Predicción del desarrollo de tromboembolia pulmonar en pacientes con infección por SARS-CoV-2 / Prediction of pulmonary embolism in patients with SARS-CoV-2 infection

Objetivo:Pretendemos determinar los factores predictores de enfermedad tromboembólica pulmonar (ETEP) en pacientes con infección por SARS-CoV-2 (COVID-19) atendidos en el servicio de urgencias de un hospital terciario durante la primera ola pandémica.Métodos:Estudio observacional unicéntrico realizado en una cohorte retrospectiva de pacientes con infección confirmada por SARS-CoV-2 (o alta sospecha clínico-radiológica de COVID-19) sometidos a despistaje de ETEP mediante tomografía computarizada de arterias pulmonares (TCAP). Se exploraron los factores predictores de ETEP mediante regresión logística, creándose dos modelos predictivos (sin o con los valores de dímeros-D).Resultados:De un total de 274 TCAP realizados, 70 procedimientos presentaron hallazgos diagnósticos de ETEP, representando una incidencia acumulada del 25,54% (intervalo de confianza [IC] 95%: 20,49-31,14). En el modelo no ajustado por el nivel de dímeros-D, la frecuencia respiratoria >22rpm (odds ratio [OR]: 3,162; IC 95%: 1,627-6,148; p=0,001) y la ausencia de hallazgos sugerentes de COVID-19 en la radiología simple de tórax (OR: 3,869; IC 95%: 0,869-17,225; p=0,076) fueron predictores de ETEP. En el segundo modelo se mantuvo la presencia de taquipnea (OR: 4,967; IC 95%: 2,053-12,018; p<0,001), identificándose además un nivel de dímeros-D>3.000ng/mL (OR: 7,494; IC 95%: 3,038-18,485; p<0,001).Conclusiones:La presencia de taquipnea (>22rpm) y la ausencia de hallazgos radiológicos sugestivos de infección por SARS-CoV-2 en la radiografía simple de tórax, además de los valores de dímero-D>3.000ng/mL, fueron identificados como factores predictores de ETEP en pacientes con COVID-19.

Objective:To determine the predictive factors of pulmonary thromboembolic (PTE) in patients with SARS-CoV-2 infection (COVID-19) assessed in the emergency department at a tertiary hospital during the first pandemic wave.Methods:Observational single-center study conducted in a retrospective cohort of patients with confirmed SARS-CoV-2 infection (or high clinical-radiological suspicion) who underwent PTE screening by computed tomography pulmonary angiography (CTPA). Predictive factors of PTE were explored using logistic regression, creating two predictive models (without or with D-dimer values).Results:Out of a total of 274 CTPA performed, 70 procedures presented diagnostic findings of PTE, representing a cumulative incidence of 25.54% (95% confidence interval [CI]: 20.49-31.14). In the non–D-dimer based model, respiratory rate>22bpm (odds ratio [OR]: 3.162; 95% CI: 1.627-6.148; p=0.001) and the absence of findings suggestive of COVID-19 in plain chest X-ray (OR: 3.869; 95% CI: 0.869-17.225; p=0.076) were predictors of PTE. In the D-dimer-based model, tachypnea remained as a predictive factor (OR: 4.967; 95% CI: 2.053-12.018; p<0.001), as well as D-dimers>3,000ng/ml (OR: 7.494; 95% CI: 3.038-18.485; p<0.001).Conclusions:The presence of tachypnea (>22bpm) and the absence of radiological findings suggestive of SARS-CoV-2 infection in the chest X-ray, in addition to D-dimer values>3,000 ng/mL, were identified as predictive factors of PTE in patients with COVID-19. (AU)

[Prediction of pulmonary embolism in patients with SARS-CoV-2 infection]. / Predicción del desarrollo de tromboembolia pulmonar en pacientes con infección por SARS-CoV-2.

