Pulmonary embolism severity and in-hospital mortality: An international comparative study between COVID-19 and non-COVID patients
Por:
Miro, O, Jimenez, S, Llorens, P, Roussel, M, Gorlicki, J, Garcia-Lamberechts, EJ, Le Borgne, P, Jacob, J, Chauvin, A, Lucidarme, O, Burillo-Putze, G, Aguirre, A, Brigant, F, Lozano, L, del Castillo, JG, Freund, Y
Publicada:
1 may 2022
Ahead of Print:
1 mar 2022
Resumen:
Objective: To compare the severity of pulmonary embolism (PE) between patients with and without COVID, and to assess the association between severity and in-hospital-mortality.
Methods: We performed an analysis of 549 COVID (71.3% PCR-confirmed) and 439 non-COVID patients with PE consecutively included by 62 Spanish and 16 French emergency departments. PE-severity was assessed by size, the presence of right ventricular dysfunction (RVD), and the sPESI. The association of PE-severity and in-hospital-mortality was assessed both in COVID and non-COVID patients, and the interaction of COVID status and PE severity/outcome associations was also evaluated.
Results: COVID patients had PEs of smaller size (43% vs 56% lobar or larger, 42% vs. 35% segmental and 13% vs. 9% subsegmental, respectively; p = 0.01 for trend), less RVD (22% vs. 16%, p=0.02) and lower sPESI (p=0.03 for trend). Risk of in-hospital death was higher in COVID patients (12.8% vs. 5.3%, p < 0.001). PE-severity assessed by RVD and sPESI was independently associated with in-hospital-mortality in COVID patients, while PE size and sPESI were significantly associated with in-hospital-mortality in non-COVID. COVID status showed a significant interaction in the association of PE size and outcome (p=0.01), with OR for in-hospital mortality in COVID and non-COVID patients with lobar or larger PE of 0.92 (95%CI=0.19-4.47) and 4.47 (95% CI=1.60-12.5), respectively. Sensitivity analyses using only PCR-confirmed COVID cases confirmed these results.
Conclusion: COVID patients present a differential clinical picture, with PE of less severity than in non-COVID patients. An increased sPESI was associated with the risk of mortality in both groups but, PE size did not seem to be associated with in-hospital mortality in COVID patients.
Filiaciones:
Miro, O:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona, Catalonia, Spain
Jimenez, S:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona, Catalonia, Spain
Llorens, P:
Univ Miguel Hernandez, Hosp Gen Alicante, Emergency Dept, Alicante, Spain
Roussel, M:
Rouen Univ Hosp, Emergency Dept, Rouen, France
Gorlicki, J:
Hop Avicenne, Assistance Publ Mipitaux Paris APHP, Emergency Dept, Bobigny, France
Garcia-Lamberechts, EJ:
Univ Complutense, Emergency Dept, Hosp Clin San Carlos, IDISSC, Madrid, Spain
Le Borgne, P:
Ctr Univ Hosp Strasbourg, Emergency Dept, Strasbourg, France
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Catalonia, Spain
Chauvin, A:
Hop Lariboisiere, APHP, Emergency Dept, Paris, France
Lucidarme, O:
Sorbonne Univ, Paris, France
Hop La Pitie Salpetriere, APHP, Radiol Dept, Paris, France
Burillo-Putze, G:
Hosp Univ Canarias, Emergency Dept, Tenerife, Spain
Aguirre, A:
Hosp Mar, Emergency Dept, Barcelona, Catalonia, Spain
Brigant, F:
Hop St Antoine, APHP, Emergency Dept, Paris, France
Lozano, L:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
del Castillo, JG:
Univ Complutense, Emergency Dept, Hosp Clin San Carlos, IDISSC, Madrid, Spain
Freund, Y:
Sorbonne Univ, Paris, France
Hop La Pitie Salpetriere, APHP, Emergency Dept, Paris, France
Green Published, Bronze
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