Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.205
J. Walker, R. Hughes, A. Ainley
Introduction and ObjectivesCOVID-19 is associated with a pro-inflammatory, hypercoagulable state, increasing the likelihood of developing pulmonary embolism (PE). Higher D-dimer levels have been noted in COVID-19 patients compared to the general population, which may lead to over-investigation by computed tomography pulmonary angiography (CTPA) if traditional thresholds (positive ≥0.5mg/L) are used. We aimed to investigate whether a higher D-dimer threshold could be used.MethodsA retrospective observational study was performed at Barking Havering and Redbridge University Hospitals NHS Trust from April 2020 - March 2021. The study included a cohort of confirmed/suspected cases of COVID-19 requiring hospital admission. D-dimer level on admission, CTPA outcome and requirement for intensive care unit (ICU) admission were analysed to assess D-dimer as a predictor of PE and clinical outcome in COVID-19.ResultsIn 404 patients included, mean D-dimer was 3.03mg/L. 186 (46%) underwent CTPA, 32 (17%) of which detected PE. In those with PE, mean D-dimer was (8.62mg/L), significantly higher than those without PE (2.55mg/L) (P = <0.0001). Patients admitted to ICU had a significantly higher D-dimer (4.35mg/L) than those who were not (2.69mg/L) (P = 0.049). Applying the traditional threshold of 0.5mg/L resulted in a sensitivity of 97% and specificity of 10% for detecting PE. Using higher thresholds of 1.0mg/L and 2.0ml/L resulted in sensitivity of 87% and 71%, and specificity of 37% and 69%, respectively.ConclusionsOur data strongly suggests that higher D-dimer levels are associated with disease severity e.g. complication with PE and requirement for ICU admission. Caution is needed as higher thresholds of 2.0ml/L or greater, as suggested in previous studies,1 would have resulted in an unacceptably low sensitivity in this cohort. Our study highlights the need for further work evaluating use of adjusted D-dimer thresholds in patients with acute COVID-19 to aid decision making and help balance the risks of radiation associated with CTPA and consequences associated with missed diagnosis of PE.ReferenceVentura-Díaz S, et al. A higher D-dimer threshold for predicting pulmonary embolism in patients with COVID-19: a retrospective study. Emerg Radiol. 2020;27(6):679-689. doi:10.1007/s10140-020-01859-1
{"title":"P95 Elevated D-dimers in COVID-19 patients predict PE but caution is needed with higher thresholds","authors":"J. Walker, R. Hughes, A. Ainley","doi":"10.1136/thorax-2021-btsabstracts.205","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.205","url":null,"abstract":"Introduction and ObjectivesCOVID-19 is associated with a pro-inflammatory, hypercoagulable state, increasing the likelihood of developing pulmonary embolism (PE). Higher D-dimer levels have been noted in COVID-19 patients compared to the general population, which may lead to over-investigation by computed tomography pulmonary angiography (CTPA) if traditional thresholds (positive ≥0.5mg/L) are used. We aimed to investigate whether a higher D-dimer threshold could be used.MethodsA retrospective observational study was performed at Barking Havering and Redbridge University Hospitals NHS Trust from April 2020 - March 2021. The study included a cohort of confirmed/suspected cases of COVID-19 requiring hospital admission. D-dimer level on admission, CTPA outcome and requirement for intensive care unit (ICU) admission were analysed to assess D-dimer as a predictor of PE and clinical outcome in COVID-19.ResultsIn 404 patients included, mean D-dimer was 3.03mg/L. 186 (46%) underwent CTPA, 32 (17%) of which detected PE. In those with PE, mean D-dimer was (8.62mg/L), significantly higher than those without PE (2.55mg/L) (P = <0.0001). Patients admitted to ICU had a significantly higher D-dimer (4.35mg/L) than those who were not (2.69mg/L) (P = 0.049). Applying the traditional threshold of 0.5mg/L resulted in a sensitivity of 97% and specificity of 10% for detecting PE. Using higher thresholds of 1.0mg/L and 2.0ml/L resulted in sensitivity of 87% and 71%, and specificity of 37% and 69%, respectively.ConclusionsOur data strongly suggests that higher D-dimer levels are associated with disease severity e.g. complication with PE and requirement for ICU admission. Caution is needed as higher thresholds of 2.0ml/L or greater, as suggested in previous studies,1 would have resulted in an unacceptably low sensitivity in this cohort. Our study highlights the need for further work evaluating use of adjusted D-dimer thresholds in patients with acute COVID-19 to aid decision making and help balance the risks of radiation associated with CTPA and consequences associated with missed diagnosis of PE.ReferenceVentura-Díaz S, et al. A higher D-dimer threshold for predicting pulmonary embolism in patients with COVID-19: a retrospective study. Emerg Radiol. 2020;27(6):679-689. doi:10.1007/s10140-020-01859-1","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125073299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.202
J. Menendez Lorenzo, D. Dhasmana
BackgroundCo-infection with Aspergillus previously described to cause significant morbidity and mortality in those with severe Influenza, has more recently been described in COVID-19. ‘Influenza-Associated Pulmonary Aspergillosis’ (IAPA) and ‘COVID-Associated Pulmonary Aspergillosis’ (CAPA) have been reported in up to 23% and 35% of severe disease, respectively. Establishing evidence of invasive Aspergillosis (IA) in these patients is challenging, requiring specific clinical, radiological and microbiological criteria. The burden of IAPA and CAPA in the ICU in our region is unknown.AimsTo identify the incidence of invasive Aspergillosis (IA) and other opportunistic fungal infection in those with severe Influenza and COVID-19 in a district general hospital, Fife, Scotland.MethodsRetrospective cohort review of ICU admissions with severe Influenza or COVID-19 from May 2017 - February 2021. IA was diagnosed using international definitions according to EORTC/MSG, AspICU and modified AspICU criteria.Results89 patients were identified with Influenza (27;median age 53.3 yrs, male 56%) and COVID-19 (62;median age 59.1 yrs, male 61%). No case satisfied criteria for definite IA, however, the majority of patients did not undergo all relevant tests;CT imaging features in 26/89 (29.2%), and fungal biomarkers in 3/89 (3.4%). Two patients demonstrated Aspergillus culture from respiratory samples but did not meet other criteria. Fungal infections were identified in 39/89 (44%), the majority Candida (37), mostly from ET secretions (54%). Candida was significantly higher in COVID-19 than in Influenza, including 2 patients with Candidaemia. Positive fungal culture was associated with increased length of stay (43d vs 20d), ICU bed days (26d vs 19d), but not mortality (33.3% vs 30.0%). Few patients (7.9%) received antifungal treatment, with possible explanations including unclear diagnosis, high costs, uncertain benefit. 54/89 (60.7%) demonstrated bacterial co-infection, including 31/89 (34.8%) with bacteraemia (COVID, 23;Influenza, 8).ConclusionsIAPA and CAPA were not identified in this 4-year cohort, although case finding was limited by inadequate diagnostics. Timely access to fungal biomarkers compromises diagnostic testing. The incidence is likely to be low, despite the significant study limitations. We recommend prospective systematic practice of investigations and improved fungal diagnostics to better understand the burden of Aspergillosis in these patients.
