Diagnostic features of pulmonary embolism in hospitalized patients with COVID-19

Aim. To determine the effectiveness of diagnosing venous thromboembolic complications in patients with novel coronavirus infection COVID-19 using validated VTE risk assessment scales and routine diagnostic methods such as D-dimer level testing and echocardiography.

Materials and methods. A retrospective, cohort, single-center, controlled, observational study was conducted at the Egorov Central Clinical Medical and Sanitary Unit for patients with novel coronavirus infection in 2020–2021. The study included 1050 patients with a confirmed diagnosis of COVID-19. To establish the diagnosis, patients had to have a positive laboratory test result for SARS-CoV-2 RNA, performed by nucleic acid amplification (real-time polymerase chain reaction test). All patients underwent clinical examination, laboratory, and instrumental diagnostic methods in accordance with the versions of the Provisional Methodological Recommendations for the Prevention, Diagnosis, and Treatment of Novel Coronavirus Infection (COVID-19) of the Ministry of Health of Russia (versions 6–11) valid at the time of hospitalization.

Results. Diagnosing venous thromboembolic complications in the context of novel coronavirus infection COVID-19 can be challenging, as the clinical manifestations of pulmonary embolism and severe coronavirus pneumonia can be similar. When using commonly accepted VTE risk assessment scales, effectiveness in terms of accuracy and completeness of prediction was noted only for the IMPROVEDD scale, while the Wells scale was the least accurate. Furthermore, both conditions can be accompanied by an increase in D-dimer levels and show signs of right ventricular dysfunction on transthoracic echocardiography.

Conclusion. The diagnosis of pulmonary embolism in patients with novel coronavirus infection COVID-19 using standard algorithms can be difficult, suggesting the potential indispensability of initial computed tomography angiography of the lungs. Moreover, the obtained data demonstrate that performing reperfusion therapy for high-risk pulmonary embolism patients solely based on echocardiographic findings may be erroneous.