Abstract
Introduction. Acute pulmonary embolism (APE) is a frequent condition in patients with COVID-19 and is associated with worse outcomes. Previous studies suggested an immunothrombosis instead of a thrombus embolism, but the precise mechanisms remain unknown. Objective. To assess the determinants and prognosis of APE during COVID-19. Methods. We retrospectively included all consecutive patients with APE confirmed by computed tomography pulmonary angiography hospitalized at Strasbourg University Hospital from 1 March to 31 May 2019 and 1 March to 31 May 2020. A comprehensive set of clinical, biological, and imaging data during hospitalization was collected. The primary outcome was transfer to the intensive care unit (ICU). Results. APE was diagnosed in 140 patients: 59 (42.1%) with COVID-19, and 81 (57.9%) without COVID-19. A 812% reduction of non-COVID-19 related APE was registered during the 2020 period. COVID-19 patients showed a higher simplified pulmonary embolism severity index (sPESI) score (1.15 ± 0.76 vs. 0.83 ± 0.83, p = 0.019) and were more frequently transferred to the ICU (45.8% vs. 6.2%, p < 0.001). No difference regarding the most proximal thrombus localization, Qanadli score (8.1 ± 6.9 vs. 9.0 ± 7.4, p = 0.45), the proportion of subsegmental (10.2% vs. 11.1%, p = 0.86), and segmental pulmonary embolism (35.6% vs. 24.7%, p = 0.16) was evidenced between COVID-19 and non-COVID-19 APE. In COVID-19 patients with subsegmental or segmental APE, thrombus was, in all cases (27/27 patients), localized in areas with COVID-19-related lung injuries. Marked inflammatory and prothrombotic biological markers were associated with COVID-19 APE. Conclusions. APE patients with COVID-19 have a particular clinico–radiological and biological profile and a dismal prognosis. Our results emphasize the preeminent role of inflammation and a prothrombotic state in these patients.
Highlights
Since the outbreak of coronavirus disease 2019 (COVID-19), acute pulmonary embolism (APE) has been recognized as a frequent complication that carried a dismal prognosis [1,2]
In the first model, including all candidates’ predictors, except lupus anticoagulant (LA), creatinine at peak (hazard ratio (HR) 1.01, confidence interval (CI) 95% [1.00–1.02], p = 0.011), CRP at peak (HR 1.00, CI95% [1.00–1.01], p = 0.012) and COVID-19 (HR 4.19, CI95% [1.27–13.76], p = 0.018) were independent predictors of transfer to the intensive care unit (ICU) in patients with Acute pulmonary embolism (APE)
In this temporal analysis of 140 patients with acute pulmonary embolism, we observed a marked decline in non-COVID-19 APE during the first European wave of the pandemic
Summary
Since the outbreak of coronavirus disease 2019 (COVID-19), acute pulmonary embolism (APE) has been recognized as a frequent complication that carried a dismal prognosis [1,2]. Evidence from autopsy series reported endotheliitis [3], pulmonary vascular microthrombosis [4], and intense inflammation within the pulmonary vasculature. A decline in incidence of APE and imaging procedures has been reported due to the COVID-19 pandemic [9]. In an effort to better characterize the pathological mechanisms underlying COVID-19 associated APE, we sought to compare COVID-19 and non-COVID-19 APE. The objectives of our study were to compare the difference regarding clinical, biological, and radiological characteristics of COVID-19 and non-COVID-19 patients with APE admitted to the general ward at our institution, and to assess the impact of COVID-19 in APE prognosis
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