背景:以前曾报道过在严重流感患者中引起严重发病率和死亡率的曲霉合并感染，最近在COVID-19中也有报道。据报告，“流感相关肺曲霉病”(IAPA)和“covid - 19相关肺曲霉病”(CAPA)分别占严重疾病的23%和35%。在这些患者中建立侵袭性曲霉病(IA)的证据是具有挑战性的，需要特定的临床、放射学和微生物学标准。本地区ICU的IAPA和CAPA负担尚不清楚。目的了解苏格兰法夫郡某地区综合医院重症流感合并COVID-19患者侵袭性曲霉病(invasive Aspergillosis, IA)及其他机会性真菌感染的发生率。方法回顾性队列分析2017年5月至2021年2月ICU收治的重症流感或COVID-19患者。根据EORTC/MSG、AspICU和修改后的AspICU标准，使用国际定义诊断IA。结果89例确诊为流感(27例，中位年龄53.3岁，男性56%)和COVID-19(62例，中位年龄59.1岁，男性61%)。没有病例符合明确的IA标准，然而，大多数患者没有接受所有相关检查;CT影像学特征为26/89(29.2%)，真菌生物标志物为3/89(3.4%)。两名患者从呼吸样本中培养出曲霉，但不符合其他标准。真菌感染39/89(44%)，假丝酵母感染37(37)，主要来自ET分泌物(54%)。2019冠状病毒病患者中念珠菌明显高于流感患者，其中2例为念珠菌血症。真菌培养阳性与住院时间(43d vs 20d)、ICU住院天数(26d vs 19d)增加相关，但与死亡率无关(33.3% vs 30.0%)。少数患者(7.9%)接受了抗真菌治疗，可能的解释包括诊断不清、费用高、疗效不确定。54/89例(60.7%)表现为细菌共感染，其中31/89例(34.8%)合并菌血症(COVID, 23;Influenza, 8)。结论在这4年队列中未发现siapa和CAPA，尽管诊断不充分限制了病例发现。及时获得真菌生物标志物会影响诊断测试。尽管研究有很大的局限性，但发病率可能很低。我们建议前瞻性的系统调查实践和改进真菌诊断，以更好地了解曲霉病在这些患者中的负担。
{"title":"P92 What is the burden of aspergillosis and other opportunistic fungal infections in patients with severe influenza and COVID-19 in the ICU?","authors":"J. Menendez Lorenzo, D. Dhasmana","doi":"10.1136/thorax-2021-btsabstracts.202","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.202","url":null,"abstract":"BackgroundCo-infection with Aspergillus previously described to cause significant morbidity and mortality in those with severe Influenza, has more recently been described in COVID-19. ‘Influenza-Associated Pulmonary Aspergillosis’ (IAPA) and ‘COVID-Associated Pulmonary Aspergillosis’ (CAPA) have been reported in up to 23% and 35% of severe disease, respectively. Establishing evidence of invasive Aspergillosis (IA) in these patients is challenging, requiring specific clinical, radiological and microbiological criteria. The burden of IAPA and CAPA in the ICU in our region is unknown.AimsTo identify the incidence of invasive Aspergillosis (IA) and other opportunistic fungal infection in those with severe Influenza and COVID-19 in a district general hospital, Fife, Scotland.MethodsRetrospective cohort review of ICU admissions with severe Influenza or COVID-19 from May 2017 - February 2021. IA was diagnosed using international definitions according to EORTC/MSG, AspICU and modified AspICU criteria.Results89 patients were identified with Influenza (27;median age 53.3 yrs, male 56%) and COVID-19 (62;median age 59.1 yrs, male 61%). No case satisfied criteria for definite IA, however, the majority of patients did not undergo all relevant tests;CT imaging features in 26/89 (29.2%), and fungal biomarkers in 3/89 (3.4%). Two patients demonstrated Aspergillus culture from respiratory samples but did not meet other criteria. Fungal infections were identified in 39/89 (44%), the majority Candida (37), mostly from ET secretions (54%). Candida was significantly higher in COVID-19 than in Influenza, including 2 patients with Candidaemia. Positive fungal culture was associated with increased length of stay (43d vs 20d), ICU bed days (26d vs 19d), but not mortality (33.3% vs 30.0%). Few patients (7.9%) received antifungal treatment, with possible explanations including unclear diagnosis, high costs, uncertain benefit. 54/89 (60.7%) demonstrated bacterial co-infection, including 31/89 (34.8%) with bacteraemia (COVID, 23;Influenza, 8).ConclusionsIAPA and CAPA were not identified in this 4-year cohort, although case finding was limited by inadequate diagnostics. Timely access to fungal biomarkers compromises diagnostic testing. The incidence is likely to be low, despite the significant study limitations. We recommend prospective systematic practice of investigations and improved fungal diagnostics to better understand the burden of Aspergillosis in these patients.","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128319347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.200
S. Kumar, A. D'Souza, G. Gamtkitsulashvili, S. Waring, Y. Narayan, G. Collins, O. Taylor, S. Jiwani, K. Patrick, A. Sethuraman, S. Naik, S. Kuckreja, R. Ragatha, M. Anwar, U. Ekeowa, P. Russell
P90 Figure 1The association of PCT in COVID-19 and patient morbidity and mortality.[Figure omitted. See PDF]ConclusionsHere, we report the largest single-centre study to date in analysing a UK-based population for procalcitonin in COVID-19. We observed a significant correlation between elevated initial levels of PCT and incidence of ICU admission and mortality within our cohort, thereby demonstrating promise for PCT as an effective prognostic marker. Using a higher cut-off for PCT ≥0.5µg/L increased mortality by almost 50%, but had no effect on morbidity. We suggest that a lower universal cut-off point for PCT should be used for detecting secondary bacterial infections and procalcitonin-guided antimicrobial therapy.ReferencesHu R, et al. International Journal of Antimicrobial Agents 2020;56(2):106051.Vazzana N, et al. Acta Clin Belg. 2020 Sep 23:1–5.
