Pulmonary embolism in COVID-19

Scialpi, Michele; SIELASZUK, Ewa Barbara; Vitale, Maria Pia; Scalera, Giovanni Battista; Nicola, Refky; Mancioli, Francesco

doi:10.4103/lungindia.lungindia_710_20

Cited by 6 publications

(10 citation statements)

References 5 publications

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“…Regarding study setting, most COVID-19 articles concerned ICU patients ( n = 53) [ 4 , 6 , 25 , 26 , 27 , 29 , 30 , 40 , 42 , 43 , 46 , [48] , [49] , [50] , 52 , 54 , 55 , [57] , [58] , [59] , [62] , [63] , [64] , [65] , [66] , 68 , 69 , 73 , 76 , 79 , 83 , 86 , 88 , 93 , 94 , 97 , 98 , 104 , 106 , 108 , 113 , 114 , 116 , 119 , 121 , 123 , 124 , 126 , 130 , 132 , 133 , 135 , 136 ] followed by a mix of ICU and ward patients ( n = 38) [ 3 , 38 , 41 , 44 , 45 , 47 , 56 , 61 , 67 , 70 , 75 , 77 , 78 , 80 ...…”

Section: Resultsmentioning

confidence: 99%

Exploring heterogeneity in reported venous thromboembolism risk in COVID-19 and comparison to other viral pneumonias: a systematic review and meta-regression

Bhoelan¹,

Codreanu²,

Tichelaar³

et al. 2023

Research and Practice in Thrombosis and Haemostasis

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Section: Resultsmentioning

confidence: 99%

Exploring heterogeneity in reported venous thromboembolism risk in COVID-19 and comparison to other viral pneumonias: a systematic review and meta-regression

Bhoelan¹,

Codreanu²,

Tichelaar³

et al. 2023

Research and Practice in Thrombosis and Haemostasis

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“…Also, our analysis of the distribution of arterial branches with filling defects revealed that 91.6% occurred in alveolar lung areas with inflammatory lesions. Patients with SARS-CoV-2 infection have associated thrombosis located in the lung parenchyma with inflammatory lesions, including ground-glass opacities, consolidation, and “crazy paving.” [8,17] In their study, Mueller-Peltzer et al [8] found that all thrombi were located in segments with COVID-19-associated inflammatory lesions. Similarly, in another paper, 87% of patients had pulmonary thrombosis in the lung parenchyma affected by SARS-CoV-2 pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…[9–16] Moreover, chest imaging data of patients with SARS-CoV-2 infection could be used to analyze the association between lung inflammatory lesions and in situ vascular thrombosis. [8,14,17–19]…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16] Moreover, chest imaging data of patients with SARS-CoV-2 infection could be used to analyze the association between lung inflammatory lesions and in situ vascular thrombosis. [8,14,[17][18][19] In this study we aimed to describe clinical, quantitative chest CT imaging characteristics based on density ranges (Hounsfield units) and outcome of patients with COVID-19 associated pulmonary artery thrombosis. We used this term to cover pulmonary thromboembolism and also in situ immunothrombosis, as both mechanisms can contribute to COVID-19-associated macro-vascular thrombotic events.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative chest CT imaging characteristics and outcome of patients with COVID-19 associated pulmonary artery thrombosis: A single-center retrospective cohort study

