Journal Article

Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

Mapelli Massimo, Camporotondo Rita, Canale, Claudia, Agostoni Piergiuseppe, Iorio, Anita, Carugo Stefano, Sarullo Filippo, Leonardi, Sergio, Gnecchi Massimiliano, Tomasoni Daniela, Volterrani Maurizio, Nuzzi Vincenzo, Senni Michele, Mortara, Andrea, Ameri Pietro, Piepoli Massimo, Giovinazzo Stefano, Dalla Vecchia Laura, Catagnano Francesco, Inciardi, Riccardo M, La Rovere Maria Teresa, Monzo Luca, Lombardi, Carlo Mario, Di Pasquale Mattia, Provenzale Giovanni, Merlo, Marco, Tedino Chiara, Sinagra Gianfranco, Danzi Giambattista, Zaccone Gregorio, Maccagni Gloria, Carubelli Valentina, Metra Marco, Bellasi, Antonio, Margonato Davide, Porto Italo, Guazzi, Marco, Pozzi, Andrea

2021

Overview

BackgroundPulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited.MethodsData were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models.ResultsThe study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involvement, and higher admission d-dimer [4344 (1099–15,118) vs. 818.5 (417–1460) ng/mL, p < 0.001]. They also received more frequently darunavir/ritonavir, tocilizumab and ventilation support. Furthermore, they faced more bleeding episodes requiring transfusion (15.6% vs. 5.1%, p < 0.001) and non-significantly higher in-hospital mortality (34.6% vs. 22.9%, p = 0.06). In multivariate regression, only d-dimer was associated with PE (HR 1.72, 95% CI 1.13–2.62; p = 0.01). The relation between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer < 500 ng/mL.ConclusionsPE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of d-dimer in this population need to be clarified.Graphic abstract

• Publisher: Springer Nature B.V
• Subject: Antiretroviral drugs / Bleeding / Cardiology / Computed tomography / Congestive heart failure / Coronaviruses / COVID-19 / Dimers / Embolism / Embolisms / Kidney diseases / Lung diseases / Monoclonal antibodies / Pulmonary embolisms / Regression analysis / Renal failure / Ritonavir / Transfusion / Ventilation / Viral diseases