Publication: The proportion of pulmonary embolism in covid-19 pneumonia diagnosed by computed tomography pulmonary angiography with its associated imaging features and marker in Hospital Sultanah Bahiyah (HSB)
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Date
2023
Authors
Eng, Tan Yew
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Abstract
Background: COVID-19 pneumonia is a viral infection that primarily affects the respiratory system and can lead to severe respiratory distress. Recent studies have suggested an increased risk of pulmonary embolism (PE) in COVID-19 pneumonia which could lead to morbidity and mortality. However, the proportion, imaging features, and biomarkers such as D-dimer level of PE in COVID-19 pneumonia are yet to be established in Malaysia. The purpose of this study is to determine the proportion of PE, clinical staging of COVID-19 pneumonia, D-dimer levels, associated imaging features and the mortality rate among COVID-19 pneumonia. Methods: A cross-sectional study that using retrospective data conducted in Hospital Sultanah Bahiyah (HSB), Alor Setar, Kedah, Malaysia, on 949 patients with COVID-19 pneumonia suspected with PE underwent CTPA. All the CTPA images were reviewed and reported for the presence of PE and associated imaging features by radiologists in the Radiology Department at HSB. The demography, clinical staging of COVID-19 pneumonia, D-dimer levels and mortality status were collected. The association between PE in COVID-19 pneumonia and mortality status were tested using Pearson’s Chi-Square Test. The independent T-test was used to estimate the mean difference age and D-dimer levels between PE and without PE in COVID-19 pneumonia. Result: A total of 216 (22.8%) were diagnosed with PE by CTPA and commonly found in segmental and subsegmental pulmonary arteries. The most common associated imaging feature was ground-glass opacities. COVID-19 pneumonia with PE showed elevated D-dimer levels, with a mean of 6.74 (SD 7.34) vs. 3.93 (SD 5.51) without PE (p = <0.001). Out of the 216 death in COVID-19 pneumonia with PE, the clinical staging in stage 4 were 121 (56.0%) and followed by stage 5 which demonstrated 90 (41.7%). The mortality rate (32.4%) among the PE in COVID-19 pneumonia was statistically significant association with PE (p < 0.001). Conclusion: Our study demonstrated that one-fifth of COVID-19 pneumonia were diagnosed with PE by CTPA and highlights the importance of evaluating clinical biomarkers to identify those at risk for this complication. The identification of imaging features and biomarkers associated with PE in COVID-19 pneumonia could improve the diagnosis and treatment of this potentially life-threatening condition and thus prevent mortality.
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Keywords
COVID-19 pneumonia , computed tomography pulmonary angiography