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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Authors: Agudo Villa, Mª Teresa|||/items/2f95042a-6e79-4974-85bb-4ce6854d2dfb, Miro, Óscar, Jiménez, Sonia, Mebazaa, Alexandre, Freund, Yonathan, Burillo-Putze, Guillermo, Martín, Alfonso, Martín-Sánchez, Francisco Javier, García-Lamberechts, Eric Jorge, Alquézar-Arbe, Aitor, Jacob, Javier, Llorens, Pere, Pinera , Pascual, Gil, Víctor, Guardiola, Josep, Cardozo, Carlos, Modol Deltell, Josep Maria, Tost, Josep, Aguirre Tejedo, Alfons, Palau-Vendrell, Anna, LLauger García, Lluís, Adroher Munoz, Maria, Del Arco Galán, Carmen, Agudo Villa, Teresa, López-Laguna, Nieves, López Díez, María Pilar, Beddar Chaib, Fahd, Quero Motto, Eva, González Tejera, Matilde, Ponce, María Carmen, González del Castillo, Juan
Format: article
Publication Date:2021
Country:España
Institution:Universidad Alfonso X el Sabio
Repository:Repositorio Institucional de la Universidad Alfonso X el Sabio
Language:English
OAI Identifier:oai:archive.uax.com:20.500.12080/52269
Online Access:https://hdl.handle.net/20.500.12080/52269
Access Level:Open access
Keyword:Embolia pulmonar
COVID-19
SARS-CoV-2
Description
Summary: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 withn E 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&). 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 pulation, 95% confidence interval (CI) 8.51–9.41]. Several characteristics in COVID-19 patients were independently associ ated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart fail ure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 charac teristics, 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.

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