Document Type : Original Article
Authors
Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, University of Health Sciences, Department of Chest Diseases, Istanbul, Turkey
Abstract
Background: Multiple studies have reported an increased incidence of thrombosis in patients with COVID-19 pneumonia, contributing to higher mortality rates. This study aimed to investigate the ability of disease severity scores, the Pneumonia Severity Index (PSI), Pulmonary Embolism Severity Index (PESI), Disseminated Intravascular Coagulation (DIC), and End-Stage Liver Disease Model (MELD), to predict embolism and embolism-related mortality in patients with COVID-19 pneumonia.
Materials and Methods: In this retrospective study, demographic data, comorbidities, hospitalization dates, length of stay in the intensive care unit, percentage of CT radiological involvement, presence of embolism, and biochemical and hematological test results of the patients were recorded. PSI, PESI, DIC, and MELD scores were calculated within the first 24 hours of hospitalization.
Results: A total of 158 patients (82 males, 76 females) with a mean age of 53.47± 12.49 years were included. Embolism was detected in 24 cases (15%), and the mortality rate was 11% (18 cases) across all cases. The optimal threshold values for predicting mortality were 63 for PESI and 76 for PSI (AUC values of 0.802 and 0.747). The optimal threshold value for detecting pulmonary embolism was 4 for DIC (AUC: 0.740). In the univariate analysis, variables with a p-value less than 0.1 included radiological score, age, DIC, troponin levels, and D-dimer levels. The subsequent multivariate analysis indicated that both the DIC score (p = 0.047) and the radiological score (p = 0.043) were independently associated with pulmonary embolism. In another univariate analysis, the variables with a p-value less than 0.1 included age, radiological score, the presence of comorbidities, procalcitonin, CRP, troponin, PSI, and PESI score. The follow-up multivariate analysis suggested that the PESI score (p = 0.018) and PSI (p = 0.021) were independently linked to hospital mortality.
Conclusion: The PESI score was found to be a significant predictor of mortality, while the DIC score was found to be a significant predictor of pulmonary embolism in patients with COVID-19 pneumonia.
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