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unidades de cuidados intensivos &#40;UCI&#41;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2&#44;4&#44;6</span></a> y en pacientes hospitalizados en plantas<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Hasta donde sabemos&#44; no se ha investigado el cambio en la incidencia de TEP en la poblaci&#243;n general durante la pandemia&#44; ni las posibles caracter&#237;sticas diferenciales de los TEP sucedidos durante ese per&#237;odo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Poblaci&#243;n y m&#233;todo</span><p id="par0015" class="elsevierStylePara elsevierViewall">Hemos realizado un estudio retrospectivo utilizando el archivo radiol&#243;gico y las historias cl&#237;nicas electr&#243;nicas de un hospital universitario de la Comunidad de Madrid &#40;Espa&#241;a&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se definieron dos intervalos de tiempo&#58; el per&#237;odo de estudio&#44; desde el 01 de marzo al 31 de mayo de 2020&#59; y un per&#237;odo de control&#44; que comprende el mismo intervalo en 2019&#46; Durante esos per&#237;odos se identificaron todas las solicitudes de angiograf&#237;a pulmonar por tomograf&#237;a computarizada &#40;APTC&#41;&#44; en las que constaba la sospecha cl&#237;nica de TEP&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los estudios hab&#237;an sido realizados con tomograf&#237;a computarizada &#40;TC&#41; multidetector &#40;Brilliance&#59; Philips&#44; Eindhoven&#44; Pa&#237;ses Bajos&#41; mediante protocolos est&#225;ndar&#46; Todos ellos fueron reanalizados por dos radi&#243;logos expertos con el fin de detectar la presencia de defectos de relleno intraluminal en las arterias pulmonares proximales o distales &#40;segmentarias o subsegmentarias&#41;&#46; Se recuper&#243; la historia cl&#237;nica de los pacientes finalmente diagnosticados de TEP&#44; y se registraron las condiciones cl&#237;nicas predisponentes al TEP recogidas en la escala revisada de Ginebra<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a>&#44; as&#237; como como el d&#237;mero D&#44; determinado por inmunoturbidimetr&#237;a &#40;STA&#174;-Liatest&#174; D-Di Plus&#44; Stago&#44; Asni&#232;res-sur-Seine&#44; Francia&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo de estudio&#44; se registraron los resultados de la reacci&#243;n en cadena de la polimerasa a tiempo real &#40;RT-PCR&#41; para el SARS-CoV-2 y el tiempo desde el inicio de los s&#237;ntomas de COVID-19 y la sospecha de TEP&#46; El diagn&#243;stico de COVID-19 se bas&#243; en los criterios de la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La incidencia de COVID-19 en la poblaci&#243;n atendida por el hospital se obtuvo consultando registros p&#250;blicos<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a>&#46; Se utiliz&#243; la prueba de &#967;<span class="elsevierStyleSup">2</span> para las variables cualitativas &#40;expresadas como proporciones&#41;&#44; y la comparaci&#243;n de medias de Spearman &#40;para variables no relacionadas&#41; para las cuantitativas&#44; expresadas como media &#177; desviaci&#243;n est&#225;ndar&#46; Se consider&#243; significativa una p &#60; 0&#44;05&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La raz&#243;n de riesgo de TEP entre ambos per&#237;odos se calcul&#243; utilizando el n&#250;mero de TEP detectados y la poblaci&#243;n atendida en cada per&#237;odo&#44; con un intervalo de confianza &#40;IC&#41; del 95&#37;&#46; Los datos se analizaron con el programa IBM SPSS 22 &#40;Armonk&#44; NY&#44; EE&#46; UU&#46;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de &#201;tica de la investigaci&#243;n del hospital &#40;OE33&#47;2020&#41;&#44; que eximi&#243; de la necesidad de obtener consentimiento&#44; dada la naturaleza retrospectiva del estudio&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se solicit&#243; una APTC por sospecha de TEP durante el per&#237;odo de control a 145 pacientes&#44; 22 de ellos &#40;15&#44;2&#37;&#41; finalmente diagnosticados de TEP&#46; Durante el per&#237;odo de estudio se solicitaron 465 APTC por sospecha de TEP&#44; 99 de ellos &#40;21&#44;3&#37;&#41; confirmados&#44; ocho &#40;8&#37;&#41; ingresados en UCI&#46; Un total de 74 hab&#237;an sido previamente diagnosticados de COVID-19&#44; con un retraso medio entre ambos diagn&#243;sticos de 9&#44;1 &#177; 8&#44;4 d&#237;as&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">De los 1&#46;292 pacientes hospitalizados con diagn&#243;stico de COVID-19 en ese per&#237;odo&#44; el 5&#44;7&#37; &#40;74&#41; fueron diagnosticados de TEP&#46; Considerando la poblaci&#243;n atendida por el hospital&#44; el riesgo de TEP durante el per&#237;odo de estudio&#44; en relaci&#243;n con el per&#237;odo de control&#44; fue de 4&#44;5 &#40;IC 95&#37; 2&#44;80-6&#44;99&#41;&#46; La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra que las curvas de incidencia de TEP y de COVID-19&#44; estimadas para la poblaci&#243;n atendida por el hospital&#44; tuvieron una tendencia similar&#44; pero la de TEP suced&#237;a con retraso&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> resume el resto de los resultados&#46; Durante el per&#237;odo de estudio&#44; los pacientes con TEP tendieron a ser m&#225;s frecuentemente hombres &#40;69&#44;7 vs&#46; 54&#44;5&#37;&#44; p &#61; NS&#41;&#44; sin diferencias relevantes de la edad media &#40;65&#44;1<span class="elsevierStyleMonospace">&#177;</span>19&#44;0 vs&#46; 66&#44;6<span class="elsevierStyleMonospace">&#177;</span>15&#44;0&#44; p &#61; NS&#41;&#46; Tuvieron menos episodios de TEP previo &#40;5&#44;1 vs&#46; 18&#44;2&#37;&#44; p &#61; 0&#44;05&#41;&#44; de trombosis venosa profunda &#40;TVP&#41; &#40;11&#44;1 vs&#46; 45&#44;5&#37;&#44; p &#61; 0&#44;0001&#41; y de cirug&#237;a en el mes anterior &#40;2 vs&#46; 35&#44;4&#37;&#44; p &#61; 