Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome

Abstract

Introduction The incidence, characteristics, and prognosis of pulmonary embolism (PE) in Coronavirus disease 2019 (COVID-19) have been poorly investigated. We aimed to investigate the prevalence and the correlates with the occurrence of PE as well as the association between PE and the risk of mortality in COVID-19. Methods Retrospective multicenter study on consecutive COVID-19 patients hospitalized at 7 Italian Hospitals. At admission, all patients underwent medical history, laboratory and echocardiographic evaluation. Results The study population consisted of 224 patients (mean age 69 ± 14, male sex 62%); PE was diagnosed in 32 cases (14%). Patients with PE were hospitalized after a longer time since symptoms onset (7 IQR 3–11 days, 3 IQR 1–6 days; p = 0.001) and showed higher D-dimers level (1819 IQR 568–5017 ng/ml vs 555 IQR 13–1530 ng/ml; p < 0.001) and higher prevalence of myocardial injury(47% vs 28%, p = 0.033). At multivariable analysis, tricuspid annular plane systolic excursion (TAPSE; HR = 0.84; 95% CI 0.66–0.98; p = 0.046) and systolic pulmonary arterial pressure (sPAP; HR = 1.12; 95% CI 1.03–1.23; p = 0.008) resulted the only parameters independently associated with PE occurrence. Mortality rates (50% vs 27%; p = 0.010) and cardiogenic shock (37% vs 14%; p = 0.001) were significantly higher in PE as compared with non-PE patients. At multivariate analysis PE was significant associated with mortality. Conclusion PE is relatively common complication in COVID-19 and is associated with increased mortality risk. TAPSE and sPAP resulted the only parameters independently associated with PE occurrence in COVID-19 patients.

Tricuspid annular plane systolic excursion (TAPSE) measured by echocardiography and mortality in COVID-19: A systematic review and meta-analysis

“…( Huang et al, 2020b , Moody et al, 2020 , Stockenhuber et al, 2020 ) TAPSE was shown to be associated with the pulmonary embolism occurence in patients with COVID-19. ( Scudiero et al, 2021 ) Myocardial injury and hyperinflammation in COVID-19-induced cytokine storm could be an additional cause of ARDS-related acute RHF. ( Lim et al, 2020 , Yonas et al, 2020 ) In non-COVID-19-related ARDS, poor RV function identified by echocardiography has been found to be a predictor of patient deterioration and poor overall outcome.…”

Antithrombotic and Anti-Inflammatory Effects of Fondaparinux and Enoxaparin in Hospitalized COVID-19 Patients: The FONDENOXAVID Study

“…Following the COVID-19 outbreak, 1 which has spread rapidly from China to other countries in the world with alarming morbidity and mortality, 2 several therapeutic strategies have been reported, including oxygen support 3 and experimental antiviral therapies. 4 Based on the coexistence of inflammation and hypercoagulable state 5 leading to increased risk of venous thromboembolism events (VTEs), 6–8 the use of low–molecular weight heparins (LMWHs) is recommended as part of standard therapy in hospitalized COVID-19 patients. 9 , 10 LMWHs, such as enoxaparin, seem to act with a specific antithrombotic action and also with additional anti-inflammatory and antiviral activities in vitro against SARS-CoV2.…”

Prognostic Value of Fibrinogen among COVID-19 Patients Admitted to an Emergency Department: An Italian Cohort Study

“…From early reports to the present, alterations of hemostasis with a trend toward hypercoagulable state have been reported in COVID-19 patients [ 7 , 8 ]; in particular, increased levels of D-dimer and fibrinogen have been associated with poor prognosis among hospitalized patients [ 9 , 10 , 11 , 12 , 13 ], mainly due to pulmonary embolism or disseminated intravascular coagulation (DIC) [ 17 ]. However, the blood samples were usually collected during hospitalization, and little is still known about the role of clotting parameters in identifying, at ED admission patients, with more severe form of COVID-19, characterized by ARDS, and their relationship with thromboembolic events [ 18 ].…”