{"title":"P90 Use of procalcitonin to predict morbidity and mortality in COVID-19","authors":"S. Kumar, A. D'Souza, G. Gamtkitsulashvili, S. Waring, Y. Narayan, G. Collins, O. Taylor, S. Jiwani, K. Patrick, A. Sethuraman, S. Naik, S. Kuckreja, R. Ragatha, M. Anwar, U. Ekeowa, P. Russell","doi":"10.1136/thorax-2021-btsabstracts.200","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.200","url":null,"abstract":"P90 Figure 1The association of PCT in COVID-19 and patient morbidity and mortality.[Figure omitted. See PDF]ConclusionsHere, we report the largest single-centre study to date in analysing a UK-based population for procalcitonin in COVID-19. We observed a significant correlation between elevated initial levels of PCT and incidence of ICU admission and mortality within our cohort, thereby demonstrating promise for PCT as an effective prognostic marker. Using a higher cut-off for PCT ≥0.5µg/L increased mortality by almost 50%, but had no effect on morbidity. We suggest that a lower universal cut-off point for PCT should be used for detecting secondary bacterial infections and procalcitonin-guided antimicrobial therapy.ReferencesHu R, et al. International Journal of Antimicrobial Agents 2020;56(2):106051.Vazzana N, et al. Acta Clin Belg. 2020 Sep 23:1–5.","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132486032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.206
J. Rossdale, P. Charters, R. Foley, W. Brown, T. Burnett, R. Mackenzie Ross, J. Suntharalingam, J. Rodrigues
Aims and ObjectivesAn increased incidence of pulmonary thrombosis (PT) and right ventricular (RV) dysfunction is reported in COVID-19. The clinical significance is not fully understood and there are few large, multicentre studies. The National Covid-19 Chest Imaging Database (NCCID) was analysed for prevalence of PT in COVID-19 patients;we hypothesised associations between macroscopic PT, severity of parenchymal disease, evidence of RV dysfunction on CT and mortality.MethodsNCCID is a multicentre UK-wide centralised database comprised of radiological images from hospitalised COVID-19 patients. 391 thoracic contrast CT scans from 14 centres across England and Wales performed between 2nd March 2020 – 10th September 2020 underwent automated post-processing software (IMBIO LLC.) to determine RV:LV diameter ratio. Scans were manually reported for PT and quantitatively scored for arterial obstruction and severity of parenchymal involvement using CT- Severity Scoring (CT-SS)[1]. Imaging metrics were analysed for association with PT and 30 day mortality.ResultsAutomated RV:LV analysis was successful in 90% (351/391) of scans. Mean age: 64, 53% (186/351) male. Mortality data was available for 325 patients: 22 died within 30 days of scan (6.7% (22/325)).Macroscopic PT was present in 16% (56/351). Median Qanadli score was 6% (IQR 3%-17.5%), indicating low burden arterial obstruction. PT was not associated with mortality (p=0.18).RV:LV >1 on CT was observed in 59% (206/351) (mean RV:LV 1.08). RV:LV was significantly higher in the presence of PT (mean RVLV 1.17 vs 1.06 p=0.011, χ2(2) = 6.499). RV:LV was not predictive of mortality (AUC 0.467, CI 0.358–0.576).CT-SS significantly predicted mortality (AUC 0.787, p=<0.0005, CI 0.693–0.881). However there was no correlation between severity of parenchymal involvement and RV:LV (r 0.82, p=0.123), nor presence of PT (χ2(2) 2.305, p=0.129).ConclusionsRV dilatation and PT were prevalent in this multicentre cohort of COVID-19 patients, but were not associated with mortality or parenchymal disease severity. PT is frequently low burden and, in contrast to PT outside the context of COVID-19, RV:LV >1 is not discriminatory for prognosis.ReferenceYang R., et al. Chest CT severity score: an imaging tool for assessing severe COVID-19. Radiology: Cardiothoracic Imaging 2020;2(2):e200047. doi: 10.1148/ryct.2020200047
{"title":"P96 Pulmonary vascular disease in COVID-19: insights from artificial intelligence analysis in a large multicentre imaging database","authors":"J. Rossdale, P. Charters, R. Foley, W. Brown, T. Burnett, R. Mackenzie Ross, J. Suntharalingam, J. Rodrigues","doi":"10.1136/thorax-2021-btsabstracts.206","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.206","url":null,"abstract":"Aims and ObjectivesAn increased incidence of pulmonary thrombosis (PT) and right ventricular (RV) dysfunction is reported in COVID-19. The clinical significance is not fully understood and there are few large, multicentre studies. The National Covid-19 Chest Imaging Database (NCCID) was analysed for prevalence of PT in COVID-19 patients;we hypothesised associations between macroscopic PT, severity of parenchymal disease, evidence of RV dysfunction on CT and mortality.MethodsNCCID is a multicentre UK-wide centralised database comprised of radiological images from hospitalised COVID-19 patients. 