0&#44;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Los niveles de d&#237;mero D fueron m&#225;s altos en los TEP asociados con COVID-19 &#40;11&#44;9<span class="elsevierStyleMonospace">&#177;</span>27&#44;5 vs&#46; 3&#44;4<span class="elsevierStyleMonospace">&#177;</span>5&#44;0 mg&#47;L&#44; p &#61; 0&#44;017&#41;&#44; y tendieron a ser m&#225;s altos&#44; pero no significativamente&#44; durante el per&#237;odo de estudio&#46; Los TEP fueron m&#225;s frecuentemente distales durante el per&#237;odo pand&#233;mico &#40;73&#44;5 vs&#46; 50&#37;&#44; p &#61; 0&#44;02&#41;&#44; y tambi&#233;n en los pacientes con COVID-19 frente a los que no ten&#237;an COVID-19 &#40;83&#44;6 vs&#46; 57&#44;9&#37;&#44; p &#61; 0&#44;005&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Nuestro estudio muestra un incremento en la incidencia de TEP durante los primeros meses de la pandemia&#44; con un riesgo hasta 4&#44;5 veces superior al del mismo per&#237;odo del a&#241;o anterior&#46; Incluye TEP asociados y no asociados a COVID-19&#59; en las plantas de hospitalizaci&#243;n &#40;91 casos&#41; y en las UCI &#40;ocho casos&#41;&#46; La diferencia entre ambos per&#237;odos &#40;77 casos&#41; coincide pr&#225;cticamente con los casos de TEP asociado con COVID-19 &#40;74 episodios&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Algunos autores<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> han descrito una incidencia acumulativa de TEP del 24&#37; en pacientes con COVID-19 en los que se realiz&#243; una APTC&#46; Este dato lleva a confusi&#243;n&#44; porque se refiere a la proporci&#243;n de estudios positivos en los pacientes a los que por alguna raz&#243;n se hizo la prueba&#44; y no a la prevalencia en toda la poblaci&#243;n ingresada con COVID-19&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Algunos metaan&#225;lisis han mostrado una alta incidencia de TEP&#44; pero la mayor&#237;a de los casos incluidos proven&#237;an de pacientes ingresados en UCI&#44; en los que la incidencia es mayor<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a>&#46; Siendo as&#237;&#44; la informaci&#243;n m&#225;s clara la podemos encontrar en series concretas&#46; En una serie de 184 pacientes con COVID-19 admitidos en tres UCI&#44; 25 &#40;13&#44;6&#37;&#41; sufrieron un TEP<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a>&#44; dato similar &#40;16&#44;7&#37;&#41; al que ofreci&#243; un an&#225;lisis prospectivo de 150 pacientes consecutivos admitidos en otras cuatro UCI<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En el otro extremo&#44; una serie de pacientes admitidos en las plantas de Medicina Interna de un hospital mostr&#243; una incidencia de TEP de 6&#44;2&#37;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a>&#44; similar a nuestro hallazgo de 5&#44;7&#37;&#46; As&#237; pues&#44; alrededor de un 6&#37; de los pacientes ingresados por COVID-19 puede sufrir un TEP&#44; subiendo hasta el 13-17&#37; en los casos cr&#237;ticos en la UCI&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Hemos observado un retraso entre el diagn&#243;stico de COVID-19 y la sospecha de TEP&#44; claramente apreciable en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Todo ello nos debe poner alerta ante datos de deterioro de los pacientes con COVID-19&#44; a partir de la primera semana de su ingreso&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los TEP encontrados durante el per&#237;odo de pandemia difer&#237;an de los diagnosticados el a&#241;o previo&#44; con menos condiciones predisponentes para sufrirlo y m&#225;s a menudo con obstrucci&#243;n distal&#46; Lo mismo ocurri&#243; cuando comparamos a los pacientes con TEP&#44; con y sin COVID-19&#46; La COVID-19 parece estar asociada por s&#237; misma con un mayor riesgo de desarrollar TEP&#44; probablemente mayor que el descrito para otros tipos de neumon&#237;a&#44; en los que tambi&#233;n el TEP distal es m&#225;s com&#250;n<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Otros autores tambi&#233;n han encontrado un aumento del TEP distal en los pacientes con COVID-19<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a>&#44; y esto podr&#237;a deberse al menos en parte a la asociaci&#243;n de COVID-19 con la trombosis pulmonar <span class="elsevierStyleItalic">in situ</span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a>&#46; En parte&#44; porque cabe esperar un aumento de otros tipos de TEP durante la pandemia&#44; ya que el confinamiento puede ser causa de inmovilizaci&#243;n y ha habido un aumento dram&#225;tico en el n&#250;mero de pacientes cr&#237;ticamente enfermos con mayor riesgo de TEP&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Limitaciones</span><p id="par0105" class="elsevierStylePara elsevierViewall">La naturaleza retrospectiva del estudio no permite la estandarizaci&#243;n de la sospecha de TEP&#46; No se ha realizado una estratificaci&#243;n de riesgo de los TEP observados por el escaso tama&#241;o de la muestra&#46; La TVP puede no haber sido investigada sistem&#225;ticamente durante el pico de la pandemia debido a razones log&#237;sticas&#46; La mayor&#237;a de las muestras para RT-PCR se obtuvieron usando hisopos nasofar&#237;ngeos&#44; una t&#233;cnica con una sensibilidad estimada del 63&#37;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a>&#44; por lo que algunos de los 25 casos de TEP sin diagn&#243;stico de COVID-19 podr&#237;an haber estado infectados&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La incidencia de TEP estimada para la poblaci&#243;n es solo una aproximaci&#243;n&#58; ha habido muchas causas posibles de p&#233;rdida de casos que podr&#237;an causar subestimaci&#243;n&#44; incluyendo los pacientes que murieron en residencias y los casos terminales no investigados&#46; En todo caso&#44; la incidencia real de TEP durante la pandemia deber&#237;a ser mayor&#44; y no menor que durante el