Predicción del desarrollo de tromboembolia pulmonar en pacientes con infección por SARS-CoV-2

Mosquera, Manuel Gil; Fernández-Ruiz, Mario; Rodríguez, Elena Sanz; Martínez, Aránzazu Mata; Sanz, Laín Ibáñez; Martín, David Muñoz; Pardo, Otilia Bisbal; Chamorro, Elena Martínez

Objective: To determine the predictive factors of pulmonary thromboembolic disease in patients with SARS-CoV-2 (COVID-19) infection assessed in the emergency department at a tertiary hospital during the first pandemic wave. Method: Observational single-center study conducted in a retrospective cohort of patients with confirmed SARS-CoV-2 infection (or with high clinical-radiological suspicion) who underwent pulmonary thromboembolism (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: Of a total of 274 CTPA performed, 70 procedures presented diagnostic findings of PE, representing a cumulative incidence of 25.54% (95% confidence interval [CI]: 20.49 - 31.14). In the non–D-dimer based model, respiratory rate >22 bpm (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 >3,000 ng/ml (OR: 7.494; 95% CI: 3.038-18.485; p <0.001). Conclusions: The presence of tachypnea (>22 bpm) and the absence of radiological findings suggestive of SARS-CoV-2 infection in the chest X-ray, in addition to D-dimer values >3000 ng/mL, were identified as predictive factors of PTE in patients with COVID-19.