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The site and cause of infection in patients with pulmonary embolism combined with infectious disease
Source publication
Background:
Infectious conditions may increase the risk of venous thromboembolism. The purpose of this study was to evaluate the risk factor for combined infectious disease and its influence on mortality in patients with pulmonary embolism (PE).
Methods:
Patients with PE diagnosed based on spiral computed tomography findings of the chest were re...
Contexts in source publication
Context 1
... tract in three (4.5%), gastrointestinal tract in two (2.98%), bones and joints in three (4.5%), and other organ systems in four (5.4%) ( Table 2). ...Similar publications
Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE). Limited data are available on the utilization of the Pulmonary Embolism Response Team (PERT) in the setting of the COVID-19 global pandemic. We performed a single-center study to evaluate treatment, mortality, and bleeding outcomes in patients who received...
Citations
... Protein C (PC) plays an essential physiological role in the regulation of blood coagulation, and patients with hereditary protein C deficiency or low circulating APC levels are at an elevated risk of venous thromboembolism (VTE) [27]. Recent research has linked PC and APC to various clinical diseases, including pneumonia, obesity, sepsis, cutaneous wound healing, deep vein thrombosis/pulmonary embolism, preeclampsia, and chronic renal failure [28]. In addition, APC can reduce graft-versus-host disease by preventing neutrophil extracellular trap formation and leukocyte cytokine release in two different tumor cell models [29]. ...
Ischemic heart disease, which results from plaque formation in the coronary arteries, hinders the flow of oxygenated blood to the heart, leading to ischemia. Reperfusion injury remains a significant challenge for researchers, and the mechanisms underlying myocardial ischemia–reperfusion injury (MIRI) are not entirely understood. The review directs future research into potential targets in clinical treatment based on our present understanding of the pathophysiological mechanisms of MIRI. The study provides insights into the mechanisms underlying MIRI and offers direction for future research in this area. The use of targeted therapies may hold promise in improving cardiac function in the elderly and minimizing the adverse effects of revascularization therapies. The purpose of this review is to analyze the role of activated protein C (APC) in the pathogenesis of ischemic heart disease, heart failure, and myocardial ischemia–reperfusion injury, and discuss the potential of APC-based therapeutics.
Graphical Abstract
... Our results underline the close link between COVID-19 and prothrombotic diathesis. Several reports showed that various infectious conditions are associated with the development of venous thromboembolism (VTE) [15,16] and a substantial portion of patients with PE has an underlying acute infectious condition, especially respiratory tract infections [17,18]. Although the precise mechanism underpinning this association has not yet been clarified, there is evidence suggesting that infections can promote thrombosis through endothelial injury, tissue factor-induced activation of the procoagulant pathway, down-regulation of the endogenous anticoagulant pathway, and inhibition of fibrinolysis [19][20][21][22]. ...
... Our results underline the close link between COVID-19 and prothrombotic diathesis. Several reports showed that various infectious conditions are associated with the development of venous thromboembolism (VTE) [15,16] and a substantial portion of patients with PE has an underlying acute infectious condition, especially respiratory tract infections [17,18]. Although the precise mechanism underpinning this association has not yet been clarified, there is evidence suggesting that infections can promote thrombosis through endothelial injury, tissue factor-induced activation of the procoagulant pathway, down-regulation of the endogenous anticoagulant pathway, and inhibition of fibrinolysis [19][20][21][22]. ...
Background and aims
Several studies reported a high incidence of pulmonary embolism (PE) among patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but detailed data about clinical characteristics, risk factors of these patients and prognostic role of PE are still lacking. We aim to evaluate the occurrence of pulmonary embolism among patients with SARS-CoV-2 infection, and to describe their risk factors, clinical characteristics, and in-hospital clinical outcomes.
Methods
This is a multicenter Italian study including 333 consecutive SARS-CoV-2 patients admitted to seven hospitals from February 22 to May 15, 2020. All the patients underwent computed tomography pulmonary angiography (CTPA) for PE detection. In particular, CTPA was performed in case of inadequate response to high-flow oxygen therapy (Fi0 2 ≥0.4 to maintain Sp02≥92%), elevated D-dimer (>0.5μg/mL), or echocardiographic signs of right ventricular dysfunction. Clinical, laboratory and radiological data were also analyzed.
