Impact of pulmonary embolism on COVID-19 pneumonia hospitalizations: analysis of the national inpatient sample 2020

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Abstract Background SARS-CoV-2 swept across the globe, overwhelming healthcare systems across the world regardless of borders and socioeconomic factors. While many were directly affected by COVID pneumonia (CP), others were impacted by complications from the illness. Pulmonary embolism (PE) is a well described complication in this population and results in worsening ventilation-perfusion mismatch further worsening their pulmonary reserve. We aimed to assess the impact of underlying PE on CP patients with a large sample size. Methods We utilized the National Inpatient Sample from 2020 to identify 1,058,815 hospitalized adults with CP. These hospitalizations were further stratified based on the presence of PE. A multivariate regression model was used to adjust for confounders and analyze the variables. Results Of those who were admitted for CP, 29,845 (2.8%) had PE. In-hospital mortality was higher in those with PE (16.5% vs 10.9%; p<0.001). Figure 1 shows the Forrest plot for multivariate analysis of in-hospital outcomes when adjusted for patient demographics, comorbidities, and hospital characteristics. When adjusted similarly, CP patients with PE had longer length of stay (LOS) by 2.4 days (p<0.001) and had additional hospital costs (HC) of $45,470 (p<0.001). Conclusion CP patients who had PE had significantly worse outcomes in terms of in-hospital mortality, LOS, HC, cardiac arrest, arrhythmias, stroke, AKI, GI bleed, sepsis, cardiogenic shock, and being intubated. These patients poorly tolerate the ventilation-perfusion mismatch due to an already reduced pulmonary reserve.