Radiological assessment of the vascular complications of COVID-19 in correlation with D-dimer level

Abstract

Background: The COVID-19 pandemic causes primarily respiratory disease as well as non-respiratory complications such as thromboembolic complications with D-dimer elevation, which lead to multisystem organ dysfunction and respiratory failure. Aim of the work: To determine the value of radiological assessment of vascular complications in COVID-19 infections and its relation to D-dimer levels as important tools for early diagnosis and proper management of these patients.Patients & Methods: The study included 100 patients diagnosed as COVID-19 positive with embolic manifestations depending on their symptoms, signs, and laboratory assessment, which included D-dimer levels. They underwent radiological assessment of their vascular complications, including CT, MRI, and CT angiography. Results: Among 100 COVID-positive patients with thromboembolic symptoms, 55 had evidence of pulmonary embolism, 13 had strokes, 4 had mesenteric arterial occlusion and 28 patients had no radiological evidence of vascular manifestations. D-dimer levels were increased (0.50 mcg/mL or greater) in 70 percent of positive COVID patients, including 89% of those with pulmonary embolism, 84% of those with stroke, 75% of mesenteric thrombosis cases, and in 7 patients (25% of those with symptoms suggestive of vascular thrombosis without radiological imaging of thromboembolic manifestations), with a sensitivity of 88.6%, specificity of 75%, positive predictive value of 90.9%, and negative predictive value of 70%.Conclusion: This study confirmed that D-dimer elevation in COVID-positive patients is highly suggestive of thromboembolic complications, especially pulmonary, cranial, and abdominal embolisms, and that confirmation by proper radiological evaluation is mandatory for the diagnosis of these findings and proper management of their complications.