per&#237;odo de control&#44; y reforzar&#237;a la hip&#243;tesis inicial&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Tambi&#233;n podr&#237;a pensarse que la TC haya sido infrautilizada debido a situaci&#243;n de emergencia&#46; Sin embargo&#44; se orden&#243; una APTC por la sospecha de TEP en un tercio de los pacientes ingresados por COVID-19 durante el per&#237;odo de estudio&#44; con una tasa de diagn&#243;stico confirmado del 21&#44;3&#37;&#44; que no fue no estad&#237;sticamente diferente de la tasa encontrada durante el per&#237;odo de control&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Cuando se utiliza correctamente&#44; la APTC debe detectar un TEP en el 30&#37; de todas las APTC solicitadas<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a>&#44; por lo que nuestros datos no sugieren infrautilizaci&#243;n en ninguno de los per&#237;odos&#44; y concuerdan con la capacidad diagn&#243;stica de la prueba en otros estudios realizados en pacientes con COVID-19<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="par0125" class="elsevierStylePara elsevierViewall">La pandemia de COVID-19 se asocia con un mayor riesgo de TEP&#46; Este riesgo parece aumentar una o dos semanas despu&#233;s de la infecci&#243;n&#46; Durante el per&#237;odo pand&#233;mico&#44; el TEP afecta a pacientes con un perfil cl&#237;nico diferente&#44; frecuentemente con COVID-19&#44; y la obstrucci&#243;n de los vasos es m&#225;s frecuentemente distal&#46; Nuestros resultados respaldan la hip&#243;tesis de que la COVID-19 es un factor de riesgo para sufrir un TEP&#44; con caracter&#237;sticas espec&#237;ficas&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Financiaci&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se ha descrito una elevada incidencia de tromboembolismo pulmonar &#40;TEP&#41; durante la pandemia por coronavirus&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo unic&#233;ntrico&#44; con revisi&#243;n de las angiograf&#237;as pulmonares por tomograf&#237;a computarizada solicitadas por sospecha de tromboembolismo pulmonar durante dos per&#237;odos&#44; del 01 de marzo del 2020 al 31de mayo del 2020 &#40;pandemia&#41;&#44; e igual intervalo en 2019 &#40;control&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se diagnosticaron 22 tromboembolismos pulmonares durante el per&#237;odo control y 99 en el pand&#233;mico&#44; 74 asociados con COVID-19&#46; El 5&#44;3&#37; de los pacientes hospitalizados con COVID-19 sufri&#243; un tromboembolismo pulmonar&#44; con un retraso entre ambos diagn&#243;sticos de 9&#44;1 &#177; 8&#44;4 d&#237;as&#46; Durante la pandemia&#44; los pacientes con tromboembolismo pulmonar ten&#237;an menos condiciones predisponentes &#40;tromboembolismo pulmonar previo 5&#44;1 vs&#46; 18&#44;2&#37;&#44; p &#61; 0&#44;05&#44; cirug&#237;a previa 2 vs&#46; 35&#44;4&#37;&#44; p &#61; 0&#44;0001&#44; trombosis venosa profunda 11&#44;1 vs&#46; 45&#44;5&#37;&#44; p &#61; 0&#44;0001&#41;&#44; y los tromboembolismos pulmonares perif&#233;ricos eran m&#225;s frecuentes &#40;73&#44;5 vs&#46; 50&#37;&#44; p &#61; 0&#44;029&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Existe un riesgo incrementado de sufrir un TEP durante la pandemia por SARS-CoV-2&#44; que afecta a pacientes con perfil cl&#237;nico diferente y causa m&#225;s frecuentemente TEP distales&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A high incidence of pulmonary embolism has been described during the coronavirus pandemic&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a single-center retrospective study which reviewed computed tomography pulmonary angiograms ordered due to suspected pulmonary embolism during two periods&#58; from March 1&#44; 2020 to May 31&#44; 2020 &#40;pandemic&#41; and during the same interval in 2019 &#40;control&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Twenty-two pulmonary embolism were diagnosed during the control period and 99 in the pandemic&#44; 74 of which were associated with COVID-19&#46; Of all patients hospitalized with COVID-19&#44; 5&#46;3&#37; had a pulmonary embolism&#44; with a delay between the two diagnoses of 9&#46;1 &#177; 8&#46;4 days&#46; During the pandemic&#44; patients with pulmonary embolism had fewer predisposing conditions &#40;previous pulmonary embolism 5&#46;1 vs&#46; 18&#46;2&#37;&#44; p &#61; &#46;05&#59; previous surgery 2 vs&#46; 35&#46;4&#37;&#44; p &#61; &#46;0001&#59; deep vein thrombosis 11&#46;1 vs&#46; 45&#46;5&#37;&#44; p &#61; &#46;0001&#41;&#59; peripheral pulmonary embolisms were the most frequent &#40;73&#46;5 vs&#46; 50&#37;&#44; p &#61; &#46; 029&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">There is an increased risk of having a pulmonary embolism during the SARS-CoV-2 pandemic&#44; which affects patients with a different clinical profile and more often causes distal pulmonary embolisms&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Gr&#225;fica de incidencias de COVID-19 y TEP en la poblaci&#243;n de referencia durante la pandemia&#46; Las l&#237;neas representan la suma diaria de casos durante los 14 d&#237;as anteriores&#44; tanto para COVID-19 como para los casos de TEP en la poblaci&#243;n de referencia del hospital&#46; La escala de incidencia de TEP es diez veces menor que la de COVID-19&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">TEP&#58; tromboembolismo pulmonar&#46;</p>"
        ]
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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            "rol" => "short"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IC&#58; intervalo de confianza&#59; LDH&#58; deshidrogenasa l&#225;ctica&#59; lpm&#58; latidos por minuto&#59; Muerte&#58; muerte intrahospitalaria&#59; PCR&#58; prote&#237;na C reactiva&#59; RR&#58; raz&#243;n de riesgo&#59; RT-PCR&#58; reacci&#243;n en cadena de la polimerasa con transcriptasa inversa&#59; Sat O<span class="elsevierStyleInf">2</span>&#58; saturaci&#243;n de ox&#237;geno&#59; TVP&#58; trombosis venosa profunda&#59; UCI&#58; ingreso en Unidad de Cuidados Intensivos&#59; NS&#58; no significativo&#46;</p>"
