Association of the changes in pulmonary artery diameters with clinical outcomes in hospitalized patients with COVID-19 infection: A cross-sectional study

Abstract

Objective: Enlarged pulmonary artery diameter (PAD) can be associated with mortality risk in coronavirus disease 2019 (COVID-19) patients. Our aim is to find the factors that cause changes in PAD and the relationship between radiological findings and clinical outcomes in COVID-19 patients. Patients and Methods: In this descriptive, retrospective, and single centered study, among the hospitalized 3264 patients, 209 patients with previous chest computed tomography (CT) were included. Findings of current chest CTs of patients obtained during COVID-19 were compared with that of previous chest CTs. Pulmonary involvements, World Health Organization (WHO) Clinical Progression Scale scores and laboratory variables were recorded. Intensive Care Unit (ICU) admission, intubation and mortality were clinical outcomes that were evaluated by using uni – and multivariate analyses. Results: Patients with high D-dimer had significantly increased risk for enlarged PAD and increase in PAD compared to previous chest CT (ΔPAD) (OR=1.18, p<0.05, OR=1.2 p<0.05). Both high D-dimer and an increase over 2 mm in PAD (ΔPAD 2mm) had significant risks for ICU admission, intubation, and mortality (OR= 1.18 p<0.01, OR=1.22 p<0.01, OR=2.62 p<0.05, OR=2.12 p<0.01, OR=2.32 p<0.01, OR=2.09 p<0.001 respectively). It was found that with enlarged PAD, risk of ICU admission and mortality increased. (OR=3.03 p<0.001, OR=2.52 p<0.01). Combined with age and lymphocyte counts, PAD predicted mortality with a 50% sensitivity, 88% specificity (AUC=0.83, p<0.001). Conclusion: PPatients with an increase over 2 mm (ΔPAD 2mm) in PAD had significantly increased clinical severity, ICU admission, intubation, and mortality. High levels of D-dimer and CRP in patients suggest that increased inflammation and thrombosis may be effective in pathogenesis.