Patient Characteristics and Predictors of Pulmonary Embolism in Patients Infected with COVID – 19 in Upper Egypt

Figures & data

Figure 1 Flowchart showing the patients’ inclusion in the study.

Table 1 Patients Distribution Regarding Their Baseline Demographic Characteristics

Parameters	All Patients No=297	No PE No = 243 (81.8%)	PE No = 54 (18.2%)	P-value
Age (years, mean ± SD)	49±15.9	47.5±16.1	55.9±13.6	0.004
Age categories
18–40 years	108(36.4%)	99(91.7%)	9(8.3%)	0.005
41–65 years	135(45.5%)	108(80%)	27(20%)
>65	54(18.2%)	36(66.7%)	18(33.3%)
Sex				0.002
Males	117(39.4%)	108(92.3%)	9(7.7%)
Females	180(60.6%)	135(75%)	45(25%)
BMI	28.9±5.2	28.1±5.1	33±3.8	<0.001
19–25	63(21.2%)	63(100%)	0(0)
26–30	138(46.5%)	120(87%)	18(13%)	<0.001
>30	96(32.3%)	60(62.5%)	36(37.5%)
HTN				<0.001
Yes	105(35.4%)	72(68.6%)	33(31.4%)
DM				0.001
Yes	54(18.2%)	33(61.1%)	21(38.9%)
Associated co-morbidities				<0.001
Yes	102(22.8%)	63(61.8%)	39(38.2%)
Smoking				0.002
Yes	54(18.2%)	54(100%)	0

Abbreviations: BMI, body mass index; DM, diabetes mellitus; HTN, hypertension; No, Number; P value, probability value; PE, pulmonary embolism; SD, standard deviation.

Table 2 Patients Distribution Regarding Their Baseline Clinical Presentations

Parameters	All Patients No=297	No PE No=243 (81.8%)	PE No=54 (18.2%)	P-value
Fever				0.021
Yes	204 (68.7%)	174 (85.3%)	30 (14.7%)
Cough				0.111
Yes	204 (68.7%)	162 (79.4%)	42 (20.6%)
Dyspnea				<0.001
Yes	231(77.8%)	177 (76.6%)	54 (23.4%)
Taste and smell loss	81(27.3%)	81(100%)	0	<0.001
GIT symptoms	42 (14.1%)	42 (100%)	0	0.001
Chest pain				<0.001
Yes	66 (22.2%)	39 (59.1%)	27 (40.9%)
SBP	126±16	128.5±15.7	116.8±12.9	<0.001
HR	99±9	96±7	111±6	<0.001
Temperature	37.7±0.6	37.7±0.5	37.5±0.7	0.011
SPO2	94.9±2	95.6±1.7	91.9±1.4	<0.001
Duration of symptoms at hospital admission	9.3±5.3	8.1±4.5	14.3±6.1	<0.001

Abbreviations: GIT, gastrointestinal; HR, heart rate; No, Number; P value, probability value; PE, pulmonary embolism; SBP, systolic blood pressure; SPO2; oxygen saturation.

Table 3 Patients Distribution Regarding Their Laboratory Investigations

Parameters	All Patients No=297	No PE No=243 (81.8%)	PE No=54 (18.2%)	P-value
RV basal diameter (mm)	3.4±0.6	3.3±0.5	4±0.6	<0.001
TAPSE	19.4±3	19.9±2.8	17.2±2.8	<0.001
sPAP	39.9±14.1	36.3±12	52±13.9	<0.001
Hb (gm/dl)	12.9±1.5	13.1±1.5	12.4±1.2	0.003
Platelets×10^3	222.2±95.5	232.2±94.4	177.2±90.1	0.002
Total leucocytic count	6796.9±3063.7	7306.1±2912.8	4505.6±2718.4	<0.001
Absolute Lymphocytic count	1.2±0.4	1.3±0.5	0.8±0.3	0.002
ESR 1	45.2±27.5	44.2±28.9(median=39)	49.9±18.9(48)	0.166
Serum Ferritin	578.9±1517 (median=180)	541.9±1381(median=177)	745.7±2027(median=210)	0.373
C-reactive protein	29.7±29.5 (median=16)	28±28.2(median=15)	37.3±34.9(median=18)	0.227
D- dimer	863.5±686.5(median=600)	702.9±620.7(median=450)	1586.1±471.9(median=1375)	<0.001
CO-RADS
3	18(6.1)	18(100)	0(0)	<0.001
4	117(39.4)	117(100)	0(0)
5	162(54.5)	108(66.7)	54(33.3)

Abbreviations: ESR 1, erythrocytic sedimentation rate first hour; Hb, hemoglobin; No, Number; P value, probability value; sPAP, systolic pulmonary artery pressure; TAPSE, tricuspid annular plane systolic excursion; RV, right ventricle.

