Pulmonary embolism or thrombosis in ARDS COVID-19 patients: A French monocenter retrospective study.
Identifieur interne : 000465 ( Main/Corpus ); précédent : 000464; suivant : 000466Pulmonary embolism or thrombosis in ARDS COVID-19 patients: A French monocenter retrospective study.
Auteurs : Damien Contou ; Olivier Pajot ; Radj Cally ; Elsa Logre ; Megan Fraissé ; Hervé Mentec ; Gaëtan PlantefèveSource :
- PloS one [ 1932-6203 ] ; 2020.
English descriptors
- KwdEn :
- Aged (MeSH), Betacoronavirus (MeSH), Computed Tomography Angiography (MeSH), Coronavirus Infections (complications), Female (MeSH), France (MeSH), Humans (MeSH), Incidence (MeSH), Male (MeSH), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (complications), Pulmonary Embolism (virology), Respiratory Distress Syndrome, Adult (virology), Retrospective Studies (MeSH), Thrombosis (virology).
- MESH :
- geographic : France.
- complications : Coronavirus Infections, Pneumonia, Viral.
- virology : Pulmonary Embolism, Respiratory Distress Syndrome, Adult, Thrombosis.
- Aged, Betacoronavirus, Computed Tomography Angiography, Female, Humans, Incidence, Male, Middle Aged, Pandemics, Retrospective Studies.
Abstract
Hypercoagulability and endotheliopathy reported in patients with coronavirus disease 2019 (COVID-19) combined with strict and prolonged immobilization inherent to deep sedation and administration of neuromuscular blockers for Acute Respiratory Distress Syndrome (ARDS) may expose critically ill COVID-19 patients to an increased risk of venous thrombosis and pulmonary embolism (PE). We aimed to assess the rate and to describe the clinical features and the outcomes of ARDS COVID-19 patients diagnosed with PE during ICU stay. From March 13th to April 24th 2020, a total of 92 patients (median age: 61 years, 1st-3rd quartiles [55-70]; males: n = 73/92, 79%; baseline SOFA: 4 [3-7] and SAPS II: 31 [21-40]; invasive mechanical ventilation: n = 83/92, 90%; ICU mortality: n = 45/92, 49%) were admitted to our 41-bed COVID-19 ICU for ARDS due to COVID-19. Among them, 26 patients (n = 26/92, 28%) underwent a Computed Tomography Pulmonary Angiography which revealed PE in 16 (n = 16/26, 62%) of them, accounting for 17% (n = 16/92) of the whole cohort. PE was bilateral in 3 (19%) patients and unilateral in 13 (81%) patients. The most proximal thrombus was localized in main (n = 4, 25%), lobar (n = 2, 12%) or segmental (n = 10, 63%) pulmonary artery. Most of the thrombi (n = 13/16, 81%) were located in a parenchymatous condensation. Only three of the 16 patients (19%) had lower limb venous thrombosis on Doppler ultrasound. Three patients were treated with alteplase and anticoagulation (n = 3/16, 19%) while the 13 others (n = 13/16, 81%) were treated with anticoagulation alone. ICU mortality was higher in patients with PE compared to that of patients without PE (n = 11/16, 69% vs. n = 2/10, 20%; p = 0.04). The low rate of lower limb venous thrombosis together with the high rate of distal pulmonary thrombus argue for a local immuno-thrombotic process associated with the classic embolic process. Further larger studies are needed to assess the real prevalence and the risk factors of pulmonary embolism/thrombosis together with its prognostic impact on critically ill patients with COVID-19.