391 thoracic contrast CT scans from 14 centres across England and Wales performed between 2nd March 2020 – 10th September 2020 underwent automated post-processing software (IMBIO LLC.) to determine RV:LV diameter ratio. Scans were manually reported for PT and quantitatively scored for arterial obstruction and severity of parenchymal involvement using CT- Severity Scoring (CT-SS)[1]. Imaging metrics were analysed for association with PT and 30 day mortality.ResultsAutomated RV:LV analysis was successful in 90% (351/391) of scans. Mean age: 64, 53% (186/351) male. Mortality data was available for 325 patients: 22 died within 30 days of scan (6.7% (22/325)).Macroscopic PT was present in 16% (56/351). Median Qanadli score was 6% (IQR 3%-17.5%), indicating low burden arterial obstruction. PT was not associated with mortality (p=0.18).RV:LV >1 on CT was observed in 59% (206/351) (mean RV:LV 1.08). RV:LV was significantly higher in the presence of PT (mean RVLV 1.17 vs 1.06 p=0.011, χ2(2) = 6.499). RV:LV was not predictive of mortality (AUC 0.467, CI 0.358–0.576).CT-SS significantly predicted mortality (AUC 0.787, p=<0.0005, CI 0.693–0.881). However there was no correlation between severity of parenchymal involvement and RV:LV (r 0.82, p=0.123), nor presence of PT (χ2(2) 2.305, p=0.129).ConclusionsRV dilatation and PT were prevalent in this multicentre cohort of COVID-19 patients, but were not associated with mortality or parenchymal disease severity. PT is frequently low burden and, in contrast to PT outside the context of COVID-19, RV:LV >1 is not discriminatory for prognosis.ReferenceYang R., et al. Chest CT severity score: an imaging tool for assessing severe COVID-19. Radiology: Cardiothoracic Imaging 2020;2(2):e200047. doi: 10.1148/ryct.2020200047","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131773731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.201
S. Waring, G. Gamtkitsulashvili, S. Kumar, Y. Narayan, A. D'Souza, S. Jiwani, O. Taylor, G. Collins, K. Patrick, A. Sethuraman, S. Naik, S. Kuckreja, R. Ragatha, M. Anwar, U. Ekeowa, P. Russell
P91 Table 1(a) Most frequently observed bacterial species (b) Culture type positivity with relation to rates of mortality(a) Bacteria Number isolated (b) Culture Type Number of positives Number of deaths Positivity mortality Enterococcus 67 Urine 104 28 26.9% Escherichia 65 Blood 76 28 36.8% Staphylococcus 64 Skin 40 16 40% Pseudomonas 24 Sputum & BAL 33 20 60.6% Klebsiella 12 Stool 13 5 38.5% Streptococcus 12 Central venous line 8 4 50% ConclusionBacterial infection is observed far more frequently in COVID-19 patients than previously reported and adversely affects morbidity and mortality. Multiple sites of bacterial infection prolongs inpatient stay and increases mortality. Thorough culture collection should be encouraged in COVID-19 patients with biochemical evidence of bacterial infection to identify responsible pathogens and respective antimicrobial sensitivity. Given the higher mortality rates, empirical use of antibiotics in COVID-19 patients without supporting evidence of bacterial infection is strongly discouraged.ReferencesLansbury, et al. J Infect. 2020 Aug;81(2):266–2.Russell C, et al. Lancet Microbe. 2021 Jun 2. https://doi.org/10.1016/S2666-5247(21)00090-2
{"title":"P91 Impact of bacterial infections in patients with COVID-19 on morbidity and mortality during the second UK SARS-CoV-2 wave","authors":"S. Waring, G. Gamtkitsulashvili, S. Kumar, Y. Narayan, A. D'Souza, S. Jiwani, O. Taylor, G. Collins, K. Patrick, A. Sethuraman, S. Naik, S. Kuckreja, R. Ragatha, M. Anwar, U. Ekeowa, P. Russell","doi":"10.1136/thorax-2021-btsabstracts.201","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.201","url":null,"abstract":"P91 Table 1(a) Most frequently observed bacterial species (b) Culture type positivity with relation to rates of mortality(a) Bacteria Number isolated (b) Culture Type Number of positives Number of deaths Positivity mortality Enterococcus 67 Urine 104 28 26.9% Escherichia 65 Blood 76 28 36.8% Staphylococcus 64 Skin 40 16 40% Pseudomonas 24 Sputum & BAL 33 20 60.6% Klebsiella 12 Stool 13 5 38.5% Streptococcus 12 Central venous line 8 4 50% ConclusionBacterial infection is observed far more frequently in COVID-19 patients than previously reported and adversely affects morbidity and mortality. Multiple sites of bacterial infection prolongs inpatient stay and increases mortality. Thorough culture collection should be encouraged in COVID-19 patients with biochemical evidence of bacterial infection to identify responsible pathogens and respective antimicrobial sensitivity. Given the higher mortality rates, empirical use of antibiotics in COVID-19 patients without supporting evidence of bacterial infection is strongly discouraged.ReferencesLansbury, et al. J Infect. 2020 Aug;81(2):266–2.Russell C, et al. Lancet Microbe. 2021 Jun 2. https://doi.org/10.1016/S2666-5247(21)00090-2","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115335945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.204
S. Desai, A. Devaraj, S. Dintakurti, C. Mahon, S. Padley, S. Singh, B. Rawal, C. Ridge, T. Semple