Results
Among 333 patients with laboratory confirmed SARS-CoV-2 pneumonia and undergoing CTPA, PE was detected in 109 (33%) cases. At CTPA, subsegmental, segmental, lobar and central thrombi were detected in 31 (29%), 50 (46%), 20 (18%) and 8 (7%) cases, respectively. In-hospital death occurred in 29 (27%) patients in the PE-group and in 47 (21%) patients in the non-PE group (p = 0.25). Patients in PE-group had a low rate of traditional risk factors and deep vein thrombosis was detected in 29% of patients undergoing compression ultrasonography. In 71% of cases with documented PE, the thrombotic lesions were located in the correspondence of parenchymal consolidation areas.
Conclusions
Despite a low rate of risk factors for venous thromboembolism, PE is present in about 1 out 3 patients with SARS-CoV-2 pneumonia undergoing CTPA for inadequate response to oxygen therapy, elevated D-dimer level, or echocardiographic signs of right ventricular dysfunction. In most of the cases, the thromboses were located distally in the pulmonary tree and were mainly confined within pneumonia areas.
... from a primary care general practice database. Recently, Lee et al. 10 reported that infection combined with VTE increased mortality. However, there was the limitation that PE was diagnosed incidentally by conventional computed tomography in over two-thirds of the patients. ...
Background
Abdominal CT is a mainstay in the evaluation of abdominal infections, trauma, oncology, and postoperative complications. Pulmonary embolism is a common complication, but there is a risk that these ancillary findings are overlooked. In addition, data on detection rate and characteristics of incidental pulmonary embolism (iPE) on abdominal CT are lacking.
Purpose
The current study compared the period before and after implementing an artificial intelligence (AI) algorithm for iPE detection regarding detection rate and characteristics.
Material and Methods
A retrospective cross-sectional study was performed on abdominal CTs between August 1, 2019, and January 31, 2021 (before AI implementation, 8026 studies) and August 1, 2021, and January 31, 2023 (after AI implementation, 8765 studies). iPE cases were identified through text search and manually confirmed. Study indication and urgency were recorded for iPE patients, and the most proximal iPE level was assessed. A total of 1000 cases after AI implementation were randomly selected and manually reviewed for AI accuracy analysis.
Results
A total of 5876 patients with a mean age of 63.6 ± 17.7 years were included before AI implementation, and 6310 patients with a mean age of 63.2 ± 18.3 years after AI implementation. The iPE detection rate was higher after AI implementation, 0.57% (50/8765 studies) vs 0.12% (10/8026), P < .001. The most common study indications were abdominal pain (25%, 15/60 cases) and infection (30%, 18/60 cases). There were no differences in CT pulmonary angiography usage or the most proximal extent of the iPE between the periods before or after AI implementation, P > .05. AI identified 46/50 of the reported iPE with 7 AI false-positive cases for a positive predictive value of 87% (95% confidence interval: 75-93%). In the manually reviewed randomly selected subset, iPE prevalence was 1.7% (15/874, 95% confidence interval: 1.0-2.8%) with AI having 40% sensitivity (95% CI, 16-68) and 100% specificity (95% CI, 99.5-100).
Conclusion
Implementing AI for iPE detection and triage increased the iPE detection rate in abdominal CT. The AI sensitivity was moderate, with very few AI false positives.
Background
Atrial fibrillation (AF) is a common arrhythmia with increasing prevalence with respect to age and comorbidities. AF may influence the prognosis in patients hospitalized with Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis.
Methods and results
We assessed the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis. Data of all COVID-19 patients hospitalized in the University Hospital in Krakow, Poland, between March 2020 and April 2021, were analyzed. The following outcomes: short-term (30-days since hospital admission) and long-term (180-days after hospital discharge) mortality, major cardiovascular events (MACEs), pulmonary embolism, and need for red blood cells (RBCs) transfusion, as a surrogate for major bleeding events during hospital stay were assessed. Out of 4,998 hospitalized patients, 609 had AF (535 pre-existing and 74 de novo ). Compared to those without AF, patients with AF were older and had more cardiovascular disorders. In adjusted analysis, AF was independently associated with an increased risk of short-term { p = 0.019, Hazard Ratio [(HR)] 1.236; 95% CI: 1.035–1.476} and long-term mortality (Log-rank p < 0.001) as compared to patients without AF. The use of novel oral anticoagulants (NOAC) in AF patients was associated with reduced short-term mortality (HR 0.14; 95% CI: 0.06–0.33, p < 0.001). Moreover, in AF patients, NOAC use was associated with a lower probability of MACEs (Odds Ratio 0.3; 95% CI: 0.10–0.89, p = 0.030) without increase of RBCs transfusion.
Conclusions
AF increases short- and long-term risk of death in patients hospitalized due to COVID-19. However, the use of NOACs in this group may profoundly improve prognosis.
