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Original Article

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Blood Res 2023; 58(3):

Published online September 30, 2023

https://doi.org/10.5045/br.2023.2023076

© The Korean Society of Hematology

Investigating the prevalence of and predictive and risk factors for pulmonary embolism in patients with COVID-19 in Nemazee Teaching Hospital

Mahnaz Yadollahi1, Hessam Hosseinalipour1, Mehrdad Karajizadeh1, Muhammad Alinaqi1, Pooria Fazeli1, Mehrdad Jowkar2, Kazem Jamali1, Maryam Yadollahi3

Author Info. +

1Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, 2Shiraz University of Medical Sciences, 3Shiraz Central Hospital (MRI), Shiraz, Iran

Correspondence to : Pooria Fazeli, M.sc.
Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Fars Province, Shiraz 71948-15711, Iran
E-mail: Pooriafazeli9270@gmail.com

*This study was supported by a grant from the Shiraz University of Medical Science in the context of a dissertation project (grant no. 24400).

Received: April 19, 2023; Revised: June 14, 2023; Accepted: June 29, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Background
Pulmonary thromboembolism (PTE) is a significant contributing factor to vascular diseases. This study aimed to determine the prevalence of pulmonary thromboembolism and its predisposing factors in patients with COVID-19.
Methods
This cross-sectional study included 284 patients with COVID-19 who were admitted to Nemazee Teaching Hospital (Shiraz, Iran) between June and August 2021. All patients were diagnosed with COVID-19 by a physician based on clinical symptoms or positive polymerase chain reaction (PCR) test results. The collected data included demographic data and laboratory findings. Data were analyzed using the SPSS software. P≤0.05 was considered statistically significant.
Results
There was a significant difference in the mean age between the PTE group and non-PTE group (P=0.037). Moreover, the PTE group had a significantly higher prevalence of hypertension (36.7% vs. 21.8%, P=0.019), myocardial infarction (4.5% vs. 0%, P=0.006), and stroke (23.9% vs. 4.9%, P=0.0001). Direct bilirubin (P=0.03) and albumin (P=0.04) levels significantly differed between the PTE and non-PTE groups. Notably, there was a significant difference in the partial thromboplastin time (P=0.04) between the PTE and non-PTE groups. A regression analysis indicated that age (OR, 1.02; 95% CI, 1.00‒1.004; P=0.005), blood pressure (OR, 2.07; 95% CI, 1.12‒3.85; P=0.02), heart attack (OR, 1.02; 95% CI, 1.28‒6.06; P=0.009), and albumin level (OR, 0.39; 95% CI, 0.16‒0.97; P=0.04) were all independent predictors of PTE development.
Conclusion
Regression analysis revealed that age, blood pressure, heart attack, and albumin levels were independent predictors of PTE.

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Keywords: Thromboembolism, COVID-19, Mortality, Pulmonary risk factors

Article

Original Article

Blood Res 2023; 58(3): 127-132

Published online September 30, 2023 https://doi.org/10.5045/br.2023.2023076

Copyright © The Korean Society of Hematology.

Investigating the prevalence of and predictive and risk factors for pulmonary embolism in patients with COVID-19 in Nemazee Teaching Hospital

Mahnaz Yadollahi1, Hessam Hosseinalipour1, Mehrdad Karajizadeh1, Muhammad Alinaqi1, Pooria Fazeli1, Mehrdad Jowkar2, Kazem Jamali1, Maryam Yadollahi3

1Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, 2Shiraz University of Medical Sciences, 3Shiraz Central Hospital (MRI), Shiraz, Iran

Correspondence to:Pooria Fazeli, M.sc.
Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Fars Province, Shiraz 71948-15711, Iran
E-mail: Pooriafazeli9270@gmail.com

*This study was supported by a grant from the Shiraz University of Medical Science in the context of a dissertation project (grant no. 24400).

