anadolu klin

Anatolian Clinic the Journal of Medical Sciences

2149-5254 2458-8849

Hayat Sağlık ve Sosyal Hizmetler Vakfı

10.21673/anadoluklin.1493434

Radiology and Organ Imaging

Radyoloji ve Organ Görüntüleme

Relationship between deep vein thrombosis and serial chest computerized tomography severity scores in COVID-19 patients

COVID-19 hastalarında derin ven trombozu ile seri toraks bilgisayarlı tomografi şiddet skorları arasındaki ilişkisi

https://orcid.org/0000-0002-1067-9008

Akman

Burcu

AMASYA UNIVERSITY, SCHOOL OF MEDICINE

https://orcid.org/0000-0001-9803-453X

Kaya

Ahmet Turan

AMASYA UNIVERSITY, SCHOOL OF MEDICINE

https://orcid.org/0000-0001-9586-6509

Çapraz

Mustafa

AMASYA UNIVERSITY, SCHOOL OF MEDICINE

https://orcid.org/0000-0001-6148-5142

Cihangiroğlu

Mustafa

Department of Infectious Diseases and Clinical Microbiology, Medilines Hospital, Elazığ, Turkey

05 29 2025

30 2 197 210 05 31 2024 11 11 2024

1933

Anadolu Kliniği Tıp Bilimleri Dergisi

Aim: We aimed to evaluate risk factors for deep vein thrombosis (DVT) in the lower extremities veins in COVID-19 patients and the relationship between DVT and chest Computed Tomography severity scores (CT-SS). To our knowledge, our study is the first to investigate the relationship between the occurrence of DVT and serial chest CT-SS in COVID-19 patients.Methods: We retrospectively analyzed 131 COVID-19 patients (≥18 years) admitted to our hospital. Two radiologists examined chest CT scans and calculated CT-SS using a visual scoring system. Color Doppler ultrasounds of lower extremity veins were performed for DVT. CT Pulmonary Angiographies (CTPA) were performed on patients clinically suspected of pulmonary embolism (PE).Results: A total of 131 patients were included in our study. 71/131 (54.2%) of the patients were male. 18/131 (13.7%) patients were treated in ICU, and 18 (13.7%) patients died. 21/131 (16%) patients had DVT in their lower extremities. Chest CTA was performed in 44/131 (33.6%) patients, and PE was detected in 10/44 patients (22.7%). PE was considerably more common in patients with DVT (p = 0.009). The occurrence of DVT was significantly associated with high first chest CT-SS (p=0.002). However, there was no association between the DVT and the second and third CT-SS. Significant associations were found between the development of DVT with elevated serum D-Dimer, CRP, and fibrinogen levels (p

Amaç: COVID-19 hastalarında alt ekstremite venlerinde derin ven trombozu (DVT) için risk faktörlerini ve DVT ile toraks Bilgisayarlı Tomografi şiddet skorları (BT-ŞS) arasındaki ilişkiyi değerlendirmeyi amaçladık. Bildiğimiz kadarıyla, çalışmamız COVID-19 hastalarında DVT oluşumu ile seri toraks BT-ŞS arasındaki ilişkiyi araştıran ilk çalışmadır.Yöntemler: Çalışmamızda, retrospektif olarak hastanemize başvuran 131 COVID-19 hastayı (≥18 yaş) analiz ettik. İki radyolog toraks BT taramalarını inceledi ve görsel bir skorlama sistemi kullanarak BT-ŞS’ nı hesapladı. DVT için alt ekstremite damarlarının renkli Doppler ultrasonları yapıldı. Klinik olarak pulmoner emboli (PE) olduğundan şüphelenilen hastalara BT Pulmoner Anjiyografiler (BTPA) uygulandı.Bulgular: Çalışmamıza toplam 131 hasta dahil edildi. Hastaların 71/131’i (%54,2) erkekti. 18/131 (%13,7) hasta yoğun bakımda tedavi gördü ve 18 (%13,7) hasta öldü. 21/131 hastanın alt ekstremitelerinde DVT (%16) vardı. 44/131 (%33,6) hastaya toraks BTA yapıldı ve 10/44 (%22,7) hastada PE saptandı. DVT’li hastalarda PE sıklığı anlamlı olarak yüksekti (p= 0.009). DVT oluşumu, yüksek ilk göğüs BT-ŞS’si ile anlamlı şekilde ilişkiliydi (p=0.002). Ancak DVT ile ikinci ve üçüncü BT-ŞS arasında ilişki yoktu. Artmış serum D-Dimer, CRP ve fibrinojen seviyeleri ile DVT gelişimi arasında anlamlı ilişkiler bulundu (p

