Clinical characteristics of COVID-19 complicated with pulmonary thromboembolism

doi:10.11958/20230161

Abstract

Abstract:

Objective To study the clinical features of novel coronavirus pneumonia (COVID-19) complicated with pulmonary thromboembolism. Methods A total of 27 patients with COVID-19 complicated with pulmonary thromboembolism were collected from December 2022 to January 2023 in the department of respiratory and critical care medicine, Tianjin Chest Hospital. The clinical features and prognosis of patients were summarized based on clinical information, laboratory tests, electrocardiogram, echocardiography, CT images, diagnosis and treatment. Results Among the 27 patients, 12 were males and 15 were females. The mean age was (71.78±9.21) years, ranged in age from 64 to 93 years old. There were 7 cases of coronary heart disease, 7 cases of malignant tumor, 4 cases of chronic obstructive pulmonary disease, 2 cases of pulmonary tuberculosis and 1 case of pulmonary interstitial fibrosis. The main clinical manifestations were shortness of breath, cough, fever and pleural effusion. The electrocardiogram of most patients showed that T-wave of chest lead was inverted (12/27). Ultrasonography revealed deep venous thrombosis of lower extremity (13/27). The main CT findings were multiple ground-glass opacity (21/27), consolidation (17/27), segmental pulmonary embolism (23/27) and subsegmental pulmonary embolism (10/27). There were 11 patients accompanied by right ventricular dysfunction (RVD) and 2 died within 30 days after admission. All of them were elderly patients. Conclusion When patients with malignant tumors and chronic cardiopulmonary diseases have unexplained dyspnea and other manifestations, the possibility of COVID-19 combined with pulmonary thromboembolism should be considered. The imaging findings are mostly segmental and subsegmental pulmonary embolism with ground-glass opacity of both lungs. The prognosis of elderly patients with right ventricular dysfunction is not good.

Key words: COVID-19, SARS-CoV-2, pulmonary embolism, prognosis

CLC Number:

R563.12

Figures/Tables 7

References 10

[1]	ZHANG L, FENG X, ZHANG D, et al. Deep vein thrombosis in hospitalized patients with COVID-19 in Wuhan,China:prevalence,risk factors,and outcome[J]. Circulation, 2020, 142(2):114-128. doi:10.1161/CIRCULATIONAHA.120.046702.
[2]	BACCELLIERI D, BERTOGLIO L, APRUZZI L, et al. Incidence of deep venous thrombosis in COVID-19 hospitalized patients during the first peak of the Italian outbreak[J]. Phlebology, 2021, 36(5):375-383. doi:10.1177/0268355520975592.
[3]	中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018, 98(14):1060-1087.
	Pulmonary Embolism and Pulmonary Vascular Disease Group,Respiratory Society of Chinese Medical Association,Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of Respiratory Physician Branch of Chinese Medical Doctor Association,National Cooperative Group on Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Disease. Guidelines for diagnosis,treatment and prevention of pulmonary thromboembolism[J]. Natl Med J China, 2018, 98(14):1060-1087. doi:10.3760/cma.j.issn.0376-2491.2018.14.007.
[4]	RAISI-ESTABRAGH Z, COOPER J, SALIH A, et al. Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank[J]. Heart, 2022, 109(2):119-126. doi:10.1136/heartjnl-2022-321492.
[5]	KLOK F A, KRUIP M J H A, VAN DER MEER N J M, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19[J]. Thromb Res, 2020, 191:145-147. doi:10.1016/j.thromres.2020.04.013.
[6]	王玉亮, 王峰, 耿洁. 细胞因子与细胞因子风暴[J]. 天津医药, 2020, 48(6):494-499.
	WANG Y L, WANG F, GENG J. Cytokine and cytokine storm[J]. Tianjin Med J, 2020, 48(6):494-499. doi:10.11958/20200323.
[7]	中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组, 等. 新型冠状病毒肺炎相关静脉血栓栓塞症防治建议(试行)[J]. 中华医学杂志, 2020, 100(11):808-813.
	Pulmonary Embolism and Pulmonary Vascular Disease Group,Respiratory Society of Chinese Medical Association,Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of Respiratory Physician Branch of Chinese Medical Doctor Association,National Cooperative Group on Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Disease, et al. Prevention and control recommendations of venous thromboembolism associated with COVID-19(trial)[J]. Natl Med J China, 2020, 100(11):808-813. doi:10.3760/cma.j.issn.0376-2491.2020.0007.
[8]	BARBAR S, NOVENTA F, ROSSETTO V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism:the Padua Prediction Score[J]. J Thromb Haemost, 2010, 8(11):2450-2457. doi:10.1111/j.1538-7836.2010.04044.x.
[9]	ROSENBERG D, EICHORN A, ALARCON M, et al. External validation of the risk assessment model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) for medical patients in a tertiary health system[J]. J Am Heart Assoc, 2014, 3(6):e001152. doi:10.1161/JAHA.114.001152.
[10]	SIMONNEAU G, LAPORTE S, MISMETTI P, et al. A randomized study comparing the efficacy and safety of nadroparin 2850 IU(0.3 mL)vs. enoxaparin 4000 IU(40 mg)in the prevention of venous thromboembolism after colorectal surgery for cancer[J]. J Thromb Haemost, 2006, 4(8):1693-1700. doi:10.1111/j.1538-7836.2006.02083.x.