Received: April 19, 2023; Revised: June 14, 2023; Accepted: June 29, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background
Pulmonary thromboembolism (PTE) is a significant contributing factor to vascular diseases. This study aimed to determine the prevalence of pulmonary thromboembolism and its predisposing factors in patients with COVID-19.
Methods
This cross-sectional study included 284 patients with COVID-19 who were admitted to Nemazee Teaching Hospital (Shiraz, Iran) between June and August 2021. All patients were diagnosed with COVID-19 by a physician based on clinical symptoms or positive polymerase chain reaction (PCR) test results. The collected data included demographic data and laboratory findings. Data were analyzed using the SPSS software. P≤0.05 was considered statistically significant.
Results
There was a significant difference in the mean age between the PTE group and non-PTE group (P=0.037). Moreover, the PTE group had a significantly higher prevalence of hypertension (36.7% vs. 21.8%, P=0.019), myocardial infarction (4.5% vs. 0%, P=0.006), and stroke (23.9% vs. 4.9%, P=0.0001). Direct bilirubin (P=0.03) and albumin (P=0.04) levels significantly differed between the PTE and non-PTE groups. Notably, there was a significant difference in the partial thromboplastin time (P=0.04) between the PTE and non-PTE groups. A regression analysis indicated that age (OR, 1.02; 95% CI, 1.00‒1.004; P=0.005), blood pressure (OR, 2.07; 95% CI, 1.12‒3.85; P=0.02), heart attack (OR, 1.02; 95% CI, 1.28‒6.06; P=0.009), and albumin level (OR, 0.39; 95% CI, 0.16‒0.97; P=0.04) were all independent predictors of PTE development.
Conclusion
Regression analysis revealed that age, blood pressure, heart attack, and albumin levels were independent predictors of PTE.

Keywords: Thromboembolism, COVID-19, Mortality, Pulmonary risk factors


Demographic information, clinical characteristics, and condition of the patients at the time of admission..


Total
(N=284)		PTE
(N=62)		Non-PTE
(N=222)		P
Age (yr), mean±SD52.42±15.6857.6±16.551±15.20.037
Sex (male)a), N (%)14338 (61.3)105 (51.2)0.11
Pre-conditional health
COVID-19 history, N (%)0.999
Yes68 (24)13 (21.3)45 (21.1)
No180 (63.4)40 (65.6)140 (65.7)
Unknown36 (12.6)8 (13.1)28 (13.1)
Current smoking, N (%)26 (9.1)12 (19.3)14 (6.3)0.001
Malignancy, N (%)27 (9.5)2 (3.3)25 (11.8)0.052
Hypertension, N (%)68 (24)22 (36.7)46 (21.8)0.019
MI, N (%)3 (1)3 (4.5)0 (0)0.006
Diabetes, N (%)40 (14)12 (17.9)28 (16.7)0.81
CVA, N (%)23 (8)16 (23.9)7 (4.9)<0.0001
GI disease, N (%)5 (1.7)1 (1.5)5 (2.4)0.67
Allergy, N (%)6 (2.1)0 (0)6 (2.8)0.36
CRD, N (%)5 (1.7)2 (3.3)3 (1.4)0.33
DVT history, N (%)8 (2.8)4 (6.7)4 (1.8)0.1
On admission clinical presentation
Temperature, °C (mean±SD)36.89±0.5836.8±0.6336.9±0.570.44
RR, breaths per minute, (mean±SD)21.41±4.0921±2.1721.5±4.50.68
HR, beats per minute, (mean±SD)99.3±17.62101.9±17.598.6±17.60.34
Systolic blood pressure, (mmHg)122.47±27.19125.2±22.2121.6±26.70.35
Diastolic blood pressure, (mmHg)89.13±24.6287±21.289.8±25.60.87
Oxygen therapy
Blood O2 saturation, (mean±SD)92.88±4.2793.2±6.0692.7±3.50.01

a)Seven patients were missing..