PurposeTo describe the incidence of pulmonary artery thrombosis in COVID-19 versus influenza pneumonia using CT angiography and to assess whether it may increase the risk of pulmonary hypertension.Materials and MethodsSingle and dual energy CT pulmonary angiography of age- and gender-matched patients with influenza and COVID-19 pneumonia, referred for extra-corporeal membrane oxygenation (ECMO) and/or mechanical ventilation from January 2016 to January 2021, were retrospectively evaluated. Two independent observers qualitatively and quantitively assessed clot burden and Qanadli CT Obstruction Index. Two consensus observers calculated pulmonary artery volume and right to left ventricular diameter ratio (Terarecon, California, USA) to diagnose pulmonary hypertension. Pulmonary infarct volume and perfused blood volume relative enhancement were also calculated (Syngo via, Siemens Healthineers, Forchheim, Germany). All radiologic parameters were correlated with clinical data. To assess if in situ thrombosis could be visualised on CT, isolated segmental and subsegmental filling defects were used as an imaging surrogate. For statistical analyses, Graphpad Prism9 and IBM SPSS v27.0 software were used.ResultsThe incidence of either central PE or DVT was equal between patients with COVID-19 and influenza pneumonia (20%). The incidence of isolated segmental and subsegmental filling defects was higher in COVID-19 but without statistical significance (44% vs 32%;p=0.5607). Right to left ventricular diameter and pulmonary artery to aorta ratios were higher in COVID-19 compared to influenza (1.01 vs 0.866 and 1.04 vs 0.904;p=0.0071 and p=0.0023, respectively).ConclusionIn a comparable group of patients with severe COVID-19 and influenza pneumonia, CT features of pulmonary hypertension are more often present in patients with COVID-19 pneumonia despite an equal clot burden on CT. This is not attributable to pulmonary thrombosis visible on CT and supports the hypothesis that micro- rather than macrovascular obstruction is the cause of severe hypoxia in COVID-19 pneumonia.
目的利用CT血管造影分析新冠肺炎患者与流感肺炎患者肺动脉血栓形成的发生率，并评估其是否会增加肺动脉高压的发生风险。材料与方法回顾性评价2016年1月至2021年1月期间，年龄和性别匹配的流感和COVID-19肺炎患者进行体外膜氧合(ECMO)和/或机械通气的单能量和双能量CT肺血管造影。两名独立观察员定性和定量评估血块负担和Qanadli CT阻塞指数。两名共识观察员计算肺动脉体积和左右心室直径比(Terarecon, California, USA)来诊断肺动脉高压。同时计算肺梗死体积和灌注血容量相对增强(Syngo via, Siemens Healthineers, Forchheim, Germany)。所有放射学参数均与临床资料相关。为了评估原位血栓是否可以在CT上显示，孤立的节段和亚节段填充缺陷被用作成像替代。统计学分析采用Graphpad Prism9和IBM SPSS v27.0软件。结果COVID-19患者与流感肺炎患者中心性PE或DVT的发生率相等(20%)。孤立节段缺损和亚节段缺损在COVID-19组的发生率较高，但差异无统计学意义(44% vs 32%;p=0.5607)。与流感相比，COVID-19患者的右心室与左心室直径和肺动脉与主动脉的比值更高(分别为1.01 vs 0.866和1.04 vs 0.904;p=0.0071和p=0.0023)。结论在一组重症COVID-19和流行性感冒肺炎患者中，尽管CT上血块负担相等，但COVID-19肺炎患者更常出现肺动脉高压的CT特征。这不能归因于CT上可见的肺血栓形成，并支持了微血管阻塞而不是大血管阻塞是COVID-19肺炎严重缺氧的原因的假设。
{"title":"P94 Influenza and COVID-19 pneumonia: the difference is pulmonary hypertension","authors":"S. Desai, A. Devaraj, S. Dintakurti, C. Mahon, S. Padley, S. Singh, B. Rawal, C. Ridge, T. Semple","doi":"10.1136/thorax-2021-btsabstracts.204","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.204","url":null,"abstract":"PurposeTo describe the incidence of pulmonary artery thrombosis in COVID-19 versus influenza pneumonia using CT angiography and to assess whether it may increase the risk of pulmonary hypertension.Materials and MethodsSingle and dual energy CT pulmonary angiography of age- and gender-matched patients with influenza and COVID-19 pneumonia, referred for extra-corporeal membrane oxygenation (ECMO) and/or mechanical ventilation from January 2016 to January 2021, were retrospectively evaluated. Two independent observers qualitatively and quantitively assessed clot burden and Qanadli CT Obstruction Index. Two consensus observers calculated pulmonary artery volume and right to left ventricular diameter ratio (Terarecon, California, USA) to diagnose pulmonary hypertension. Pulmonary infarct volume and perfused blood volume relative enhancement were also calculated (Syngo via, Siemens Healthineers, Forchheim, Germany). All radiologic parameters were correlated with clinical data. To assess if in situ thrombosis could be visualised on CT, isolated segmental and subsegmental filling defects were used as an imaging surrogate. For statistical analyses, Graphpad Prism9 and IBM SPSS v27.0 software were used.ResultsThe incidence of either central PE or DVT was equal between patients with COVID-19 and influenza pneumonia (20%). The incidence of isolated segmental and subsegmental filling defects was higher in COVID-19 but without statistical significance (44% vs 32%;p=0.5607). Right to left ventricular diameter and pulmonary artery to aorta ratios were higher in COVID-19 compared to influenza (1.01 vs 0.866 and 1.04 vs 0.904;p=0.0071 and p=0.0023, respectively).ConclusionIn a comparable group of patients with severe COVID-19 and influenza pneumonia, CT features of pulmonary hypertension are more often present in patients with COVID-19 pneumonia despite an equal clot burden on CT. This is not attributable to pulmonary thrombosis visible on CT and supports the hypothesis that micro- rather than macrovascular obstruction is the cause of severe hypoxia in COVID-19 pneumonia.","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132893581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.198
Rl Young, KV Mullins, A. Ainley
