CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 4 AFRICA Cardiovascular Topics Changing face of pulmonary embolism with COVID-19 Bayram Bagırtan, Emine Altuntas, Servan Yasar, Kanber Ocal Karabay Abstract Aim: This study aimed to describe the baseline characteristics of coronavirus disease 2019 (COVID-19) patients with pulmonary embolism, and to examine the Geneva score, pulmonary embolism severity index (PESI), radiological and biochemical findings. Methods: From March 2020 to June 2021, the files of 41 COVID-19 patients with pulmonary embolism were accessed. Results: Mean D-dimer value was 6.04 mg/dl and 61% of the patients received at least one dose of anticoagulant treatment. In patients receiving deep venous thrombosis prophlaxis, an optimal D-dimer cut-off point was calculated as 5.69 mg/dl. The area under the curve was 0.753 (p = 0.007; sensivity 64%; specificity 62.5%). The mean Geneva score was 4.31, mean PESI was 72.48 and mean Qanadli score was 11.29. Conclusions: According to this study, traditional clinical predictive scores had little discriminatory power in these patients, and a higher D-dimer cut-off value should be considered to better diagnose patients for pulmonary embolism. Keywords: COVID-19, thrombosis, pulmonary embolism, D-dimer, anticoagulant therapy Submitted 12/10/21, accepted 9/2/22 Published online 4/3/22 Cardiovasc J Afr 2023; 34: 4–8 www.cvja.co.za DOI: 10.5830/CVJA-2022-011 With the emergence of coronavirus disease 2019 (COVID-19) in December 2019, a new pandemic page has been opened in the history of the world. The disease, which was initially thought to be a highly contagious viral infection, later evolved into a multisystem inflammatory and thrombotic disease due to the involvement of cardiovascular and pulmonary structures.1 A clinic of patients infected with COVID-19 ranges from completely asymptomatic to rapidly devastating courses with acute respiratory distress syndrome associated with high fatality rates. Pulmonary embolism (PE), deep-vein thrombosis, ischaemic stroke and myocardial infarction are examples of complications of the disease.1 Excessive inflammation, hypoxia, immobilisation, platelet activation and endothelial dysfunction are contributors to the prothrombotic state.2,3 COVID-19 infection affects not only the pulmonary parenchyma but also the pulmonary vascular bed. Autopsy studies have demonstrated the presence of thrombi in the pulmonary arteries and alveolar capillaries of individuals deceased from COVID-19.4,5 Recent studies have revealed that patients with COVID-19 had higher PE prevalence than usually encountered in non-infected critically ill patients. 6-9 Several prognostic indicators of mortality, such as admission clinical properties and laboratory parameters have been defined in PE. PE severity index (PESI) is a powerful predictor of a worse prognosis, and clinical use of PESI is recommended by the European Society of Cardiology. Also, the Geneva score is a clinical prediction rule to assess PE pre-test probability.10-13 This study aimed to describe the baseline characteristics of COVID19 patients with PE, and assess the Geneva score and PESI. Methods The study was retrospective and single centred. From March 2020 to June 2021, the files of all patients admitted to hospital with a diagnosis of PE were accessed. Among them, patients who had simultaneous COVID-19 infection were included in the study. The exclusion criteria were pregnancy and those younger than 18 years. According to World Health Organisation criteria, COVID-19 infectionwas determined by positive results from real-time reverse transcription polymerase chain reaction of nasopharyngeal swabs or by typical imaging characteristics on chest computed tomography. Patients without computed tomography pulmonary angiography (CTPA) to diagnose PE were excluded. The study protocol was approved by the local ethics committee. From the hospital record system, baseline information including demographic characteristics and co-existing medical conditions were obtained. Clinical parameters and biological findings at the diagnosis of PE were recorded for calculation of PESI andGeneva scores. Laboratory data such as complete blood count, albumin, D-dimer, C-reactive protein (CRP), ferritin, fibrinogen, fasting glucose and high-sensitivity (hs) troponin T levels, and kidney and liver function tests were collected on the day of diagnosis of PE. Data on pharmacological therapies, respiratory complications, morbidity and mortality were also gathered during the hospitalisation. CTPA examinations with 16-section (Cannon Aquilion Lightning, Canon Medical Systems Europe BV, Zoerterme Cardiology Department , Sancaktepe Sehit Prof Dr Ilhan Varank Education and Training Hospital, Istanbul, Turkey Bayram Bagırtan, MD Emine Altuntas, MD, emine_altuntas@hotmail.com Kanber Ocal Karabay, MD Radiology Department, Sancaktepe Sehit Prof Dr Ilhan Varank Education and Training Hospital, Istanbul, Turkey Servan Yasar, MD
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