Original Articles
19 July 2023
Vol. 17 No. 2 (2023)
Lung ultrasound scan score can identify pulmonary embolism high risk in patients with COVID-19: a retrospective analysis from a single center
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Background. Since the European Society of Cardiology (ESC) published guidelines to stratify the risk of pulmonary embolism (PE), the main goal of several physicians has been to find a biomarker able to identify patients with venous thromboembolism at high risk to die. Increased levels of pro-B-type natriuretic peptide (BNP) were suggested as useful biomarkers in the guidelines of ESC (i.e., 2014) to identify patients with PE at high risk of death, but its role was not confirmed in other guidelines. Lung Ultrasound Scan (LUS) has been suggested as a diagnostic and prognostic test to identify patients with a high risk of mortality for lung failure. The aim of this study is to evaluate the prognostic role of pro- BNP together with the LUS evaluation in patients with COVID-19 and PE in particular regarding mortality for pulmonary embolism and overall death. Patients and Methods. We retrospectively analyzed records from 178 patients with confirmed COVID-19, admitted to our ward (i.e., COVID Medicine Unit at Ospedale del Mare in the town of Napoli) between March 2020 and May 2021. For this study, we analyzed the LUS data of all 178 patients and the available data on the pro-BNP of 120 patients. For all selected patients, mortality for PE and overall deaths were recorded. Results. The Propensity Score Matching was used to minimize and erase confounding factors. Data showed that an association between serum levels of pro-BNP and pulmonary thrombotic events was neither present before nor after matching an association with adverse outcomes and was found for increased values of LUS. Discussion. During the first waves of the pandemic, patients with confirmed COVID-19 with severe lung failure frequently showed pulmonary embolism as a clinical acute complication inducing life-threatening evolution. Conclusions. An association between LUS score and severe PE and/or overall mortality in hospitalized patients with COVID-19 was found while a similar association was not confirmed for pro-BNP.
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The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC), 2019, ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) Eur Heart J 2014;35:3033-80.
Becattini C, Vedovati MC, Agnelli G. Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 2007;116:427433. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.680421
Chuy KL, Hakemi EU, Alyousef T, et al. The long-term prognostic value of highly sensitive cardiac troponin I in patients with acute pulmonary embolism. Clin Cardiol 2017;40:1271-8. DOI: https://doi.org/10.1002/clc.22823
Kabrhel C, Mark CD, Camargo Jr CA, et al. Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med 2010;17:589-97. DOI: https://doi.org/10.1111/j.1553-2712.2010.00765.x
Barco S, Mahmoudpour SH, Planquette B, et al. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2019;40:902-10. DOI: https://doi.org/10.1093/eurheartj/ehy873
Miró Ò, Jiménez S, Mebazaa A, et al. Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome. Eur Heart J 2021;00:1-16. DOI: https://doi.org/10.1093/eurheartj/ehab314
Scudiero F, Silverio A, Di Maio M. Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome. Thromb Res 2021;198:34-9.
Gorog DA, Storey RF, Gurbel PA, et al. Current and novel biomarkers of thrombotic risk in COVID-19: a Consensus Statement from the International COVID-19 Thrombosis Biomarkers Col-loquium. Nat Rev Cardiol 2022;19:475-95. DOI: https://doi.org/10.1038/s41569-021-00665-7
Thoreau B, Galland J, Delrue M, et al. D-dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients. Viruses 2021;13:758.
Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with COVID-19. J Thromb Haemost 2020;18:1324-9. DOI: https://doi.org/10.1111/jth.14859
Sandoval Y, Januzzi Jr JL, Jaffe AS. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19. JACC Review Topic of the Week. J Ame Coll Cardiol 2020;76:1244.58. DOI: https://doi.org/10.1016/j.jacc.2020.06.068
O’Donnell C, Ashland MD, Vasti EC, et al. N‐Terminal Pro‐B‐Type Natriuretic Peptide as a Biomarker for the Severity and Outcomes With COVID‐19 in a Nationwide Hospitalized Cohort. J Ame Heart Assoc 2021;10:e022913. DOI: https://doi.org/10.1161/JAHA.121.022913
Martínez Chamorro E, Díez Tascón A, L. Ibáñez Sanz, et al. Radiologic diagnosis of patients with COVID-19. Radiologia 2021;63:56-73. DOI: https://doi.org/10.1016/j.rxeng.2020.11.001
Soldati G, Smargiassi A, Inchingolo R, et al. Proposal for International Standardization of the use of Lung. Ultrasound for Patients with COVID-19. J Ultrasound Med 2020;39:1413-9. DOI: https://doi.org/10.1002/jum.15285
Pan F, Ye T, Sun P, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiol 2020;295:715-21. DOI: https://doi.org/10.1148/radiol.2020200370
R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available from: https://www.Rproject.org/
Khan MRA, Brandenburger T. ROCit: Performance Assessment of Binary Classifier with Visualization. R package version 2.1.1. 2020. Available from: https://CRAN.Rproject.org/package=ROCit
Ho DE, Imai K, King G, Stuart EA. MatchIt: Nonparametric Preprocessing for Parametric Causal Inference. J Stat Softw 201142:1-28.
