at the intensive care unit (ICU). We used stepwise regression to create two composite scores in order to predict TEEs in the first 48 h (H0-H48) and during the first 15 days (D1-D15) in ICU. We then evaluated the performance of our scores in our cohort. During the period H0-H48, patients with a TEE diagnosis had higher D-Dimers and ferritin values at day 1 (D1) and day 3 (D3) and a greater drop in fibrinogen between D1 and D3 compared with patients without TEEs. Over the period D1-D15, patients with a diagnosis of a TEE showed a more marked drop in fibrinogen and had higher D-Dimers and lactate dehydrogenase (LDH) values at D1 and D3. Based on ROC analysis, the COVID-related acute lung and deep vein thrombosis (CALT) 1 score, calculated at D1, had a diagnostic performance for TEEs at H0-H48, estimated using an area under the curve (AUC) of 0.85 (CI95%: 0.76-0.93, p < 10-3). The CALT 2 score, calculated at D3, predicted the occurrence of TEEs over the period D1-D15 with an estimated AUC of 0.85 (CI95%: 0.77-0.93, p < 10-3). These two scores were used as the basis for the development of the CALT protocol, a tool to assist in the decision to use anticoagulation during severe SARS-CoV-2 infections. The CALT scores showed good performances in predicting the risk of TEEs in severe COVID-19 patients at admission and during ICU stays. They could, therefore, be used as a decision support protocol on whether or not to initiate therapeutic anticoagulation.
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Affiliation(s)
- Victoria Dubar
- CHU Lille, Pôle de Médecine Intensive-Réanimation, F-59000 Lille, France
| | - Tiffany Pascreau
- Biology Department, Hôpital Foch, F-92150 Suresnes, France
- INSERM, Hémostase Inflammation Thrombose HITH U1176, Université Paris-Saclay, F-94276 Le Kremlin-Bicêtre, France
| | - Annabelle Dupont
- Hemostasis and Transfusion Department, Biology Pathology Center, University Hospital of Lille, F-59000 Lille, France
| | - Sylvain Dubucquoi
- Institut d'Immunologie, Pôle de Biologie Pathologie Génétique Médicale, CHU Lille, F-59000 Lille, France
- U1286-Institute for Translational Research in Inflammation (Infinite), Université de Lille, Inserm, CHU Lille, F-59000 Lille, France
| | | | - Benoit Ghozlan
- CHU Lille, Pôle de Médecine Intensive-Réanimation, F-59000 Lille, France
| | - Benjamin Zuber
- Intensive Care Unit, Hôpital Foch, F-92150 Suresnes, France
| | - François Mellot
- Radiology Department, Hôpital Foch, F-92150 Suresnes, France
| | - Marc Vasse
- Biology Department, Hôpital Foch, F-92150 Suresnes, France
- INSERM, Hémostase Inflammation Thrombose HITH U1176, Université Paris-Saclay, F-94276 Le Kremlin-Bicêtre, France
| | - Sophie Susen
- Hemostasis and Transfusion Department, Biology Pathology Center, University Hospital of Lille, F-59000 Lille, France
| | - Julien Poissy
- CHU Lille, Pôle de Médecine Intensive-Réanimation, F-59000 Lille, France
- CNRS, Inserm U1285, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Alexandre Gaudet
- CHU Lille, Pôle de Médecine Intensive-Réanimation, F-59000 Lille, France
- CNRS, Inserm U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Institut Pasteur de Lille, CHU Lille, Université de Lille, F-59000 Lille, France
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Kanuri SH, Jayesh Sirrkay P, Ulucay AS. COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research. Egypt Heart J 2023; 75:36. [PMID: 37120772 PMCID: PMC10149046 DOI: 10.1186/s43044-023-00359-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND COVID-19 infections are known to cause numerous systemic complications including cardiovascular disorders. In this regard, clinicians recently noticed that patients recovering from COVID-19 infections presented with diverse set of cardiovascular disorders in addition to those admitted to ICU (intensive care unit). COVID-19 heart has multifaceted presentation ranging from dysrhythmias, myocarditis, stroke, coronary artery disease, thromboembolism to heart failure. Atrial fibrillation is the most common cardiac arrhythmia among COVID-19 patients. In the background section, we briefly discussed epidemiology and spectrum of cardiac arrhythmias in COVID-19 patients. MAIN BODY In this state-of-the-art review we present here, we present the information regarding COVID-19-induced A-fib in sections, namely mechanism of action, clinical presentation, diagnosis and treatment. Unfortunately, its occurrence significantly increases the mortality and morbidity with a potential risk of complications such as cardiac arrest and sudden death. We included separate sections on complications including thromboembolism and ventricular arrhythmias. Since its mechanism is currently a gray area, we included a separate section on basic science research studies that are warranted in the future to comprehend its underlying pathogenic mechanisms. CONCLUSIONS Taken together, this review builds upon the current literature of COVID-19-induced A-fib, including pathophysiology, clinical presentation, treatment and complications. Furthermore, it provides recommendations for future research moving forward that can open avenues for developing novel remedies that can prevent as well as hasten clinical recovery of atrial fibrillation in COVID-19 patients.
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