BackgroundPrevious work has related demographic and clinical characteristics to clinical course and outcome of patients hospitalised with COVID-19.1 We sought to evaluate if initial routine laboratory test results could be utilised to predict length of inpatient stay (LOS), need for non-invasive (NIV)/invasive mechanical ventilation (IMV) and admission to an intensive care unit (ICU). We also sought to establish if C-reactive protein levels related to radiographic disease severity.MethodsA retrospective analysis was carried out on a cohort of 567 patients with a laboratory confirmed diagnosis of COVID-19 admitted during the second wave of the pandemic between April 2020 and May 2021 including descriptive statistics and multivariate and regression analysis. Radiological severity was based upon previously proposed scoring systems.2ResultsOf the 567 patients included, 342 (60%) were male, mean age 61 years, 318 (56%) were Caucasian, 143 (25%) Asian and 35 (6%) Black. Raised admission d-dimer and urea levels correlated with longer LOS (r= 0.17 and 0.16 respectively, p<0.01). Rising C-reactive protein and d-dimer correlated with increased risk of requirement for admission to ICU (r= 0.27 and 0.19 respectively, p<0.001), need for NIV (Pearson’s correlation 0.26 and 0.15 respectively, P<0.01) and progression to IMV (r=0.15 and 0.14, p<0.05). A correlation between initial routine blood results and death was not detected. C-reactive protein correlated with radiographic disease severity (r=0.32, p<0.001).ConclusionsAbnormalities in initial laboratory test results may be utilised to risk stratify patients presenting to secondary and tertiary care with COVID-19, may help predict clinical course and in doing so facilitate more efficient and streamlined delivery of care and resource utilisation with likely significant impact on patient outcomes.ReferencesCheng D, Calderwood C, Skyllberg E, et al. Clinical characteristics and outcomes of adult patients admitted with COVID-19 in East London: a retrospective cohort analysis. BMJ Open Respiratory Research 2021;8:e000813.Monaco CG, Zaottini F, Schiaffino S, et al. Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study. Eur Radiol Exp. 2020;4(1):68.
{"title":"P88 Initial routine laboratory tests can be used to predict clinical course in patients hospitalised with COVID-19","authors":"Rl Young, KV Mullins, A. Ainley","doi":"10.1136/thorax-2021-btsabstracts.198","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.198","url":null,"abstract":"BackgroundPrevious work has related demographic and clinical characteristics to clinical course and outcome of patients hospitalised with COVID-19.1 We sought to evaluate if initial routine laboratory test results could be utilised to predict length of inpatient stay (LOS), need for non-invasive (NIV)/invasive mechanical ventilation (IMV) and admission to an intensive care unit (ICU). We also sought to establish if C-reactive protein levels related to radiographic disease severity.MethodsA retrospective analysis was carried out on a cohort of 567 patients with a laboratory confirmed diagnosis of COVID-19 admitted during the second wave of the pandemic between April 2020 and May 2021 including descriptive statistics and multivariate and regression analysis. Radiological severity was based upon previously proposed scoring systems.2ResultsOf the 567 patients included, 342 (60%) were male, mean age 61 years, 318 (56%) were Caucasian, 143 (25%) Asian and 35 (6%) Black. Raised admission d-dimer and urea levels correlated with longer LOS (r= 0.17 and 0.16 respectively, p<0.01). Rising C-reactive protein and d-dimer correlated with increased risk of requirement for admission to ICU (r= 0.27 and 0.19 respectively, p<0.001), need for NIV (Pearson’s correlation 0.26 and 0.15 respectively, P<0.01) and progression to IMV (r=0.15 and 0.14, p<0.05). A correlation between initial routine blood results and death was not detected. C-reactive protein correlated with radiographic disease severity (r=0.32, p<0.001).ConclusionsAbnormalities in initial laboratory test results may be utilised to risk stratify patients presenting to secondary and tertiary care with COVID-19, may help predict clinical course and in doing so facilitate more efficient and streamlined delivery of care and resource utilisation with likely significant impact on patient outcomes.ReferencesCheng D, Calderwood C, Skyllberg E, et al. Clinical characteristics and outcomes of adult patients admitted with COVID-19 in East London: a retrospective cohort analysis. BMJ Open Respiratory Research 2021;8:e000813.Monaco CG, Zaottini F, Schiaffino S, et al. Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study. Eur Radiol Exp. 2020;4(1):68.","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131478489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.196
K. Florman, M. Jayne, A. Berezowska, E. Abouelela, J. Hudson, T. Al-Mayhani
P86 Table 1Anosmia scoring system developedScore for each smell Meaning 0 Able to identify the smell correctly 1 Able to identify the smell but it doesn’t smell right 2 Unable to identify the smell 3 Total anosmia Total scores per patient Definition 0–4 Mild anosmia 5–10 Moderate anosmia 11–15 Severe anosmia ConclusionA significant proportion of patients studied were not aware they had anosmia. This has implications for pandemic management going forward when people are required to self-report this symptom and suggests potential benefit in formal examination of the olfactory nerve.