Computed tomography angiography COVID-19 doppler ultrasonography venous thrombosis

Bilgisayarlı tomografi anjiografi COVID-19 doppler ultrason venöz tromboz

Yok

Zhang J, Meng G, Li W, et al. Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China. Respir Res. 2020;21(1):180.

Ding X, Xu J, Zhou J, Long Q. Chest CT findings of COVID-19 pneumonia by duration of symptoms. Eur J Radiol. 2020;127:109009.

Pan F, Ye T, Sun P, et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology. 2020;295(3):715-721.

Iba T, Levy JH, Connors JM, Warkentin TE, Thachil J, Levi M. The unique characteristics of COVID-19 coagulopathy. Crit Care. 2020;24(1):360.

Rauch A, Dupont A, Goutay J, et al. Endotheliopathy Is Induced by Plasma From Critically Ill Patients and Associated With Organ Failure in Severe COVID-19. Circulation. 2020;142(19):1881-4.

Voicu S, Delrue M, Chousterman BG, et al. Imbalance between procoagulant factors and natural coagulation inhibitors contributes to hypercoagulability in the critically ill COVID-19 patient: clinical implications. Eur Rev Med Pharmacol Sci. 2020;24(17):9161-8.

Salabei JK, Fishman TJ, Asnake ZT, Ali A, Iyer UG. COVID-19 Coagulopathy: Current knowledge and guidelines on anticoagulation. Heart Lung. 2021;50(2):357-60.

Wu MA, Colombo R, Arquati M, et al. Clinical-radiological correlations in COVID-19-related venous thromboembolism: Preliminary results from a multidisciplinary study. Int J Clin Pract. 2021;75(9):e14370.

Thomas MR, Scully M. Clinical features of thrombosis and bleeding in COVID-19. Blood. 2022;140(3):184-95.

Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–81.

Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-7.

Goeijenbier M, van Wissen M, van de Weg C, et al. Review: Viral infections and mechanisms of thrombosis and bleeding. J Med Virol. 2012;84(10):1680-96.

Han H, Yang L, Liu R, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-20.

Terpos E, Ntanasis-Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(7):834-47.

Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18(6):1421-4.

Trigonis RA, Holt DB, Yuan R, et al. Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019 Patients Receiving Prophylactic Anticoagulation. Crit Care Med. 2020;48(9):e805-8.

Léonard-Lorant I, Delabranche X, Séverac F, et al. Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to d-Dimer Levels. Radiology. 2020;296(3):E189-91.

Needleman L, Cronan JJ, Lilly MP, et al. Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference. Circulation. 2018;137(14):1505-15.

Li JY, Wang HF, Yin P, et al. Clinical characteristics and risk factors for symptomatic venous thromboembolism in hospitalized COVID-19 patients: A multicenter retrospective study. J Thromb Haemost. 2021;19(4):1038-48.

Elmokadem AH, Mounir AM, Ramadan ZA, Elsedeiq M, Saleh GA. Comparison of chest CT severity scoring systems for COVID-19. Eur Radiol. 2022;32(5):3501-12.