et al. 2023

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Coronavirus disease 2019 (COVID-19)-associated pulmonary thrombotic events occur frequently and are associated with disease severity and worse clinical outcomes. We aimed to describe the clinical and quantitative chest computed tomography (CT) imaging characteristics based on density ranges (Hounsfield units) and the outcomes of patients with COVID-19 associated pulmonary artery thrombosis. This retrospective cohort study included all patients with COVID-19 hospitalized in a tertiary care hospital between March 2020 and June 2022 who underwent a CT pulmonary angiography. We included 73 patients: 36 (49.3%) with and 37 (50.7%) without pulmonary artery thrombosis. The in-hospital all-cause mortality was 22.2 versus 18.9% (P = .7), and the intensive care unit admission rates were 30.5 versus 8.1% (P = .01) at the time of diagnosis of pulmonary artery thrombosis. Except for D-dimers (median of 3142 vs 533, P = .002), the other clinical, coagulopathy, and inflammatory markers were similar. Logistic regression analysis revealed that only D-dimers were associated with pulmonary artery thrombosis (P = .012). ROC curve analysis of D-dimers showed that a value greater than 1716 ng/mL predicted pulmonary artery thrombosis with an area under the curve of 0.779, 72.2% sensitivity, and 73% specificity (95% CI 0.672–0.885). Peripheral distribution of pulmonary artery thrombosis was recorded in 94.5% of cases. In the lower lobes of the lungs, the incidence of pulmonary artery thrombosis was 6 times higher than that in the upper lobes (58–64%), with a percentage of lung injury of 80% to 90%. Analysis of the distribution of arterial branches with filling defects revealed that 91.6% occurred in lung areas with inflammatory lesions. Quantitative chest CT imaging provides valuable information regarding the extent of COVID-19 associated lung damage and can be used to anticipate the co-location of pulmonary immunothrombotic events. In patients with severe COVID-19, in-hospital all-cause mortality was similar regardless of the presence of associated distal pulmonary thrombosis.

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“…Patients with COVID-19 pneumonia and associated pulmonary thrombosis had significantly worse segmental opacifications in CT imaging and all thrombi were located in segments with inflammation [ 5 ]. The percentage of ground-glass opacities, consolidation, and crazy paving in the lobes with thrombosis was higher than in the contralateral pulmonary lobes without pulmonary thrombosis [ 151 ]. In another paper, the distribution of thrombosis correlated with the pattern of consolidation, and in 93% of cases, it involved peripheral or subsegmental arteries [ 152 ].…”

Section: Chest Ct Imaging Data Supporting the Role Of Pulmonary Immun...mentioning

confidence: 99%

Mechanisms of COVID-19 Associated Pulmonary Thrombosis: A Narrative Review

2023

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COVID-19, the infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is frequently associated with pulmonary thrombotic events, especially in hospitalized patients. Severe SARS-CoV-2 infection is characterized by a proinflammatory state and an associated disbalance in hemostasis. Immune pathology analysis supports the inflammatory nature of pulmonary arterial thrombi composed of white blood cells, especially neutrophils, CD3+ and CD20+ lymphocytes, fibrin, red blood cells, and platelets. Immune cells, cytokines, chemokines, and the complement system are key drivers of immunothrombosis, as they induce the damage of endothelial cells and initiate proinflammatory and procoagulant positive feedback loops. Neutrophil extracellular traps induced by COVID-19-associated “cytokine storm”, platelets, red blood cells, and coagulation pathways close the inflammation–endotheliopathy–thrombosis axis, contributing to SARS-CoV-2-associated pulmonary thrombotic events. The hypothesis of immunothrombosis is also supported by the minor role of venous thromboembolism with chest CT imaging data showing peripheral blood clots associated with inflammatory lesions and the high incidence of thrombotic events despite routine thromboprophylaxis. Understanding the complex mechanisms behind COVID-19-induced pulmonary thrombosis will lead to future combination therapies for hospitalized patients with severe disease that would target the crossroads of inflammatory and coagulation pathways.

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Pulmonary embolism in COVID-19

Cited by 6 publications

References 5 publications

Exploring heterogeneity in reported venous thromboembolism risk in COVID-19 and comparison to other viral pneumonias: a systematic review and meta-regression

Exploring heterogeneity in reported venous thromboembolism risk in COVID-19 and comparison to other viral pneumonias: a systematic review and meta-regression

Quantitative chest CT imaging characteristics and outcome of patients with COVID-19 associated pulmonary artery thrombosis: A single-center retrospective cohort study

Mechanisms of COVID-19 Associated Pulmonary Thrombosis: A Narrative Review

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