Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
Por:
Miro, O, Jimenez, S, Mebazaa, A, Freund, Y, Burillo-Putze, G, Martin, A, Martin-Sanchez, FJ, Garcia-Lamberechts, EJ, Alquezar-Arbe, A, Jacob, J, Llorens, P, Pinera, P, Gil, V, Guardiola, J, Cardozo, C, Deltell, JMM, Tost, J, Tejedo, AA, Palau-Vendrell, A, Garcia, LL, Munoz, MA, Galan, CD, Villa, TA, Lopez-Laguna, N, Diez, MPL, Chaib, FB, Motto, EQ, Tejera, MG, Ponce, MC, del Castillo, JG
Publicada:
1 sep 2021
Ahead of Print:
1 jun 2021
Resumen:
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 with PE 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 parts per thousand). 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 population, 95% confidence interval (CI) 8.51-9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, 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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Filiaciones:
Miro, O:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Villarroel 170, Barcelona 08036, Catalonia, Spain
Jimenez, S:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Villarroel 170, Barcelona 08036, Catalonia, Spain
Mebazaa, A:
Univ Hosp St Louis Lariboisiere, AP HP, Dept Anesthesiol Burn & Crit Care, Rue Ambroise Pare, F-75010 Paris, France
Freund, Y:
Sorbonne Univ, Hop Pitie Salpetriere, Assistance Publ Hop 18 Paris APHP, Emergency Dept, 47-83 Blvd Hop, F-75013 Paris, France
Burillo-Putze, G:
Hosp Univ Canarias, Emergency Dept, Carretera Ofra S-N, San Cristobal De La Lagu 38320, Santa Cruz De T, Spain
Martin, A:
Hosp Severo Ochoa, Emergency Dept, M-402,8, Madrid 28914, Spain
Martin-Sanchez, FJ:
Univ Complutense, Emergency Dept, Hosp Clin San Carlos, IDISSC, Calle Prof Martin Lagos S-N, Madrid 28040, Spain
Garcia-Lamberechts, EJ:
Univ Complutense, Emergency Dept, Hosp Clin San Carlos, IDISSC, Calle Prof Martin Lagos S-N, Madrid 28040, Spain
Alquezar-Arbe, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Carrer St Quinti 89, Barcelona 08041, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Carrer Feixa Llarga S-N, Lhospitalet De Llobregat 08907, Spain
Llorens, P:
Univ Miguel Hernandez, Hosp Gen Alicante, Emergency Dept, Calle Pintor Baeza 11, Alicante 03010, Spain
Pinera, P:
Hosp Gen Univ Reina Sofia, Emergency Dept, Av Intendente Jorge Palacios 1, Murcia 30003, Spain
Gil, V:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Villarroel 170, Barcelona 08036, Catalonia, Spain
Guardiola, J:
Hosp Santa Creu & Sant Pau, Emergency Dept, Carrer St Quinti 89, Barcelona 08041, Spain
Cardozo, C:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Villarroel 170, Barcelona 08036, Catalonia, Spain
Deltell, JMM:
Hosp Badalona Germans Trias & Pujol, Emergency Dept, Carretera Canyet S-N, Barcelona 08916, Spain
Tost, J:
Hosp Terrassa, Emergency Dept, Carretera Torrebon S-N, Barcelona 08227, Spain
Tejedo, AA:
Hosp Mar, Emergency Dept, Passeig Maritim Barceloneta 25,29, Barcelona 08003, Spain
Palau-Vendrell, A:
Hosp Univ Joan XXIII, Emergency Dept, Carrer Dr Mallafre Guasch 4, Tarragona 43005, Spain
Garcia, LL:
Hosp Univ Vic, Emergency Dept, Carrer Francesc Pla Vigata 1, Vic Barcelona 08500, Spain
Munoz, MA:
Hosp Univ Girona Dr Josep Trueta, Emergency Dept, Avinguda Franca S-N, Girona 17007, Spain
Galan, CD:
Hosp Univ Princesa, Emergency Dept, Calle Diego Leon 62, Madrid 28006, Spain
Villa, TA:
Hosp Univ Severo Ochoa, Emergency Dept, M-402,8, Madrid 28914, Spain
Lopez-Laguna, N:
Clin Univ Navarra, Emergency Dept, Calle Marquesado Sta Marta 1, Madrid 28027, Spain
Diez, MPL:
Hosp Univ Burgos, Emergency Dept, Av Islas Baleares 3, Burgos 09006, Spain
Chaib, FB:
Complejo Asistencial Soria, Emergency Dept, Soria 42005, Spain
Motto, EQ:
Hosp Clin Univ Virgen Arrixaca, Emergency Dept, Ctra Madrid Cartagena S-N, Murcia 30120, Spain
Tejera, MG:
Hosp Gen Univ Elche, Emergency Dept, Carrer Almazara 11, Alicante 03203, Spain
Ponce, MC:
Hosp Vega Baja Orihuela, Emergency Dept, Carretera Orihuela Almoradi S-N, Alicante, Spain
del Castillo, JG:
Univ Complutense, Emergency Dept, Hosp Clin San Carlos, IDISSC, Calle Prof Martin Lagos S-N, Madrid 28040, Spain
Green Published, Bronze
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