Cronan JJ, Dorfman GS, Scola FH, Schepps B, Alexander J. Deep venous thrombosis: US assessment using vein compression. Radiology. 1987;162(1 Pt 1):191-4.

The Lancet Haematology. COVID-19 coagulopathy: an evolving story. Lancet Haematol. 2020;7(6):e425.

Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(23):2950-73.

Zhai Z, Li C, Chen Y, et al. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines. Thromb Haemost. 2020;120(6):937-48.

Suh YJ, Hong H, Ohana M, et al. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 2021;298(2):E70-80.

Voicu S, Bonnin P, Malissin I, et al. Characteristics of deep vein thrombosis in the critically ill COVID-19 patient - an observational cohort study with Doppler ultrasound measurements. Eur Rev Med Pharmacol Sci. 2022;26(2):686-94.

Goldhaber SZ, Piazza G. Pulmonary Embolism and Deep Vein Thrombosis. Cardiovasc Ther A Companion to Braunwald’s Hear Dis Fourth Ed. 2012;19(5):580–95.

Jiménez D, García-Sanchez A, Rali P, et al. Incidence of VTE and Bleeding Among Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. Chest. 2021;159(3):1182-96.

Edler C, Schröder AS, Aepfelbacher M, et al. Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany. Int J Legal Med. 2020;134(4):1275-1284.

Zhou S, Chen C, Hu Y, Lv W, Ai T, Xia L. Chest CT imaging features and severity scores as biomarkers for prognostic prediction in patients with COVID-19. Ann Transl Med. 2020;8(21):1449.

Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30(12):6808-17.

Espallargas I, Rodríguez Sevilla JJ, Rodríguez Chiaradía DA, et al. CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis. Eur Radiol. 2021;31(4):1915-22.

Fang C, Garzillo G, Batohi B, et al. Extent of pulmonary thromboembolic disease in patients with COVID-19 on CT: relationship with pulmonary parenchymal disease. Clin Radiol. 2020;75(10):780-8.

Yu Y, Tu J, Lei B, et al. Incidence and Risk Factors of Deep Vein Thrombosis in Hospitalized COVID-19 Patients. Clin Appl Thromb Hemost. 2020;26:1076029620953217.

Dujardin RWG, Hilderink BN, Haksteen WE, et al. Biomarkers for the prediction of venous thromboembolism in critically ill COVID-19 patients. Thromb Res. 2020;196:308-12.

Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18(8):1995-2002.

Barnes GD, Burnett A, Allen A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020;50(1):72-81.

Kirshblum SC, DeLauter G, Eren F, et al. Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital. Am J Phys Med Rehabil. 2021;100(5):419-23.

Ahuja N, Bhinder J, Nguyen J, et al. Venous thromboembolism in patients with COVID-19 infection: risk factors, prevention, and management. Semin Vasc Surg. 2021;34(3):101-16.

Lippi G, Favaloro EJ. D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis. Thromb Haemost. 2020;120(5):876-8.

Thondapu V, Montes D, Rosovsky R, et al. Venous thrombosis, thromboembolism, biomarkers of inflammation, and coagulation in coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord. 2021;9(4):835-44.

Al-Samkari H, Karp Leaf RS, Dzik WH, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020;136(4):489-500.

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-9.

Zhou Y, Yang Q, Chi J, et al. Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis. Int J Infect Dis. 2020;99:47-56.

Xiong X, Chi J, Gao Q. Prevalence and risk factors of thrombotic events on patients with COVID-19: a systematic review and meta-analysis. Thromb J. 2021;19(1):32.

Koleilat I, Galen B, Choinski K, et al. Clinical characteristics of acute lower extremity deep venous thrombosis diagnosed by duplex in patients hospitalized for coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord. 2021;9(1):36-46.

Chang H, Rockman CB, Jacobowitz GR, et al. Deep vein thrombosis in hospitalized patients with coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord. 2021;9(3):597-604.