Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome

Aims We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization. Methods and Results We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 S...

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Autores: Miro, O, Jimenez, S, Mebazaa, A, Freund, Y, Burillo-Putze, G, Martin, A, Martin-Sanchez, FJ, Garcia-Lamberechts, EJ, Alquezar-Arbe, A, Jacob, J, Llorens, P, Pinera, P, Gil, V, Guardiola, J, Cardozo, C, Deltell, JMM, Tost, J, Tejedo, AA, Palau-Vendrell, A, Garcia, LL, Munoz, MA, Galan, CD, Villa, TA, Lopez-Laguna, N, Diez, MPL, Chaib, FB, Motto, EQ, Tejera, MG, Ponce, MC, del Castillo, JG, Spanish Investigators Emergency Si
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
Repositorio:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
OAI Identifier:oai:isabial.fundanetsuite.com:p7635
Acceso en línea:https://isabial.portalinvestigacion.com/publicaciones7635
Access Level:acceso abierto
Palabra clave:Pulmonary embolism
COVID-19
SARS-CoV-2
Incidence
Clinical characteristics
Risk factors
Outcome
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spelling Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcomeMiro, OJimenez, SMebazaa, AFreund, YBurillo-Putze, GMartin, AMartin-Sanchez, FJGarcia-Lamberechts, EJAlquezar-Arbe, AJacob, JLlorens, PPinera, PGil, VGuardiola, JCardozo, CDeltell, JMMTost, JTejedo, AAPalau-Vendrell, AGarcia, LLMunoz, MAGalan, CDVilla, TALopez-Laguna, NDiez, MPLChaib, FBMotto, EQTejera, MGPonce, MCdel Castillo, JGSpanish Investigators Emergency SiPulmonary embolismCOVID-19SARS-CoV-2IncidenceClinical characteristicsRisk factorsOutcomeAims We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization. Methods and Results We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92 parts per thousand). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population [35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51-9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65-1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97-2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66-4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations. Conclusions PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE. [GRAPHICS] .OXFORD UNIV PRESS2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://isabial.portalinvestigacion.com/publicaciones7635EUROPEAN HEART JOURNALISSN: 0195668XISSNe: 15229645reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicanteinstname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)Inglésinfo:eu-repo/semantics/openAccessoai:isabial.fundanetsuite.com:p76352026-06-12T10:20:37Z
dc.title.none.fl_str_mv Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
title Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
spellingShingle Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
Miro, O
Pulmonary embolism
COVID-19
SARS-CoV-2
Incidence
Clinical characteristics
Risk factors
Outcome
title_short Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
title_full Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
title_fullStr Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
title_full_unstemmed Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
title_sort Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
dc.creator.none.fl_str_mv Miro, O
Jimenez, S
Mebazaa, A
Freund, Y
Burillo-Putze, G
Martin, A
Martin-Sanchez, FJ
Garcia-Lamberechts, EJ
Alquezar-Arbe, A
Jacob, J
Llorens, P
Pinera, P
Gil, V
Guardiola, J
Cardozo, C
Deltell, JMM
Tost, J
Tejedo, AA
Palau-Vendrell, A
Garcia, LL
Munoz, MA
Galan, CD
Villa, TA
Lopez-Laguna, N
Diez, MPL
Chaib, FB
Motto, EQ
Tejera, MG
Ponce, MC
del Castillo, JG
Spanish Investigators Emergency Si
author Miro, O
author_facet Miro, O
Jimenez, S
Mebazaa, A
Freund, Y
Burillo-Putze, G
Martin, A
Martin-Sanchez, FJ
Garcia-Lamberechts, EJ
Alquezar-Arbe, A
Jacob, J
Llorens, P
Pinera, P
Gil, V
Guardiola, J
Cardozo, C
Deltell, JMM
Tost, J
Tejedo, AA
Palau-Vendrell, A
Garcia, LL
Munoz, MA
Galan, CD
Villa, TA
Lopez-Laguna, N
Diez, MPL
Chaib, FB
Motto, EQ
Tejera, MG
Ponce, MC
del Castillo, JG
Spanish Investigators Emergency Si
author_role author
author2 Jimenez, S
Mebazaa, A
Freund, Y
Burillo-Putze, G
Martin, A
Martin-Sanchez, FJ
Garcia-Lamberechts, EJ
Alquezar-Arbe, A
Jacob, J
Llorens, P
Pinera, P
Gil, V
Guardiola, J
Cardozo, C
Deltell, JMM
Tost, J
Tejedo, AA
Palau-Vendrell, A
Garcia, LL
Munoz, MA
Galan, CD
Villa, TA
Lopez-Laguna, N
Diez, MPL
Chaib, FB
Motto, EQ
Tejera, MG
Ponce, MC
del Castillo, JG
Spanish Investigators Emergency Si
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Pulmonary embolism
COVID-19
SARS-CoV-2
Incidence
Clinical characteristics
Risk factors
Outcome
topic Pulmonary embolism
COVID-19
SARS-CoV-2
Incidence
Clinical characteristics
Risk factors
Outcome
description Aims We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization. Methods and Results We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92 parts per thousand). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population [35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51-9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65-1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97-2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66-4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations. Conclusions PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE. [GRAPHICS] .
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://isabial.portalinvestigacion.com/publicaciones7635
url https://isabial.portalinvestigacion.com/publicaciones7635
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv OXFORD UNIV PRESS
publisher.none.fl_str_mv OXFORD UNIV PRESS
dc.source.none.fl_str_mv EUROPEAN HEART JOURNAL
ISSN: 0195668X
ISSNe: 15229645
reponame:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
instname:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
instname_str Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
reponame_str r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
collection r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
repository.name.fl_str_mv
repository.mail.fl_str_mv
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