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            0 => array:2 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Per&#237;odo</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Significaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Casos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RR 4&#44;5 &#40;IC 95&#37; 2&#44;80-6&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#233;nero &#40;var&#243;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;54&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;69&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad media &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;1<span class="elsevierStyleMonospace">&#177;</span>19&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;6<span class="elsevierStyleMonospace">&#177;</span>15&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COVID-19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TEP previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;18&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirug&#237;a en el mes previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;35&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neoplasia activa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;27&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;45&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;11&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TEP perif&#233;rico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;73&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frecuencia cardiaca &#40;lpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98<span class="elsevierStyleMonospace">&#177;</span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90<span class="elsevierStyleMonospace">&#177;</span>23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sat O<span class="elsevierStyleInf">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91<span class="elsevierStyleMonospace">&#177;</span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89<span class="elsevierStyleMonospace">&#177;</span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neutr&#243;filos &#40;x10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;252<span class="elsevierStyleMonospace">&#177;</span>3&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;666<span class="elsevierStyleMonospace">&#177;</span>4&#46;744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">PCR mg&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">95&#44;2<span class="elsevierStyleMonospace">&#177;</span>120&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#44;8<span class="elsevierStyleMonospace">&#177;</span>69&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ferritina &#951;gr&#47;mL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">691<span class="elsevierStyleMonospace">&#177;</span>629&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">UCI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;9&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;8&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Muerte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;9&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Datos cl&#237;nicos y radiol&#243;gicos de pacientes con diagn&#243;stico de tromboembolismo pulmonar &#40;TEP&#41; durante el per&#237;odo de control &#40;2019&#41; y el per&#237;odo pand&#233;mico &#40;2020&#41;</p>"
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                      "titulo" => "Organ-specific manifestations of COVID-19 infection"
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                          "etal" => true
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                            2 => "D&#46; Fotiou"
                            3 => "I&#46; Ntanasis-Stathopoulos"
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                            5 => "E&#46; Kastritis"
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                            3 => "M&#46;S&#46; Arbous"
                            4 => "D&#46; Gommers"
                            5 => "K&#46;M&#46; Kant"
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                            3 => "M&#46; Tordjman"
                            4 => "H&#46; Abdoul"
                            5 => "L&#46; Fournier"
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                      "titulo" => "Incidence of pulmonary embolism in non-critically ill COVID-19 patients&#46; Predicting factors for a challenging diagnosis"
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                            3 => "A&#46; Franco-Moreno"
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                            5 => "D&#46; Salazar-Chiriboga"
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                    0 => array:2 [
                      "doi" => "10.1007/s11239-020-02190-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thromb Thrombolysis&#46;"
                        "fecha" => "2020"
                        "volumen" => "29"
                        "paginaInicial" => "1"
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                      "titulo" => "Prediction of pulmonary embolism in the emergency department&#58; the revised Geneva score"
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ORIGINAL BREVE
Tromboembolismo pulmonar durante la pandemia por SARS-CoV-2: características clínicas y radiológicas
Pulmonary embolism during SARS-CoV-2 pandemic: clinical and radiological features
A. García-Lledóa,b,
Corresponding author
josealberto.garcia@salud.madrid.org

Autor para correspondencia.
