Is there a link between lung parenchyma lesions , BMI , CRP , D-dimer and acute pulmonary embolism in patients infected with COVID-19 ?

Introduction: ince the outbreak of the COVID-19 pandemic , increasing suggests that infected patients present a high incidence of venous thromboembolic events (VTE). The main objective of this retrospective study was to evaluate the prevalence of acute pulmonary embolism (PE) on pulmonary computer tomography angiograms (CTPA) in patients classified as COVID-19 infection. The second objective was to determine if there is a link between D-dimer levels, serum C-reactive protein (CRP ), body mass index (BMI) , the lung parenchyma lesions (LPL) and acute pulmonary embolism (PE) in these patients. Material and Methods: 120 patients with mean age 65 ±14.5 years infected with COVID- 19 underwent in our institution a CTPA for suspected PE .Thirty four were in intensive care units (ICU). A COVID-19 diagnosis was made by transcriptase polymerase chain reaction by means of nasopharyngeal swab or by chest CT images. Demographics and co-morbidities characteristics were collected . Laboratory parameters were automatically extracted from our heath information system. When PE was suspected a CTPA were acquired after injection of high concentration iodine contrast media .The criterion of suspected PE were based on the clinical respiratory deterioration , with an increased need for oxygen. A venous duplex ultrasound (DU) test of lower limbs was performed on admission. Results: CTPA showed 24 acute PE (20%) , of which 11 primary and 13 associated with deep venous thrombosis diagnosed on DU .Eleven of the 24 (45.8 %)had PE despite preventive and therapeutic anticoagulation with low molecular weight heparin with Enoxaparin (7 with preventive anticoagulation and 4 had therapeutic dose), of them 8 (72.7%) with risk factors for VTE .Acute PE was not significantly associated with CRP and LPL. However , we found a significant association between acute PE and BMI (mean 32.41±5.90 versus 27.1± 5.2 kg/m2, p 0.0007) or D-dimer Levels (mean 6040±5068 versus 3396.7±5361.5 ng/ml ,p <0.0001). Conclusions: Hospitalized patients infected with COVID-19 in conventional units or ICU have a high frequency of PE justifying preventive anticoagulation. For those who have a risk factors for VTE a therapeutic anticoagulation may be indicated.