{"title":"P86 Characterising anosmia in hospitalised patients with COVID-19","authors":"K. Florman, M. Jayne, A. Berezowska, E. Abouelela, J. Hudson, T. Al-Mayhani","doi":"10.1136/thorax-2021-btsabstracts.196","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.196","url":null,"abstract":"P86 Table 1Anosmia scoring system developedScore for each smell Meaning 0 Able to identify the smell correctly 1 Able to identify the smell but it doesn’t smell right 2 Unable to identify the smell 3 Total anosmia Total scores per patient Definition 0–4 Mild anosmia 5–10 Moderate anosmia 11–15 Severe anosmia ConclusionA significant proportion of patients studied were not aware they had anosmia. This has implications for pandemic management going forward when people are required to self-report this symptom and suggests potential benefit in formal examination of the olfactory nerve.","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129844233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.199
S. Kumar, R. Ragatha, S. Waring, G. Gamtkitsulashvili, A. D'Souza, M. Mahenthiran, S. Tan, M. Parsons, S. Visuvanathan, A. Sefton, U. Ekeowa, P. Russell
BackgroundVitamin D plays a vital part in modulating the immune system, with Vitamin D deficiency leading to increased susceptibility to infection.1 There is some evidence to suggest Vitamin D may play a protective role in the prevention of COVID-19 infection in hospitalised patients,2 but the topic remains controversial. Our study aims to investigate if low Vitamin D levels correlate with increased risk of COVID-19 infection, thereby representing a modifiable risk factor for COVID-19 infection.MethodA retrospective observational study was conducted on 3198 health care workers of a Greater London District General Hospital, who had undergone testing for 25-OH Vitamin D levels and COVID-19 antibody in June 2020. In accordance with NICE guidelines, Vitamin D deficiency was defined as less than 25 nmol/L, insufficiency as 25–50 nmol/L, and those with levels over 50 nmol/L were used as control comparisons. Evidence of previous SARS-CoV-2 infection was assessed by detection of SARS-CoV-2 IgG antibodies. Regression analysis was performed to determine independent significance, accounting for age and gender.Results3191 participants were included in this study, with age ranging from 19–78 years (mean 42.9) of which 78.2% were female. Both age and gender were not independently associated with positive SARS-CoV-2 IgG antibodies. 1997 (62.6%) participants had Vitamin D levels within the normal range, 899 (28.2%) participants had insufficient levels and 302 (9.4%) had Vitamin D deficiency. Both Vitamin D deficiency (OR 1.61, p=0.002) and insufficiency (OR 1.33, p=0.006) independently correlated with significantly increased incidence of positive COVID-19 antibodies than personnel with normal Vitamin D levels.ConclusionsWe report the largest single-centre study investigating the impact of low Vitamin D levels within healthcare workers to date. Significant correlation between low levels of Vitamin D and previous COVID-19 infection was identified. Oral Vitamin D supplementation to maintain levels >50 nmol/L may play a protective role against COVID-19. Larger studies are needed to investigate the role of Vitamin D supplementation in healthcare workers for further COVID-19 waves.ReferencesAranow C, et al. Journal of Investigative Medicine 2011;59:881–886.Nogues X, et al. J Clin Endocrinol Metab. 2021 Jun 7:dgab405.
{"title":"P89 Vitamin D deficiency increases susceptibility to COVID-19 infection","authors":"S. Kumar, R. Ragatha, S. Waring, G. Gamtkitsulashvili, A. D'Souza, M. Mahenthiran, S. Tan, M. Parsons, S. Visuvanathan, A. Sefton, U. Ekeowa, P. Russell","doi":"10.1136/thorax-2021-btsabstracts.199","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.199","url":null,"abstract":"BackgroundVitamin D plays a vital part in modulating the immune system, with Vitamin D deficiency leading to increased susceptibility to infection.1 There is some evidence to suggest Vitamin D may play a protective role in the prevention of COVID-19 infection in hospitalised patients,2 but the topic remains controversial. Our study aims to investigate if low Vitamin D levels correlate with increased risk of COVID-19 infection, thereby representing a modifiable risk factor for COVID-19 infection.MethodA retrospective observational study was conducted on 3198 health care workers of a Greater London District General Hospital, who had undergone testing for 25-OH Vitamin D levels and COVID-19 antibody in June 2020. In accordance with NICE guidelines, Vitamin D deficiency was defined as less than 25 nmol/L, insufficiency as 25–50 nmol/L, and those with levels over 50 nmol/L were used as control comparisons. Evidence of previous SARS-CoV-2 infection was assessed by detection of SARS-CoV-2 IgG antibodies. Regression analysis was performed to determine independent significance, accounting for age and gender.Results3191 participants were included in this study, with age ranging from 19–78 years (mean 42.9) of which 78.2% were female. Both age and gender were not independently associated with positive SARS-CoV-2 IgG antibodies. 1997 (62.6%) participants had Vitamin D levels within the normal range, 899 (28.2%) participants had insufficient levels and 302 (9.4%) had Vitamin D deficiency. Both Vitamin D deficiency (OR 1.61, p=0.002) and insufficiency (OR 1.33, p=0.006) independently correlated with significantly increased incidence of positive COVID-19 antibodies than personnel with normal Vitamin D levels.ConclusionsWe report the largest single-centre study investigating the impact of low Vitamin D levels within healthcare workers to date. Significant correlation between low levels of Vitamin D and previous COVID-19 infection was identified. Oral Vitamin D supplementation to maintain levels >50 nmol/L may play a protective role against COVID-19. Larger studies are needed to investigate the role of Vitamin D supplementation in healthcare workers for further COVID-19 waves.ReferencesAranow C, et al. Journal of Investigative Medicine 2011;59:881–886.Nogues X, et al. J Clin Endocrinol Metab. 2021 Jun 7:dgab405.","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114653413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1136/thorax-2021-btsabstracts.197