, M. del Palacio-Salgadoc, C. Álvarez-Sanzb,c, M.M. Pérez-Gila, Á. Cruz-Díazb,c
a Servicio de Cardiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
b Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España
c Servicio de Radiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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unidades de cuidados intensivos &#40;UCI&#41;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2&#44;4&#44;6</span></a> y en pacientes hospitalizados en plantas<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Hasta donde sabemos&#44; no se ha investigado el cambio en la incidencia de TEP en la poblaci&#243;n general durante la pandemia&#44; ni las posibles caracter&#237;sticas diferenciales de los TEP sucedidos durante ese per&#237;odo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Poblaci&#243;n y m&#233;todo</span><p id="par0015" class="elsevierStylePara elsevierViewall">Hemos realizado un estudio retrospectivo utilizando el archivo radiol&#243;gico y las historias cl&#237;nicas electr&#243;nicas de un hospital universitario de la Comunidad de Madrid &#40;Espa&#241;a&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se definieron dos intervalos de tiempo&#58; el per&#237;odo de estudio&#44; desde el 01 de marzo al 31 de mayo de 2020&#59; y un per&#237;odo de control&#44; que comprende el mismo intervalo en 2019&#46; Durante esos per&#237;odos se identificaron todas las solicitudes de angiograf&#237;a pulmonar por tomograf&#237;a computarizada &#40;APTC&#41;&#44; en las que constaba la sospecha cl&#237;nica de TEP&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los estudios hab&#237;an sido realizados con tomograf&#237;a computarizada &#40;TC&#41; multidetector &#40;Brilliance&#59; Philips&#44; Eindhoven&#44; Pa&#237;ses Bajos&#41; mediante protocolos est&#225;ndar&#46; Todos ellos fueron reanalizados por dos radi&#243;logos expertos con el fin de detectar la presencia de defectos de relleno intraluminal en las arterias pulmonares proximales o distales &#40;segmentarias o subsegmentarias&#41;&#46; Se recuper&#243; la historia cl&#237;nica de los pacientes finalmente diagnosticados de TEP&#44; y se registraron las condiciones cl&#237;nicas predisponentes al TEP recogidas en la escala revisada de Ginebra<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a>&#44; as&#237; como como el d&#237;mero D&#44; determinado por inmunoturbidimetr&#237;a &#40;STA&#174;-Liatest&#174; D-Di Plus&#44; Stago&#44; Asni&#232;res-sur-Seine&#44; Francia&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo de estudio&#44; se registraron los resultados de la reacci&#243;n en cadena de la polimerasa a tiempo real &#40;RT-PCR&#41; para el SARS-CoV-2 y el tiempo desde el inicio de los s&#237;ntomas de COVID-19 y la sospecha de TEP&#46; El diagn&#243;stico de COVID-19 se bas&#243; en los criterios de la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La incidencia de COVID-19 en la poblaci&#243;n atendida por el hospital se obtuvo consultando registros p&#250;blicos<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a>&#46; Se utiliz&#243; la prueba de &#967;<span class="elsevierStyleSup">2</span> para las variables cualitativas &#40;expresadas como proporciones&#41;&#44; y la comparaci&#243;n de medias de Spearman &#40;para variables no relacionadas&#41; para las cuantitativas&#44; expresadas como media &#177; desviaci&#243;n est&#225;ndar&#46; Se consider&#243; significativa una p &#60; 0&#44;05&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La raz&#243;n de riesgo de TEP entre ambos per&#237;odos se calcul&#243; utilizando el n&#250;mero de TEP detectados y la poblaci&#243;n atendida en cada per&#237;odo&#44; con un intervalo de confianza &#40;IC&#41; del 95&#37;&#46; Los datos se analizaron con el programa IBM SPSS 22 &#40;Armonk&#44; NY&#44; EE&#46; UU&#46;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de &#201;tica de la investigaci&#243;n del hospital &#40;OE33&#47;2020&#41;&#44; que eximi&#243; de la necesidad de obtener consentimiento&#44; dada la naturaleza retrospectiva del estudio&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se solicit&#243; una APTC por sospecha de TEP durante el per&#237;odo de control a 145 pacientes&#44; 22 de ellos &#40;15&#44;2&#37;&#41; finalmente diagnosticados de TEP&#46; Durante el per&#237;odo de estudio se solicitaron 465 APTC por sospecha de TEP&#44; 99 de ellos &#40;21&#44;3&#37;&#41; confirmados&#44; ocho &#40;8&#37;&#41; ingresados en UCI&#46; Un total de 74 hab&#237;an sido previamente diagnosticados de COVID-19&#44; con un retraso medio entre ambos diagn&#243;sticos de 9&#44;1 &#177; 8&#44;4 d&#237;as&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">De los 1&#46;292 pacientes hospitalizados con diagn&#243;stico de COVID-19 en ese per&#237;odo&#44; el 5&#44;7&#37; &#40;74&#41; fueron diagnosticados de TEP&#46; Considerando la poblaci&#243;n atendida por el hospital&#44; el riesgo de TEP durante el per&#237;odo de estudio&#44; en relaci&#243;n con el per&#237;odo de control&#44; fue de 4&#44;5 &#40;IC 95&#37; 2&#44;80-6&#44;99&#41;&#46; La <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> muestra que las curvas de incidencia de TEP y de COVID-19&#44; estimadas para la poblaci&#243;n atendida por el hospital&#44; tuvieron una tendencia similar&#44; pero la de TEP suced&#237;a con retraso&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> resume el resto de los resultados&#46; Durante el per&#237;odo de estudio&#44; los pacientes con TEP tendieron a ser m&#225;s frecuentemente hombres &#40;69&#44;7 vs&#46; 54&#44;5&#37;&#44; p &#61; NS&#41;&#44; sin diferencias relevantes de la edad media &#40;65&#44;1<span