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Multisystem Assessment of the Imaging Manifestations of Coagulopathy in Hospitalized Patients With Coronavirus Disease (COVID-19).

冠状病毒病住院患者凝血功能障碍影像学表现的多系统评估 (新型冠状病毒肺炎)。

  • 影响因子:2.91
  • DOI:10.2214/AJR.20.24132
  • 作者列表:"O'Shea A","Parakh A","Hedgire S","Lee SI
  • 发表时间:2021-04-01
Abstract

:BACKGROUND. Coronavirus disease (COVID-19) is known to be associated with a distinct form of coagulopathy. OBJECTIVE. The purpose of this study was to describe the imaging manifestations of COVID-19-associated coagulopathy across anatomic sites and modalities in hospitalized patients and to identify clinical variables associated with positive imaging findings. METHODS. We conducted a retrospective review of consecutive adult patients with COVID-19 admitted to our hospital over a 3-week period. Data on patient demographics, hematologic values, cross-sectional imaging examinations, and clinical outcomes (death and intubation) were collected. Imaging was reviewed for manifestations of coagulopathy. Multivariable logistic regression analyses were performed to assess associations of patient demographics, hematologic markers, and outcomes with the need for imaging and imaging manifestations of coagulopathy. RESULTS. Of 308 hospitalized patients with COVID-19, 142 (46%) underwent 332 cross-sectional imaging examinations. Of these, 37 (26%) had imaging results positive for coagulopathy. The most common imaging manifestations of coagulopathy were pulmonary embolus (n = 21) on contrast-enhanced CT or CTA, thrombus in the upper- or lower-extremity veins (n = 13) on Doppler ultrasound, end-organ infarction in the bowel (n = 4) and kidney (n = 4) on contrast-enhanced CT, and thrombus or parenchymal infarction in the brain (n = 2) on contrast-enhanced CTA or MRI with MRA. Among patients with imaging results positive for coagulopathy, eight (22%) had multisite involvement. Thrombi were multifocal in four of five patients with positive upper-extremity and three of eight patients with positive lower-extremity examination results and involved superficial veins, deep veins, or both. In multivariable analysis, intubation (p < .001) and prolonged prothrombin time (p = .04) were significantly associated with undergoing imaging. No patient variable was significantly associated with imaging results positive for coagulopathy (p > .05). CONCLUSION. Imaging commonly shows manifestations of coagulopathy in hospitalized patients with COVID-19. Over one-fifth of patients with such manifestations show multisite involvement. Clinical variables poorly predict which patients have positive imaging results, indicating a complementary role of imaging in detecting COVID-19-associated coagulopathy. CLINICAL IMPACT. In patients with COVID-19 with suspected systemic coagulopathy, pulmonary CTA, extremity Doppler ultrasound, contrast-enhanced abdominal CT, and contrast-enhanced brain MRI and MRA may all be appropriate in the absence of imaging contraindications.

摘要

: 背景。冠状病毒疾病 (新型冠状病毒肺炎) 已知与不同形式的凝血病有关。目的。本研究的目的是描述COVID-19-associated凝血病在住院患者解剖部位和方式上的影像学表现,并确定与阳性影像学表现相关的临床变量。方法。我们对我院连续收治的新型冠状病毒肺炎例成人患者进行了为期3周的回顾性分析。收集患者人口统计学、血液学值、横断面影像学检查和临床结局 (死亡和插管) 的数据。影像学检查凝血功能障碍的表现。进行多变量logistic回归分析以评估患者人口统计学、血液学标志物和结局与凝血病的影像学和影像学表现需要的相关性。结果。新型冠状病毒肺炎的308例住院患者中,142例 (46%) 接受了332次横断面影像学检查。其中37例 (26%) 的影像学结果为凝血障碍阳性。凝血病最常见的影像学表现是肺栓子 (n = 21),增强CT或CTA,上或下肢静脉血栓 (n = 13),肠道终末器官梗死 (n = 4)。和肾脏 (n = 4) 增强CT,对比增强CTA或MRI与MRA显示的脑内血栓或实质梗死 (n = 2)。在影像学结果为凝血障碍阳性的患者中,8例 (22%) 存在多部位受累。5例上肢检查阳性的患者中有4例为多灶性血栓,8例下肢检查结果阳性的患者中有3例累及浅静脉、深静脉或两者兼有。在多变量分析中,插管 (p < .001) 和凝血酶原时间延长 (p = .04) 与进行成像显著相关。没有患者变量与凝血障碍的影像学结果阳性显著相关 (p> .05)。结论。影像学常显示新型冠状病毒肺炎住院患者的凝血功能障碍表现。超过5分之1的具有这种表现的患者显示多部位受累。临床变量难以预测哪些患者具有阳性影像学结果,表明影像学在检测COVID-19-associated凝血障碍中的补充作用。临床影响。对新型冠状病毒肺炎例疑似全身性凝血功能障碍的患者,在无影像学禁忌症的情况下,肺CTA、四肢多普勒超声、腹部增强CT、增强脑MRI和MRA可能都适用。

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