Abbreviations: CRD, chronic respiratory disease; CVA, cerebrovascular accident; DVT, deep vein thrombosis; GI, gastrointestinal; HR, heart rate; MI, myocardial infarction; PTE, pulmonary thromboembolism; RR, respiratory rate..

Laboratory findings in the PTE and the non-PTE populations of the study on admission..


On-admission laboratory tests (mean±SD)Total (N=284)
(mean±SD)		PTE (N=62)
(mean±SD)		Non-PTE (N=222)
(mean±SD)		P
Biochemistry parameters
BUN (mg/dL)19.71±17.2421.2±15.519.2±17.80.2
Cr (mg/dL)1.16±1.141.18±1.061.12±0.630.7
AST (IU/L)46.65±28.958.4±33.843.2±26.40.01
ALT (IU/L)45.1±36.241.8±31.153.4±45.80.1
ALKP (IU/L)251.6±197.4225.85±114.83242±99.740.5
Total protein (g/dL) 6.7±0.786.14±0.815.84±0.640.1
Total bilirubin (mg/dL) 1.4±1.27 1.9±1.091.73±1.490.1
Direct bilirubin (mg/dL)0.85±0.50.88±0.720.84±0.440.03
Albumin (g/dL) 3.2±0.493.11±0.513.3±0.470.04
CPK (IU/L)149.5±158.8150.2±161.65152.2±153.70.9
LDH (IU/L)1,080.0±1,058.41,072.3±1,0171,284±1,0230.2
Troponin (ng/mL)85.4±114.741.4±60.7173.4±149.40.05
Hematologic parameters
Hemoglobin (mg/dL)12.46±2.4612.32±2.4812.98±2.350.08
ESR (mm/h)32.8±25.0832.7±22.435.5±37.10.8
PLT×103 (per mL)226±105.25209.9±98.3230.9±107.70.2
PT (s)15.9±4.1415.47±3.3116.96±5.660.1
PTT (s)34.3±16.835.0±18.731.2±5.640.04
INR1.19±0.321.16±0.261.28±0.450.1
Serologic and immunologic parameters
CRP (mg/L)74.27±70.0781.7±68.573.6±71.10.4
D-dimer (μg/mL)3,020.5±2,961.42,048.4±1,824.44,575.9±3,9460.2

Abbreviations: ALKP, alkaline phosphatase; ALT, alanine transaminase; AST, aspartate transaminase; BUN, blood urea nitrogen; CPK, creatine phosphokinase; Cr, creatinine; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; INR, international normalized ratio; LDH, lactate dehydrogenase; PLT, platelet; PT, prothrombin time; PTE, pulmonary thromboembolism; PTT, partial thromboplastin time..

The logistic regression analysis of PTE predictive factors..


OR (95% CI)P
Age1.02 (1.00–1.04)0.005
Sex (male)1.65 (0.93–2.95)0.085
Pre-conditional health
Hypertension2.07 (1.12–3.85)0.02
MI2.79 (1.28–6.06)0.009
CVA0.86 (0.31–2.42)0.78
On-admission laboratory findings
Total protein0.6 (0.29–1.25)0.1
Direct bilirubin1.36 (0.81–2.3)0.2
Albumin0.39 (0.16–0.97)0.04
LDH1.00 (1.00–1.00)0.2
PT1.04 (0.98–1.11)0.2
PTT0.97 (0.94–1.01)0.2

Abbreviations: CI, confidence interval; CVA, cerebrovascular accident; LDH, lactate dehydrogenase; MI, myocardial infarction; OR, odds ratio; PT, prothrombin time; PTT, partial thromboplastin time..

The multivariate logistic regression analyses of PTE risk factors..


BOR (95% CI)P
Age0.221.02 (0.99–1.05)0.12
Albumin-1.040.35 (0.13–0.92)0.03

Abbreviations: CI, confidence interval; OR, odds ratio..
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