Allen M, Poggiali D, Whitaker K, et al. Raincloud plots: a multi-platform tool for robust data visualization. Welcome Open Res 2021:4:63. DOI: https://doi.org/10.12688/wellcomeopenres.15191.2
Jin JM, Bai P, He W, et al. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front Pub Health 2020;8:152. DOI: https://doi.org/10.3389/fpubh.2020.00152
STROBE, Strengthening the reporting of observational studies in epidemiology. Available from: https://www.strobe-statement.org/
Stein PD, Matta F, Janjua M, et al. Outcome in stable patients with acute pulmonary embolism who had right ventricular enlargement and/or elevated levels of troponin I. Am J Cardiol 2010;106:558-63. DOI: https://doi.org/10.1016/j.amjcard.2010.03.071
Pasha SM, Klok FA, van der Bijl N, et al. NT-pro-BNP levels in patients with acute pulmonary embolism are correlated to right but not left ventricular volume and function. Thromb Haemost 2012;108:367-72. DOI: https://doi.org/10.1160/TH11-12-0901
Kiely DG, Kennedy NS, Pirzada O, et al. Elevated levels of natriuretic peptides in patients with pulmonary thromboembolism. Respir Med 2005;99:1286-91. DOI: https://doi.org/10.1016/j.rmed.2005.02.029
Jimenez D, Aujesky D, Moores L, et al. Combinations of prognostic tools for identification of high-risk normotensive patients with acute symptomatic pulmonary embolism. Thorax 2011;66:75-81. DOI: https://doi.org/10.1136/thx.2010.150656
Pruszczyk P, Kostrubiec M, Bochowicz A, et al. Torbicki N-terminal pro-brain natriuretic pep-tide in patients with acute pulmonary embolism. Eur Respir J 2003;22:649-53. DOI: https://doi.org/10.1183/09031936.03.00023303
Alonso Fernández A, Toledo-Pons N, Cosío BG, et al. Prevalence of pulmonary embolism in patients with COVID-19 pneumonia and high D-dimer values: A prospective study. PLoS One 2020;15:e0238216. DOI: https://doi.org/10.1371/journal.pone.0238216
Guzik TJ, Mohiddin SA, Dimarco A, et al. COVID-19 and the cardiovascular system: Implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res 2020;116:1666-87. DOI: https://doi.org/10.1093/cvr/cvaa106
Islam M, Levitus M, Eisen L, et al. Lung Ultrasound for the Diagnosis and Management of Acute Respiratory Failure. Lung 2020;198:1-11. DOI: https://doi.org/10.1007/s00408-019-00309-1
Yoo J, Grewal P, Hotelling J, et al. Admission NT-proBNP and outcomes in patients without history of heart failure hospitalized with COVID-19. ESC Heart Fail 2021;8:4278-87. DOI: https://doi.org/10.1002/ehf2.13548
Klok FA, Mos ICM, Huisman MV. Brain-type natriuretic peptide levels in the prediction of ad-verse outcome in patients with pulmonary embolism: a systematic review and meta-analysis. Ame J Respir Crit Care Med 2008;178:425.30. DOI: https://doi.org/10.1164/rccm.200803-459OC
Caro-Codón J, Rey JR, Buño A, et al. Characterization of NT-proBNP in a large cohort of COVID-19 patients. Eur J Heart Fail 2021;23:456-64. DOI: https://doi.org/10.1002/ejhf.2095
Platz E, Merz AA, Jhund PS, et al. Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. Eur J Heart Fail 2017;19:1154-63. DOI: https://doi.org/10.1002/ejhf.839
Scudiero F, Silverio A, Di Maio M, et al. Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome for. Thromb Res 2021,198:34-9. DOI: https://doi.org/10.1016/j.thromres.2020.11.017
Gil-Rodríguez J, Martos-Ruiz M, Peregrina-Rivas JA, et al. Lung Ultrasound, Clinical and An-alytic Scoring Systems as Prognostic Tools in SARS-CoV-2 Pneumonia: A Validating Cohort. Di-agnostics 2021;11:2211. DOI: https://doi.org/10.3390/diagnostics11122211
Lichter Y, Topilsky Y, Taieb P, et al. Lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Med 2020;46:1873-83. DOI: https://doi.org/10.1007/s00134-020-06212-1
Portale G, Ciolina F, Arcari L, et al. Lung Ultrasound in COVID-19: Clinical Correlates and Comparison with Chest Computed Tomography. SN Compr Clin Med 2021;3:2075-81. DOI: https://doi.org/10.1007/s42399-021-00986-1
Senter R, Capone F, Pasqualin S, et al. Lung Ultrasound Patterns and Clinical-Laboratory Cor relates during COVID-19 Pneumonia: A Retrospective Study from North East Italy. J Clin Med 2021;10:1288. DOI: https://doi.org/10.3390/jcm10061288
Thoreau B, Galland J, Delrue M, et al. D-dimer Level and Neutrophils Count as Predictive and Prognostic Factors of Pulmonary Embolism in Severe Non-ICU COVID-19 Patients. Viruses 2021;13:758. DOI: https://doi.org/10.3390/v13050758
Lugarà M, Tamburrini S, Coppola MG, et al. The Role of Lung Ultrasound in SARS-CoV-19 Pneumonia Management. Diagnostics 2022;12:1856. DOI: https://doi.org/10.3390/diagnostics12081856
Tsai NW, Ngai CW, Mok KL, Tsung JW. Lung ultrasound imaging in avian influenza A (H7N9) respiratory failure. Crit Ultrasound J 2014;6:6. DOI: https://doi.org/10.1186/2036-7902-6-6
How to Cite
Lung ultrasound scan score can identify pulmonary embolism high risk in patients with COVID-19: a retrospective analysis from a single center. (2023). Italian Journal of Medicine, 17(2). https://doi.org/10.4081/itjm.2023.1617
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