DOI: 10.1371/journal.pone.0238413
PubMed: 32853267
PubMed Central: PMC7451560
Links to Exploration step
pubmed:32853267Le document en format XML
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France.</nlm:affiliation></affiliation></author><author><name sortKey="Logre, Elsa" sort="Logre, Elsa" uniqKey="Logre E" first="Elsa" last="Logre">Elsa Logre</name><affiliation><nlm:affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Fraisse, Megan" sort="Fraisse, Megan" uniqKey="Fraisse M" first="Megan" last="Fraissé">Megan Fraissé</name><affiliation><nlm:affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Mentec, Herve" sort="Mentec, Herve" uniqKey="Mentec H" first="Hervé" last="Mentec">Hervé Mentec</name><affiliation><nlm:affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Plantefeve, Gaetan" sort="Plantefeve, Gaetan" uniqKey="Plantefeve G" 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polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Pajot, Olivier" sort="Pajot, Olivier" uniqKey="Pajot O" first="Olivier" last="Pajot">Olivier Pajot</name><affiliation><nlm:affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Cally, Radj" sort="Cally, Radj" uniqKey="Cally R" first="Radj" last="Cally">Radj Cally</name><affiliation><nlm:affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Logre, Elsa" sort="Logre, Elsa" uniqKey="Logre E" first="Elsa" last="Logre">Elsa Logre</name><affiliation><nlm:affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Fraisse, Megan" sort="Fraisse, Megan" uniqKey="Fraisse M" first="Megan" last="Fraissé">Megan Fraissé</name><affiliation><nlm:affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Mentec, Herve" sort="Mentec, Herve" uniqKey="Mentec H" first="Hervé" last="Mentec">Hervé Mentec</name><affiliation><nlm:affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Plantefeve, Gaetan" sort="Plantefeve, Gaetan" uniqKey="Plantefeve G" first="Gaëtan" last="Plantefève">Gaëtan Plantefève</name><affiliation><nlm:affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</nlm:affiliation></affiliation></author></analytic><series><title level="j">PloS one</title><idno type="eISSN">1932-6203</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Betacoronavirus (MeSH)</term><term>Computed Tomography Angiography (MeSH)</term><term>Coronavirus Infections (complications)</term><term>Female (MeSH)</term><term>France (MeSH)</term><term>Humans (MeSH)</term><term>Incidence (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (complications)</term><term>Pulmonary Embolism (virology)</term><term>Respiratory Distress Syndrome, Adult (virology)</term><term>Retrospective Studies (MeSH)</term><term>Thrombosis (virology)</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>France</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Pulmonary Embolism</term><term>Respiratory Distress Syndrome, Adult</term><term>Thrombosis</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Betacoronavirus</term><term>Computed Tomography Angiography</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Retrospective Studies</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Hypercoagulability and endotheliopathy reported in patients with coronavirus disease 2019 (COVID-19) combined with strict and prolonged immobilization inherent to deep sedation and administration of neuromuscular blockers for Acute Respiratory Distress Syndrome (ARDS) may expose critically ill COVID-19 patients to an increased risk of venous thrombosis and pulmonary embolism (PE). We aimed to assess the rate and to describe the clinical features and the outcomes of ARDS COVID-19 patients diagnosed with PE during ICU stay. From March 13th to April 24th 2020, a total of 92 patients (median age: 61 years, 1st-3rd quartiles [55-70]; males: n = 73/92, 79%; baseline SOFA: 4 [3-7] and SAPS II: 31 [21-40]; invasive mechanical ventilation: n = 83/92, 90%; ICU mortality: n = 45/92, 49%) were admitted to our 41-bed COVID-19 ICU for ARDS due to COVID-19. Among them, 26 patients (n = 26/92, 28%) underwent a Computed Tomography Pulmonary Angiography which revealed PE in 16 (n = 16/26, 62%) of them, accounting for 17% (n = 16/92) of the whole cohort. PE was bilateral in 3 (19%) patients and unilateral in 13 (81%) patients. The most proximal thrombus was localized in main (n = 4, 25%), lobar (n = 2, 12%) or segmental (n = 10, 63%) pulmonary artery. Most of the thrombi (n = 13/16, 81%) were located in a parenchymatous condensation. Only three of the 16 patients (19%) had lower limb venous thrombosis on Doppler ultrasound. Three patients were treated with alteplase and anticoagulation (n = 3/16, 19%) while the 13 others (n = 13/16, 81%) were treated with anticoagulation alone. ICU mortality was higher in patients with PE compared to that of patients without PE (n = 11/16, 69% vs. n = 2/10, 20%; p = 0.04). The low rate of lower limb venous thrombosis together with the high rate of distal pulmonary thrombus argue for a local immuno-thrombotic process associated with the classic embolic process. Further larger studies are needed to assess the real prevalence and the risk factors of pulmonary embolism/thrombosis together with its prognostic impact on critically ill patients with COVID-19.