AJ Chung, MN Dang, T Niaz, P Palchaudhuri
Introduction and ObjectivesMultiple studies have demonstrated increased risk of pulmonary embolism (PE) in COVID-19. Our study at a major NHS Trust examined the clinical characteristics, attributes and outcomes of PE in COVID-19, which have infrequently been explored in literature.MethodsWe performed a retrospective cohort study of COVID-19 patients with PE diagnosed on CT pulmonary angiogram (CTPA) over 2 months in 1st and 2nd waves (April 2020 and January 2021). Data collected from electronic health and imaging records included patient demographics, D-dimers, oxygen requirements, clinical outcomes, thromboprophylaxis/treatment and PE attributes on CTPA.ResultsWe identified 76 COVID-19 patients with PE (mean age 62.2 years, 69.7% male, 40.8% Caucasian). Patients experienced prolonged periods of COVID-19 symptoms prior to PE diagnosis - 19.6 day symptoms in 1st wave (n = 16, 21.9%) compared to 15.2 days in 2nd wave (n = 57, 78.1%). Average D-dimer was highly elevated (mean = 11576 ng/mL). 43 (56.5%) patients had high oxygen requirements - 21 (27.6%) required ≥10 litres/min via mask, 13 (17.1%) required non-invasive ventilation and 9 (11.8%) were intubated and ventilated. 22 patients (28.9%) were admitted to intensive care and 11 patients (14.5%) died. On admission, 48 patients (63.2%) were started on treatment dose enoxaparin (high PE suspicion) and 12 (15.8%) had intermediate (prophylactic) dose enoxaparin. PEs were largely treated with 3–6 months of rivaroxaban (n = 43, 56.6%) or apixaban (n = 7, 9.2%). 65.5% (n = 49) of patients had bilateral PEs;largest sizes being segmental (n = 32, 42.1%), subsegmental (n = 17, 22.4%), lobar (n = 16, 21.1%), main pulmonary artery (n= 5, 6.6%) and saddle (n = 5, 6.6%). 15 patients (19.7%) had evidence of right heart strain on CTPA.ConclusionsOur study suggests that PE in COVID-19 is more common in males and in those with COVID symptoms greater than 2 weeks, high oxygen requirements and highly elevated D-dimers. There should be a low threshold for investigating such patients for PE. Moreover, we found COVID-19 patients with PE have high likelihood of having a bilateral pulmonary distribution with right heart strain.
{"title":"P87 Clinical characteristics of COVID-19 patients with pulmonary embolism in 1st and 2nd waves","authors":"AJ Chung, MN Dang, T Niaz, P Palchaudhuri","doi":"10.1136/thorax-2021-btsabstracts.197","DOIUrl":"https://doi.org/10.1136/thorax-2021-btsabstracts.197","url":null,"abstract":"Introduction and ObjectivesMultiple studies have demonstrated increased risk of pulmonary embolism (PE) in COVID-19. Our study at a major NHS Trust examined the clinical characteristics, attributes and outcomes of PE in COVID-19, which have infrequently been explored in literature.MethodsWe performed a retrospective cohort study of COVID-19 patients with PE diagnosed on CT pulmonary angiogram (CTPA) over 2 months in 1st and 2nd waves (April 2020 and January 2021). Data collected from electronic health and imaging records included patient demographics, D-dimers, oxygen requirements, clinical outcomes, thromboprophylaxis/treatment and PE attributes on CTPA.ResultsWe identified 76 COVID-19 patients with PE (mean age 62.2 years, 69.7% male, 40.8% Caucasian). Patients experienced prolonged periods of COVID-19 symptoms prior to PE diagnosis - 19.6 day symptoms in 1st wave (n = 16, 21.9%) compared to 15.2 days in 2nd wave (n = 57, 78.1%). Average D-dimer was highly elevated (mean = 11576 ng/mL). 43 (56.5%) patients had high oxygen requirements - 21 (27.6%) required ≥10 litres/min via mask, 13 (17.1%) required non-invasive ventilation and 9 (11.8%) were intubated and ventilated. 22 patients (28.9%) were admitted to intensive care and 11 patients (14.5%) died. On admission, 48 patients (63.2%) were started on treatment dose enoxaparin (high PE suspicion) and 12 (15.8%) had intermediate (prophylactic) dose enoxaparin. PEs were largely treated with 3–6 months of rivaroxaban (n = 43, 56.6%) or apixaban (n = 7, 9.2%). 65.5% (n = 49) of patients had bilateral PEs;largest sizes being segmental (n = 32, 42.1%), subsegmental (n = 17, 22.4%), lobar (n = 16, 21.1%), main pulmonary artery (n= 5, 6.6%) and saddle (n = 5, 6.6%). 15 patients (19.7%) had evidence of right heart strain on CTPA.ConclusionsOur study suggests that PE in COVID-19 is more common in males and in those with COVID symptoms greater than 2 weeks, high oxygen requirements and highly elevated D-dimers. There should be a low threshold for investigating such patients for PE. Moreover, we found COVID-19 patients with PE have high likelihood of having a bilateral pulmonary distribution with right heart strain.","PeriodicalId":266318,"journal":{"name":"COVID-19: clinical features and risk","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124107539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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