Table 4 Pulmonary Embolism’s Risk Stratification in Affected Patients

Category	No (%) 54 Patients
Low risk PE	12 (22.2%)
Intermediate-low risk PE	9 (16.7%)
Intermediate-high risk PE	20 (37%)
High risk PE	13 (24.1%)

Abbreviations: No, Number; PE, pulmonary embolism.

Table 5 Multivariable Binary Logistic Regression Analysis for the Prediction of Pulmonary Embolism from Different Patients’ Characteristics

Variables	P-value	OR	95% C.I. for OR
			Lower	Upper
Gender (female)	0.133	4.027	0.653	24.835
Associated comorbidities	<0.001	46.476	8.689	48.591
DM	<0.001	32.537	6.004	76.321
Age>65	0.012	5.015	1.423	17.674
BMI>25	0.001	9.053	2.581	31.754
HTN	0.141	0.396	−0.115	1.360

Abbreviations: BMI, body mass index; C.I, confidence interval; DM, diabetes mellitus; HTN, hypertension; OR, odds ratio; P value, probability value.

Table 6 Cut off, Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value of Different Laboratory Parameters Associated with Pulmonary Embolism Occurrence

Items	TLC	Absolute Lymphocytic Count	D- Dimer	Ferritin	Platelets	ESR	CRP
AUC (95% CI)	0.790 (0.697–0.866)	0.771 (0.675–0.849)	0.889 (0.810–0.943)	0.579 (0.476–0.678)	0.719 (0.620–0.805)	0.642 (0.539–0.736)	0.593 (0.489–0.690)
P-value	<0.001	<0.001	<0.001	0.1747	0.003	0.0108	0.2298
Cut off	≤2800	≤0.66	>1000	>167	≤180×10^3	>35	>15
Sensitivity% (95% CI)	38.89% (17.3–64.3)	27.78% (9.7–53.5)	83.33% (58.6–96.4)	94.44% (72.7–99.9)	83.33% (58.6–96.4)	83.33% (58.6–96.4)	83.33% (58.6–96.4)
Specificity% (95% CI)	97.53% (91.4–99.7)	98.77% (93.3–100)	85.19% (75.6 −92.1)	46.91% (35.7 −58.3)	74.07% (63.1–83.2)	48.15% (36.9–59.5)	51.85% (40.5–63.1)
PPV (95% CI)	77.8% (44.2–93.9)	83.3% (38.3–97.6)	55.6% (41.6–68.7)	28.3% (23.8–33.3)	41.7% (31.9–52.1)	26.3% (21.0–32.4)	27.8% (22.1–34.3)
NPV (95% CI)	87.8% (83.2–91.2)	86% (82.2–89.1)	95.8% (89.1–98.5)	97.4% (84.8–99.6)	95.2% (87.6–98.3)	92.9% (81.9–97.4)	93.3% (83.0–97.6)

Abbreviations: AUC, Area under the curve; CI, Confidence interval; NPV, Negative predictive value; PPV, Positive predictive value; TLC, total leucocytic count.

Table 7 Cut off, Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value of Body Mass Index and Duration of Latency Till Seeking Medical Consultation Associated with Pulmonary Embolism Occurrence

Items	BMI	Duration
AUC (95% CI)	0.792 (0.699–0.867)	0.829 (0.740–0.897)
P-value	<0.001	<0.001
Cut off	>31	>10
Sensitivity% (95% CI)	66.67% (41.0–86.7)	72.22% (46.5–90.3)
Specificity% (95% CI)	79.01% (68.5–87.3)	79.01% (68.5 −87.3)
PPV (95% CI)	41.4% (29.3–54.6)	43.3% (31.5–56)
NPV (95% CI)	91.4% (84.6–95.4)	92.8% (85.8–96.5)

Abbreviations: AUC, Area under the curve; CI, Confidence interval; NPV, Negative predictive value; PPV, Positive predictive value; TLC, total leucocytic count.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.