class="elsevierStyleMonospace">&#177;</span>19&#44;0 vs&#46; 66&#44;6<span class="elsevierStyleMonospace">&#177;</span>15&#44;0&#44; p &#61; NS&#41;&#46; Tuvieron menos episodios de TEP previo &#40;5&#44;1 vs&#46; 18&#44;2&#37;&#44; p &#61; 0&#44;05&#41;&#44; de trombosis venosa profunda &#40;TVP&#41; &#40;11&#44;1 vs&#46; 45&#44;5&#37;&#44; p &#61; 0&#44;0001&#41; y de cirug&#237;a en el mes anterior &#40;2 vs&#46; 35&#44;4&#37;&#44; p &#61; 0&#44;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Los niveles de d&#237;mero D fueron m&#225;s altos en los TEP asociados con COVID-19 &#40;11&#44;9<span class="elsevierStyleMonospace">&#177;</span>27&#44;5 vs&#46; 3&#44;4<span class="elsevierStyleMonospace">&#177;</span>5&#44;0 mg&#47;L&#44; p &#61; 0&#44;017&#41;&#44; y tendieron a ser m&#225;s altos&#44; pero no significativamente&#44; durante el per&#237;odo de estudio&#46; Los TEP fueron m&#225;s frecuentemente distales durante el per&#237;odo pand&#233;mico &#40;73&#44;5 vs&#46; 50&#37;&#44; p &#61; 0&#44;02&#41;&#44; y tambi&#233;n en los pacientes con COVID-19 frente a los que no ten&#237;an COVID-19 &#40;83&#44;6 vs&#46; 57&#44;9&#37;&#44; p &#61; 0&#44;005&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Nuestro estudio muestra un incremento en la incidencia de TEP durante los primeros meses de la pandemia&#44; con un riesgo hasta 4&#44;5 veces superior al del mismo per&#237;odo del a&#241;o anterior&#46; Incluye TEP asociados y no asociados a COVID-19&#59; en las plantas de hospitalizaci&#243;n &#40;91 casos&#41; y en las UCI &#40;ocho casos&#41;&#46; La diferencia entre ambos per&#237;odos &#40;77 casos&#41; coincide pr&#225;cticamente con los casos de TEP asociado con COVID-19 &#40;74 episodios&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Algunos autores<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a> han descrito una incidencia acumulativa de TEP del 24&#37; en pacientes con COVID-19 en los que se realiz&#243; una APTC&#46; Este dato lleva a confusi&#243;n&#44; porque se refiere a la proporci&#243;n de estudios positivos en los pacientes a los que por alguna raz&#243;n se hizo la prueba&#44; y no a la prevalencia en toda la poblaci&#243;n ingresada con COVID-19&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Algunos metaan&#225;lisis han mostrado una alta incidencia de TEP&#44; pero la mayor&#237;a de los casos incluidos proven&#237;an de pacientes ingresados en UCI&#44; en los que la incidencia es mayor<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a>&#46; Siendo as&#237;&#44; la informaci&#243;n m&#225;s clara la podemos encontrar en series concretas&#46; En una serie de 184 pacientes con COVID-19 admitidos en tres UCI&#44; 25 &#40;13&#44;6&#37;&#41; sufrieron un TEP<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a>&#44; dato similar &#40;16&#44;7&#37;&#41; al que ofreci&#243; un an&#225;lisis prospectivo de 150 pacientes consecutivos admitidos en otras cuatro UCI<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En el otro extremo&#44; una serie de pacientes admitidos en las plantas de Medicina Interna de un hospital mostr&#243; una incidencia de TEP de 6&#44;2&#37;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a>&#44; similar a nuestro hallazgo de 5&#44;7&#37;&#46; As&#237; pues&#44; alrededor de un 6&#37; de los pacientes ingresados por COVID-19 puede sufrir un TEP&#44; subiendo hasta el 13-17&#37; en los casos cr&#237;ticos en la UCI&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Hemos observado un retraso entre el diagn&#243;stico de COVID-19 y la sospecha de TEP&#44; claramente apreciable en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Todo ello nos debe poner alerta ante datos de deterioro de los pacientes con COVID-19&#44; a partir de la primera semana de su ingreso&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Los TEP encontrados durante el per&#237;odo de pandemia difer&#237;an de los diagnosticados el a&#241;o previo&#44; con menos condiciones predisponentes para sufrirlo y m&#225;s a menudo con obstrucci&#243;n distal&#46; Lo mismo ocurri&#243; cuando comparamos a los pacientes con TEP&#44; con y sin COVID-19&#46; La COVID-19 parece estar asociada por s&#237; misma con un mayor riesgo de desarrollar TEP&#44; probablemente mayor que el descrito para otros tipos de neumon&#237;a&#44; en los que tambi&#233;n el TEP distal es m&#225;s com&#250;n<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Otros autores tambi&#233;n han encontrado un aumento del TEP distal en los pacientes con COVID-19<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a>&#44; y esto podr&#237;a deberse al menos en parte a la asociaci&#243;n de COVID-19 con la trombosis pulmonar <span class="elsevierStyleItalic">in situ</span><a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">15</span></a>&#46; En parte&#44; porque cabe esperar un aumento de otros tipos de TEP durante la pandemia&#44; ya que el confinamiento puede ser causa de inmovilizaci&#243;n y ha habido un aumento dram&#225;tico en el n&#250;mero de pacientes cr&#237;ticamente enfermos con mayor riesgo de TEP&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Limitaciones</span><p id="par0105" class="elsevierStylePara elsevierViewall">La naturaleza retrospectiva del estudio no permite la estandarizaci&#243;n de la sospecha de TEP&#46; No se ha realizado una estratificaci&#243;n de riesgo de los TEP observados por el escaso tama&#241;o de la muestra&#46; La TVP puede no haber sido investigada sistem&#225;ticamente durante el pico de la pandemia debido a razones log&#237;sticas&#46; La mayor&#237;a de las muestras para RT-PCR se obtuvieron usando hisopos nasofar&#237;ngeos&#44; una t&#233;cnica con una sensibilidad