OBJECTIVE: To determine the predictive factors of pulmonary thromboembolic (PTE) in patients with SARS-CoV-2 infection (COVID-19) assessed in the emergency department at a tertiary hospital during the first pandemic wave. METHODS: Observational single-center study conducted in a retrospective cohort of patients with confirmed SARS-CoV-2 infection (or high clinical-radiological suspicion) who underwent PTE screening by computed tomography pulmonary angiography (CTPA). Predictive factors of PTE were explored using logistic regression, creating two predictive models (without or with D-dimer values). RESULTS: Out of a total of 274 CTPA performed, 70 procedures presented diagnostic findings of PTE, representing a cumulative incidence of 25.54% (95% confidence interval [CI]: 20.49-31.14). In the non-D-dimer based model, respiratory rate>22bpm (odds ratio [OR]: 3.162; 95% CI: 1.627-6.148; p=0.001) and the absence of findings suggestive of COVID-19 in plain chest X-ray (OR: 3.869; 95% CI: 0.869-17.225; p=0.076) were predictors of PTE. In the D-dimer-based model, tachypnea remained as a predictive factor (OR: 4.967; 95% CI: 2.053-12.018; p<0.001), as well as D-dimers>3,000ng/ml (OR: 7.494; 95% CI: 3.038-18.485; p<0.001). CONCLUSIONS: The presence of tachypnea (>22bpm) and the absence of radiological findings suggestive of SARS-CoV-2 infection in the chest X-ray, in addition to D-dimer values>3,000 ng/mL, were identified as predictive factors of PTE in patients with COVID-19.

Usefulness of predictive models of pulmonary embolism. / Utilidad de los modelos predictivos de embolia pulmonar.

BACKGROUND: Faced with the suspicion of pulmonary embolism (PE), the guidelines recommend the use of clinical probability scales, measurement of D-dimer and, in certain cases, confirmation by pulmonary angiography by computed tomography (CTPA) or scintigraphy. Recently, it has been proposed to adjust the D-dimer according to age or use simpler scales (YEARS algorithm) for a better selection of patients. OBJECTIVE: To define the degree of application of the guidelines in our population and compare sensitivity, specificity and positive and negative predictive values of the different diagnostic models: Standard model (Wells 2 categories+D-dimer), Model adjusted for age (Wells 2 categories+D-dimer adjusted for age), YEARS algorithm. MATERIAL AND METHODS: A retrospective study of all patients who underwent APTC at our centre for the diagnosis of PE over one year. RESULTS: Of 618 cases (85.4% of initial APTC), 544 patients were included. A total of 113 EPs were diagnosed (20.8%). The degree of application of the standard model was very high (90.1%) and proved to have the best sensitivity and negative predictive value ratio (sensitivity=1.0, negative predictive value=1.0). The new models could reduce the number of scans (17, 3.2% model adjusted for age and 48, 8.8% model YEARS) with a risk of false negatives (2 PE [1.8%] undiagnosed respectively). CONCLUSIONS: The current diagnostic models for PE lead to a large number of unnecessary explorations. The new models could reduce the number of APTC although with a minimum risk of false negatives.

Algorithm for the diagnosis and follow-up of acute pulmonary embolisms. / Algoritmo para el diagnóstico y el seguimiento de la tromboembolia pulmonar aguda.

The urgent diagnosis of acute pulmonary thromboembolism benefits from the use of evidence-based clinical guidelines that improve patients' prognoses and reduce the unnecessary use of imaging tests. This article explains the diagnostic algorithms for pulmonary thromboembolism most recently published by the relevant scientific societies both for the general population and for special situations, trying to clear up common doubts and analyzing persistent controversies. It also discusses the need to follow up the thromboembolism after anticoagulation treatment, which is not currently recommended in the guidelines.

Angiografía pulmonar en un caso de embolia de líquido amniótico y revisión de la literatura / Pulmonary angiography in a case of embolism of amniotic fluid and review of the literature

Se discute el caso de una paciente que, en el puerperio inmediato, presentó shock, insuficiencia respiratoria y coagulación intravascular diseminada, compatible con el diagnóstico de embolia de líquido amniótico. Se efectuó una angiografía pulmonar que demostró la existencia de extensos trombos en las principales ramas de ambas arterias pulmonares. Mediante un catéter "pigtail", se logró el fraccionamiento de los trombos y la recanalización parcial de la luz vascular. La paciente falleció horas más tarde. Palabras clave: Angiografía pulmonar, Embolia líquido amniótico.(AU)

We discuss the case of a patient who, in the puerperium Immediate, presented shock, respiratory failure and disseminated intravascular coagulation, compatible with the diagnosis of fluid embolism amniotic. Pulmonary angiography was performed demonstrated the existence of extensive thrombi in main branches of both pulmonary arteries. Through a pigtail catheter, fractionation was achieved of thrombi and partial recanalization of the vascular light. The patient died hours later. Key words: Pulmonary angiography, Embolism amniotic fluid.