Acute pulmonary embolism in acutely ill COVID-19 patients admitted to internal medicine wards.

Abstract

INTRODUCTION. Emerging evidence linking COVID-19 to an increased risk of acute pulmonary embolism (APE). The aim of the present study was to assess the prevalence of APE in acutely ill COVID-19 patients admitted to internal medicine department wards and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE. METHODS. All consecutive patients admitted to the internal medicine department wards of a general hospital with a diagnosis of severe COVID-19, who performed a Computer Tomography Pulmonary Angiography(CTPA) for respiratory deterioration in April 2020, were included. RESULTS. Study populations: 41 subjects, median(IRQ) age: 71.7(63-76) years, CPTA confirmed APE=8(19.51%,CI95%:8.82%-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of D-dimer for predicting APE was 2454 ng/mL, sensitivity(CI95%):63(24-91), specificity:73(54-87), Positive Predictive Value:36(13-65), Negative Predictive Value: 89(71-98) and AUC:0.62(0.38-0.85). The standard and age-adjusted D-dimer cut-offs, and the Wells score > 2 did not associate with confirmed APE, albeit a cut-off value of D-dimer=2454 ng/mL showed an RR:3.21;CI95%:0.92-13.97;p = 0.073.CONCLUSION. In acutely ill COVID-19 patients admitted to internal medicine department wards who performed CTPA for respiratory deterioration, the prevalence of APE was high, and the traditional diagnostic tools to identify high APE pre-test probability patients did not show to be clinically useful. These results support the use of a lower threshold of suspicion to perform CTPA for excluding or confirming APE as the most appropriate approach in this clinical setting.