CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 AFRICA 5 the Netherlands) and 128-section (D Revolution Evo Gen 3, GE Healthcare, Waukesha, WI, USA) multislice CT devices were carried out. The CTPA protocol was performed using a multidetector scanner after intravenous injection of 50–75 ml of high-concentration iodinated contrast agent at a flow rate of 3–4 ml/s, which was triggered on the main pulmonary artery. The Qanadli score or CT obstruction index is calculated by regarding the arterial tree of each lung as having 10 segmental arteries (three to the upper lobes, two to the middle lobe and lingula, and five to the lower lobes). Embolus in a segmental artery = one point; embolus in the most proximal arterial level = a value equal to the number of segmental arteries arising distally. Weighting factor (for residual perfusion) = the degree of vascular obstruction (no thrombus = zero; partially occlusive thrombus = one; total occlusion = two). The maximal CT obstruction index = 40 for each patient (10 × maximum weighting of 2 = 20 for each side). Isolated subsegmental embolus is considered equal to a partially occluded segmental artery.14 In addition, a CT severity score of one to five was given using ground-glass opacities and consolidations and the extent of COVID-19 lung lesions and the percentage of lung volume affected.15 The CTPA results of COVID-19 and the presence of PE were analysed by an experienced radiologist. Statistical analysis In this study, the Statistical Package for Social Sciences (SPSS) 20.0 for Windows (USA, Armonk, New York) program was used for statistical analysis. Distribution of continuous data was assessed with the Kolmogorov–Smirnov test. Normally distributed variables are expressed as mean ± standard deviation, whereas non-normally distributed variables are given as median and interquartile range. Categorical variables are reported as numbers and percentages. Categorical variables were compared with the chi-squared test or Fisher’s exact test, where appropriate. Correlation analysis was used to examine the relationships between PESI score, Geneva score, CHA2DS2-VASc score, CRP, procalcitonin, fibrinogen, hs-troponin T, D-dimer and glucose. Receiver operating characteristic (ROC) curve analysis was performed and the Youden index was calculated to determine the optimal D-dimer threshold to predict in patients with COVID-19 and PE receiving thromboprophylaxis. Results Between March 2020 and June 2021, 581 patients were diagnosed with PE. After the exclusion of ineligible tests and a reduction for duplicate tests, a total of 41 cases were included in the study. The mean age was 53.92 years and 73.2% were male. Hypertension (10, 24.4%), ischaemic heart disease (five, 12.2%) and diabetes (seven, 17.7%) were the most common co-morbidities. Five patients were admitted to the intensive care unit (ICU), and the length of stay in ICU was nine days (IQR 9). The mean time from the nasopharyngeal swab test to pulmonary BTA was 13.28 days. Twenty-five of the patients needed oxygen. Twenty-five patients (61%) received thromboprophylaxis with enoxaparin by the time of admission. Four of the PE patients (9.8%) were diagnosed with deep venous thrombosis. The mean Geneva score was 4.31, and 92.7% of the patients fell into the low- to intermediate-risk group. The mean PESI was 72.48, and 65.9% of the patients were in Class I to II. The anthropometric and clinical characteristics are described in Tables 1 and 2. D-dimer levels were extremely high, while hs-troponin T levels were slightly elevated. Laboratory tests and radiological findings are presented in Table 1. The patients were also evaluated according to the severity of pneumonia and PE. Patients were classified according to the severity of lung involvement. Stage 3 to 5 involvement was observed in 29 (70.8%) of the patients. It was determined that 10 (34.5%) of them did not receive thromboprophylaxis (Table 3). The mean Qanadli score was 11.29. Bivariate analysis showed significant correlations between CHA2DS2-VASc and PESI scores (rho = 0.484, p = 0.001). Furthermore the Geneva score was positively correlated with the Qanadli score. In addition, a positive correlation was observed between the Qanadli score and the right/left ventricular (RV/LV) ratio. Correlation analysis results are given in Table 4. A ROC curve was performed to determine the optimal threshold for D-dimer to predict PE occurrence on CTPA in patients with COVID-19 receiving thromboprophylaxis. The area under the curve (AUC) was 0.753 (p = 0.007) (Fig. 1). Discussion The main findings of this study are that the Geneva score and PESI were not high in patients with COVID-19 and PE. Besides, most of the patients developed PE despite anticoagulant therapy. Table 1. Descriptive, radiological and biochemical parameters of the patients Variables Mean ± SD or n (%) Age (years) 53.92 ± 16.88 Gender, males 30 (73.2) Smoking 3 (7.3) Diabetes mellitus 7 (17.1) Hypertension 10 (24.4) Cerebrovascular event 2 (4.9) Congestive heart failure 0 Ischaemic heart disease 5 (12.2) Malignancy 3 (7.3) D-dimer (mg/dl) 6.04 (9.06) hs-troponin T (µg/ml) 0.0085 (0.01) Fibrinogen (mg/dl) 518 (226.5) Glucose (mg/dl) 113.7 (32.63) Creatinin (mg/dl) 0,79 (0.27) Procalcitonine (ng/ml) 0.1 (0.11) C-reactive protein (mg/dl) 69.01 (92.9) WBC (103/µl) 9154 ± 3771 Neutrophils (103/µl) 6865 ± 3573 Lymphocytes (103/µl) 1540 ± 686 Platelets (103/µl) 286 ± 126 Haemoglobin (g/l) 13.1 (1.88) Severity of COVID-19 pneumonia Stage 1 6 (14.6) Stage 2 6 (14.6) Stage 3 10 (24.4) Stage 4 11 (19.5) Stage 5 8 (19.5) Qanadli score 11.29 ± 8.63 RV/LV ratio 0.68 (0.13) WBC: white blood cells; LV: left ventricle; RV: right ventricle.
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