estimada del 63&#37;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">16</span></a>&#44; por lo que algunos de los 25 casos de TEP sin diagn&#243;stico de COVID-19 podr&#237;an haber estado infectados&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La incidencia de TEP estimada para la poblaci&#243;n es solo una aproximaci&#243;n&#58; ha habido muchas causas posibles de p&#233;rdida de casos que podr&#237;an causar subestimaci&#243;n&#44; incluyendo los pacientes que murieron en residencias y los casos terminales no investigados&#46; En todo caso&#44; la incidencia real de TEP durante la pandemia deber&#237;a ser mayor&#44; y no menor que durante el per&#237;odo de control&#44; y reforzar&#237;a la hip&#243;tesis inicial&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Tambi&#233;n podr&#237;a pensarse que la TC haya sido infrautilizada debido a situaci&#243;n de emergencia&#46; Sin embargo&#44; se orden&#243; una APTC por la sospecha de TEP en un tercio de los pacientes ingresados por COVID-19 durante el per&#237;odo de estudio&#44; con una tasa de diagn&#243;stico confirmado del 21&#44;3&#37;&#44; que no fue no estad&#237;sticamente diferente de la tasa encontrada durante el per&#237;odo de control&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Cuando se utiliza correctamente&#44; la APTC debe detectar un TEP en el 30&#37; de todas las APTC solicitadas<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">17</span></a>&#44; por lo que nuestros datos no sugieren infrautilizaci&#243;n en ninguno de los per&#237;odos&#44; y concuerdan con la capacidad diagn&#243;stica de la prueba en otros estudios realizados en pacientes con COVID-19<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a>&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="par0125" class="elsevierStylePara elsevierViewall">La pandemia de COVID-19 se asocia con un mayor riesgo de TEP&#46; Este riesgo parece aumentar una o dos semanas despu&#233;s de la infecci&#243;n&#46; Durante el per&#237;odo pand&#233;mico&#44; el TEP afecta a pacientes con un perfil cl&#237;nico diferente&#44; frecuentemente con COVID-19&#44; y la obstrucci&#243;n de los vasos es m&#225;s frecuentemente distal&#46; Nuestros resultados respaldan la hip&#243;tesis de que la COVID-19 es un factor de riesgo para sufrir un TEP&#44; con caracter&#237;sticas espec&#237;ficas&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Financiaci&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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            0 => array:2 [
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              "titulo" => "Background"
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            1 => array:2 [
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    "fechaRecibido" => "2020-11-25"
    "fechaAceptado" => "2021-01-03"
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          "palabras" => array:5 [
            0 => "COVID-19"
            1 => "Embolismo pulmonar"
            2 => "SARS-CoV-2"
            3 => "Coronavirus"
            4 => "Trombosis"
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      ]
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        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec1519071"
          "palabras" => array:5 [
            0 => "COVID-19"
            1 => "Pulmonary embolism"
            2 => "SARS-CoV-2"
            3 => "Coronavirus"
            4 => "Thrombosis"
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    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se ha descrito una elevada incidencia de tromboembolismo pulmonar &#40;TEP&#41; durante la pandemia por coronavirus&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo unic&#233;ntrico&#44; con revisi&#243;n de las angiograf&#237;as pulmonares por tomograf&#237;a computarizada solicitadas por sospecha de tromboembolismo pulmonar durante dos per&#237;odos&#44; del 01 de marzo del 2020 al 31de mayo del 2020 &#40;pandemia&#41;&#44; e igual intervalo en 2019 &#40;control&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se diagnosticaron 22 tromboembolismos pulmonares durante el per&#237;odo control y 99 en el pand&#233;mico&#44; 74 asociados con COVID-19&#46; El 5&#44;3&#37; de los pacientes hospitalizados con COVID-19 sufri&#243; un tromboembolismo pulmonar&#44; con un retraso entre ambos diagn&#243;sticos de 9&#44;1 &#177; 8&#44;4 d&#237;as&#46; Durante la pandemia&#44; los pacientes con tromboembolismo pulmonar ten&#237;an menos condiciones predisponentes &#40;tromboembolismo pulmonar previo 5&#44;1 vs&#46; 18&#44;2&#37;&#44; p &#61; 0&#44;05&#44; cirug&#237;a previa 2 vs&#46; 35&#44;4&#37;&#44; p &#61; 0&#44;0001&#44; trombosis venosa profunda 11&#44;1 vs&#46; 45&#44;5&#37;&#44; p &#61; 0&#44;0001&#41;&#44; y los tromboembolismos pulmonares perif&#233;ricos eran m&#225;s frecuentes &#40;73&#44;5 vs&#46; 50&#37;&#44; p &#61; 0&#44;029&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Existe un riesgo incrementado de sufrir un TEP durante la pandemia por SARS-CoV-2&#44; que afecta a pacientes con perfil cl&#237;nico diferente y causa m&#225;s frecuentemente TEP distales&#46;</p></span>"
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          0 => array:2 [