组别		n	男性		年龄/岁		吸烟	WBC/（×10⁹/L）		LYM/（×10⁹/L）			CRP/（mg/L）		ESR/（mm/1 h）		PCT/（μg/L）
总体		27	12（44.4）		71.78±9.21		7（25.9）	7.58±3.88		1.20±0.55			77.71±45.30		59.63±36.45		0.05（0.05，0.05）
不伴RVD组		16	11（68.8）		71.06±5.89		6（37.5）	7.16±3.89		1.15±0.43			71.27±48.29		36.75±23.71		0.05（0.05，0.05）
伴RVD组		11	1（9.1）		72.82±12.91		1（9.1）	8.18±3.98		1.27±0.71			87.10±40.92		92.91±23.57		0.05（0.05，0.07）
t、Z或P			0.005^▲		0.422		0.183^▲	0.665		0.487			0.888		6.602^＊＊		1.109
组别	FIB/（g/L）			D-D/（mg/L）		LDH/（U/L）			HBDH/（U/L）		CK/（U/L）	CK-MB/（U/L）		BNP/（ng/L）		hs-TNT/（μg/L）
总体	4.71±1.24			3.10（1.42，4.60）		227.52±52.16			168.07±33.42		41.15±18.04	13.78±4.82		195.66±197.58		0.015（0.007，0.046）
不伴RVD组	5.10±0.77			1.94（1.39，4.50）		200.88±33.88			158.56±33.13		35.94±12.86	12.06±2.43		86.91±112.58		0.008（0.007，0.015）
伴RVD组	4.13±1.59			1.85（4.27，10.00）		266.27±50.63			181.91±30.02		48.73±22.16	16.27±6.33		353.84±189.84		0.044（0.018，0.070）
t、Z或P	1.871			1.555		4.033^＊＊			1.867		1.899	2.103		4.593^＊＊		3.178^＊＊

组别		n	男性		年龄/岁		吸烟	WBC/（×10⁹/L）		LYM/（×10⁹/L）			CRP/（mg/L）		ESR/（mm/1 h）		PCT/（μg/L）
总体		27	12（44.4）		71.78±9.21		7（25.9）	7.58±3.88		1.20±0.55			77.71±45.30		59.63±36.45		0.05（0.05，0.05）
不伴RVD组		16	11（68.8）		71.06±5.89		6（37.5）	7.16±3.89		1.15±0.43			71.27±48.29		36.75±23.71		0.05（0.05，0.05）
伴RVD组		11	1（9.1）		72.82±12.91		1（9.1）	8.18±3.98		1.27±0.71			87.10±40.92		92.91±23.57		0.05（0.05，0.07）
t、Z或P			0.005^▲		0.422		0.183^▲	0.665		0.487			0.888		6.602^＊＊		1.109
组别	FIB/（g/L）			D-D/（mg/L）		LDH/（U/L）			HBDH/（U/L）		CK/（U/L）	CK-MB/（U/L）		BNP/（ng/L）		hs-TNT/（μg/L）
总体	4.71±1.24			3.10（1.42，4.60）		227.52±52.16			168.07±33.42		41.15±18.04	13.78±4.82		195.66±197.58		0.015（0.007，0.046）
不伴RVD组	5.10±0.77			1.94（1.39，4.50）		200.88±33.88			158.56±33.13		35.94±12.86	12.06±2.43		86.91±112.58		0.008（0.007，0.015）
伴RVD组	4.13±1.59			1.85（4.27，10.00）		266.27±50.63			181.91±30.02		48.73±22.16	16.27±6.33		353.84±189.84		0.044（0.018，0.070）
t、Z或P	1.871			1.555		4.033^＊＊			1.867		1.899	2.103		4.593^＊＊		3.178^＊＊

组别	n	PaO₂/mmHg	氧合指数/mmHg	PaCO₂/mmHg	Lac/（mmol/L）
总体	27	81.07±33.51	306.20±112.36	35.37±5.26	1.90±1.41
不伴RVD组	16	72.22±16.83	278.86±61.77	33.67±3.70	1.44±0.69
伴RVD组	11	93.95±46.77	345.96±155.45	37.85±6.33	2.58±1.90
t		1.476	1.360	1.969	1.904

组别	n	PaO₂/mmHg	氧合指数/mmHg	PaCO₂/mmHg	Lac/（mmol/L）
总体	27	81.07±33.51	306.20±112.36	35.37±5.26	1.90±1.41
不伴RVD组	16	72.22±16.83	278.86±61.77	33.67±3.70	1.44±0.69
伴RVD组	11	93.95±46.77	345.96±155.45	37.85±6.33	2.58±1.90
t		1.476	1.360	1.969	1.904

组别		n	心电图表现
组别		n	S_ⅠQ_ⅢT_Ⅲ		电轴右偏			RBBB	胸导联T波倒置			胸导联ST段改变
总体		27	10（37.0）		2（7.4）			1（3.7）	12（44.4）			2（7.4）
不伴RVD组		16	5（31.3）		0（0）			0（0）	5（31.3）			1（6.3）
伴RVD组		11	5（45.5）		2（18.2）			1（9.1）	7（63.6）			1（9.1）
t或P			0.687^▲		0.157^▲			0.407^▲	0.130^▲			1.000^▲
组别	超声表现
组别	PASP/mmHg			中重度三尖瓣反流		右心室扩大	左室舒张功能减低			LVEF	下肢DVT		胸腔积液	心包积液
总体	38.11±11.22			9（33.3）		7（25.9）	23（85.2）			0.587±0.053	13（48.1）		9（33.3）	2（7.4）
不伴RVD组	33.81±4.62			1（6.3）		0（0）	12（75.0）			0.597±0.035	6（37.5）		6（37.5）	2（12.5）
伴RVD组	44.36±14.92			8（72.7）		7（63.6）	11（100.0）			0.574±0.071	7（63.6）		3（27.3）	0（0）
t或P	2.271^＊			0.001^▲		0.000^▲	0.123^▲			1.134	0.252^▲		0.692^▲	0.499