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32853267</PMID><DateCompleted><Year>2020</Year><Month>09</Month><Day>04</Day></DateCompleted><DateRevised><Year>2020</Year><Month>09</Month><Day>04</Day></DateRevised><Article PubModel="Electronic-eCollection"><Journal><ISSN IssnType="Electronic">1932-6203</ISSN><JournalIssue CitedMedium="Internet"><Volume>15</Volume><Issue>8</Issue><PubDate><Year>2020</Year></PubDate></JournalIssue><Title>PloS one</Title><ISOAbbreviation>PLoS One</ISOAbbreviation></Journal><ArticleTitle>Pulmonary embolism or thrombosis in ARDS COVID-19 patients: A French monocenter retrospective study.</ArticleTitle><Pagination><MedlinePgn>e0238413</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1371/journal.pone.0238413</ELocationID><Abstract><AbstractText>Hypercoagulability and endotheliopathy reported in patients with coronavirus disease 2019 (COVID-19) combined with strict and prolonged immobilization inherent to deep sedation and administration of neuromuscular blockers for Acute Respiratory Distress Syndrome (ARDS) may expose critically ill COVID-19 patients to an increased risk of venous thrombosis and pulmonary embolism (PE). We aimed to assess the rate and to describe the clinical features and the outcomes of ARDS COVID-19 patients diagnosed with PE during ICU stay. From March 13th to April 24th 2020, a total of 92 patients (median age: 61 years, 1st-3rd quartiles [55-70]; males: n = 73/92, 79%; baseline SOFA: 4 [3-7] and SAPS II: 31 [21-40]; invasive mechanical ventilation: n = 83/92, 90%; ICU mortality: n = 45/92, 49%) were admitted to our 41-bed COVID-19 ICU for ARDS due to COVID-19. Among them, 26 patients (n = 26/92, 28%) underwent a Computed Tomography Pulmonary Angiography which revealed PE in 16 (n = 16/26, 62%) of them, accounting for 17% (n = 16/92) of the whole cohort. PE was bilateral in 3 (19%) patients and unilateral in 13 (81%) patients. The most proximal thrombus was localized in main (n = 4, 25%), lobar (n = 2, 12%) or segmental (n = 10, 63%) pulmonary artery. Most of the thrombi (n = 13/16, 81%) were located in a parenchymatous condensation. Only three of the 16 patients (19%) had lower limb venous thrombosis on Doppler ultrasound. Three patients were treated with alteplase and anticoagulation (n = 3/16, 19%) while the 13 others (n = 13/16, 81%) were treated with anticoagulation alone. ICU mortality was higher in patients with PE compared to that of patients without PE (n = 11/16, 69% vs. n = 2/10, 20%; p = 0.04). The low rate of lower limb venous thrombosis together with the high rate of distal pulmonary thrombus argue for a local immuno-thrombotic process associated with the classic embolic process. Further larger studies are needed to assess the real prevalence and the risk factors of pulmonary embolism/thrombosis together with its prognostic impact on critically ill patients with COVID-19.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Contou</LastName><ForeName>Damien</ForeName><Initials>D</Initials><Identifier Source="ORCID">0000-0003-4336-507X</Identifier><AffiliationInfo><Affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pajot</LastName><ForeName>Olivier</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cally</LastName><ForeName>Radj</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Logre</LastName><ForeName>Elsa</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fraissé</LastName><ForeName>Megan</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mentec</LastName><ForeName>Hervé</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Plantefève</LastName><ForeName>Gaëtan</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D064888">Observational Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>08</Month><Day>27</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>PLoS One</MedlineTA><NlmUniqueID>101285081</NlmUniqueID><ISSNLinking>1932-6203</ISSNLinking></MedlineJournalInfo><SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName><SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000072226" MajorTopicYN="N">Computed Tomography Angiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005602" MajorTopicYN="N" Type="Geographic">France</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015994" MajorTopicYN="N">Incidence</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011655" MajorTopicYN="N">Pulmonary Embolism</DescriptorName><QualifierName UI="Q000821" MajorTopicYN="Y">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName><QualifierName UI="Q000821" MajorTopicYN="Y">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013927" MajorTopicYN="N">Thrombosis</DescriptorName><QualifierName UI="Q000821" MajorTopicYN="Y">virology</QualifierName></MeshHeading></MeshHeadingList><CoiStatement>The authors have declared that no competing interests exist.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>06</Month><Day>11</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>08</Month><Day>18</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>8</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>8</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>9</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32853267</ArticleId><ArticleId IdType="doi">10.1371/journal.pone.0238413</ArticleId><ArticleId 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