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A high incidence of pulmonary embolism has been described during the coronavirus pandemic&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This work is a single-center retrospective study which reviewed computed tomography pulmonary angiograms ordered due to suspected pulmonary embolism during two periods&#58; from March 1&#44; 2020 to May 31&#44; 2020 &#40;pandemic&#41; and during the same interval in 2019 &#40;control&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Twenty-two pulmonary embolism were diagnosed during the control period and 99 in the pandemic&#44; 74 of which were associated with COVID-19&#46; Of all patients hospitalized with COVID-19&#44; 5&#46;3&#37; had a pulmonary embolism&#44; with a delay between the two diagnoses of 9&#46;1 &#177; 8&#46;4 days&#46; During the pandemic&#44; patients with pulmonary embolism had fewer predisposing conditions &#40;previous pulmonary embolism 5&#46;1 vs&#46; 18&#46;2&#37;&#44; p &#61; &#46;05&#59; previous surgery 2 vs&#46; 35&#46;4&#37;&#44; p &#61; &#46;0001&#59; deep vein thrombosis 11&#46;1 vs&#46; 45&#46;5&#37;&#44; p &#61; &#46;0001&#41;&#59; peripheral pulmonary embolisms were the most frequent &#40;73&#46;5 vs&#46; 50&#37;&#44; p &#61; &#46; 029&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">There is an increased risk of having a pulmonary embolism during the SARS-CoV-2 pandemic&#44; which affects patients with a different clinical profile and more often causes distal pulmonary embolisms&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Gr&#225;fica de incidencias de COVID-19 y TEP en la poblaci&#243;n de referencia durante la pandemia&#46; Las l&#237;neas representan la suma diaria de casos durante los 14 d&#237;as anteriores&#44; tanto para COVID-19 como para los casos de TEP en la poblaci&#243;n de referencia del hospital&#46; La escala de incidencia de TEP es diez veces menor que la de COVID-19&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">TEP&#58; tromboembolismo pulmonar&#46;</p>"
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                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">RR 4&#44;5 &#40;IC 95&#37; 2&#44;80-6&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;69&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad media &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;1<span class="elsevierStyleMonospace">&#177;</span>19&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;6<span class="elsevierStyleMonospace">&#177;</span>15&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COVID-19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TEP previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;18&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cirug&#237;a en el mes previo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;35&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neoplasia activa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;27&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;45&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;11&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TEP perif&#233;rico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;73&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frecuencia cardiaca &#40;lpm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98<span class="elsevierStyleMonospace">&#177;</span>27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">90<span class="elsevierStyleMonospace">&#177;</span>23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sat O<span class="elsevierStyleInf">2</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91<span class="elsevierStyleMonospace">&#177;</span>6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neutr&#243;filos &#40;x10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linfocitos &#40;x10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;421<span class="elsevierStyleMonospace">&#177;</span>4&#46;100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;337<span class="elsevierStyleMonospace">&#177;</span>732&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Plaquetas &#40;x10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">259<span class="elsevierStyleMonospace">&#177;</span>112&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">288<span class="elsevierStyleMonospace">&#177;</span>295&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fibrin&#243;geno mg&#47;dL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">557<span class="elsevierStyleMonospace">&#177;</span>229&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">438<span class="elsevierStyleMonospace">&#177;</span>198&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">D&#237;mero D mg&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;2<span class="elsevierStyleMonospace">&#177;</span>5&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;0<span class="elsevierStyleMonospace">&#177;</span>24&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCR mg&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;2<span class="elsevierStyleMonospace">&#177;</span>120&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#44;8<span class="elsevierStyleMonospace">&#177;</span>69&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;046&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDH U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">303<span class="elsevierStyleMonospace">&#177;</span>264&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">384<span class="elsevierStyleMonospace">&#177;</span>326&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ferritina &#951;gr&#47;mL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Datos cl&#237;nicos y radiol&#243;gicos de pacientes con diagn&#243;stico de tromboembolismo pulmonar &#40;TEP&#41; durante el per&#237;odo de control &#40;2019&#41; y el per&#237;odo pand&#233;mico &#40;2020&#41;</p>"
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Article information
ISSN: 00142565
Original language: Spanish
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Revista Clínica Española (English Edition)