Incidence of pulmonary embolism in non-critically ill COVID-19 patients. Predicting factors for a challenging diagnosis

Abstract

Recent studies suggest that thrombotic complications are a common phenomenon in the novel SARS-CoV-2 infection. The main objective of our study is to assess cumulative incidence of pulmonary embolism (PE) in non critically ill COVID-19 patients and to identify its predicting factors associated to the diagnosis of pulmonary embolism. We retrospectevely reviewed 452 electronic medical records of patients admitted to Internal Medicine Department of a secondary hospital in Madrid during Covid 19 pandemic outbreak. We included 91 patients who underwent a multidetector Computed Tomography pulmonary angiography(CTPA) during conventional hospitalization. The cumulative incidence of PE was assessed ant the clinical, analytical and radiological characteristics were compared between patients with and without PE. PE incidence was 6.4% (29/452 patients). Most patients with a confirmed diagnosed with PE recieved low molecular weight heparin (LMWH): 79.3% (23/29). D-dimer peak was significatly elevated in PE vs non PE patients (14,480 vs 7230 mcg/dL, p = 0.03). In multivariate analysis of patients who underwent a CTPA we found that plasma D-dimer peak was an independen predictor of PE with a best cut off point of > 5000 µg/dl (OR 3.77; IC95% (1.18-12.16), p = 0.03). We found ninefold increased risk of PE patients not suffering from dyslipidemia (OR 9.06; IC95% (1.88-43.60). Predictive value of AUC for ROC is 75.5%. We found a high incidence of PE in non critically ill hospitalized COVID 19 patients despite standard thromboprophylaxis. An increase in D-dimer levels is an independent predictor for PE, with a best cutoff point of > 5000 µg/ dl.

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

“…After excluding duplicates and preliminary screening, 151 full-text articles were assessed for eligibility and 130 studies were excluded for not meeting the inclusion criteria, leaving 23 investigation fulfilling the inclusion criteria ( Fig. 1) [1,3,4,8,12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”

“…Although the concomitant comorbidities were not systematically recorded by all investigations, active cancer and previous venous thromboembolic events were reported in a small percentage of cases. Fourteen studies considered ICU patients [1 , 3 , 4 , 8 , [16] , [17] , [18] , [19] , [20] , 22 , 25 , 26 , 28] while fifteen provided data of subjects hospitalized in general wards [1 , 8 , 17 , 20 , 21 , 23 , 24 , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] . Seven studies reported the data of both ICU and general wards patients [1 , 8 , 17 , 19 , 20 , 26 , 28] .…”

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

“…Our results suggest that a very high D-dimer cut-off (approximately 10 fold the standard threshold) may be associated to con rmed APE. A recent study reported that a D-dimer threshold of 2660 μg/L detected all subject with APE among hospitalized COVID-19 patients [21], and in the formerly mentioned study by Mestre-Gomez et al, the best cut-off point was 5000 ug/dL [20]. These cut-off values are much higher than those used to exclude pulmonary embolus in non-ICU patients [22][23].…”

“…These gures are much higher than the rates of APE observed in non COVID-19 ICU patients with sepsis or shock receiving guidelinerecommended thromboprophylaxis [18,19]. In one of the very few studies which describing thromboembolic events in non ICU COVID-19 patients, Mestre-Gomez et al found that 29 out of 91 subjects (31.9%) who underwent CTPA presented APE, after admission to the internal medicine department [20]. Our results con rm the nding of a high incidence of APE in internal medicine department non-critical COVID-19 patients.…”

Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

“…The diagnosis of COVID-19 in most studies required the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time polymerase chain reaction (RT-PCR), but some were based on high clinical suspicion without the PCR results. In the clinical studies, 16 and 5 studies reported the incidences of outcomes only in the ICU (2,3,8,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) or non-ICU settings (27)(28)(29)(30)(31), respectively. Seven studies reported the incidence of outcomes in the ICU, and non-ICU settings.…”