Abstract
Background: Coronavirus disease 2019 (COVID-19) is a global pandemic, which is associated with venous thromboembolism and pulmonary embolism (PE). This study aimed to estimate the pooled incidence of PE among patients hospitalized with COVID-19 within the published literature. Methods: This systematic review and meta-analysis was performed according to PRISMA guidelines. An electronic search using MEDLINE /PubMed, ScienceDirect, Cochrane, and OpenGray databases was conducted May 19th, 2020. Search terms included "COVID 19", "SARS-CoV-2”, "coronavirus disease 2019", "2019-nCoV", "Wuhan coronavirus", “Pulmonary embolism”, "pulmonary thromboembolism", “Pulmonary embol*”, “pulmonary thrombo*” and “PE”. Eligible studies included sufficient data to calculate the incidence of PE diagnosed during hospitalization in patients with COVID-19. Case reports were excluded. Quality was assessed using the Newcastle-Ottawa scale (observational cohort and case-control), AXIS tool (cross-sectional), and quality assessment tool (case series). Demographics and PE incidence data were extracted from the included studies and analyzed with R language. The pooled incidence of PE in patients hospitalized with COVID-19 was calculated. Results: The database search identified 128 records. Ten observational studies were eligible and were included in the meta-analysis with a total of 1722 patients (mean age= 63.36). The pooled PE incidence in patients hospitalized with COVID-19 was 17% (95% CI: 0.1-0.26). There was a high degree of study heterogeneity (I2 = 94%, p<0.01). Conclusion: The pooled PE incidence in patients hospitalized with COVID-19 is 17%. This increased incidence is greater than that previously reported in the general population of non-COVID-19. Attention and further investigation of this risk is warranted.
Highlights
In December 2019, pneumonia of unknown cause was detected in Wuhan, China1
Thromboembolism has been previously associated with zoonotic coronaviruses6 and may be attributed to several factors including; a hypercoagulable state associated with severe infection or inflammation7, COVID-19 associated hemostatic abnormalities8,9, recumbence7,10–12, and possible drug interactions between investigational COVID-19 therapies (Lopinavir/ritonavir) and antithrombotics5
The reported pulmonary embolism (PE) incidence among patients hospitalized with COVID-19 in all included studies ranged from 3–35% (Table 2)
Summary
In December 2019, pneumonia of unknown cause was detected in Wuhan, China. The causative agent was identified and named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While COVID-19 is primarily a pulmonary disease, there are multiple other pathologic manifestations and complications, including pulmonary embolism (PE). The relationship between COVID-19 and thromboembolism is becoming established in the literature. Thromboembolism has been previously associated with zoonotic coronaviruses and may be attributed to several factors including; a hypercoagulable state associated with severe infection or inflammation, COVID-19 associated hemostatic abnormalities, recumbence, and possible drug interactions between investigational COVID-19 therapies (Lopinavir/ritonavir) and antithrombotics. Coronavirus disease 2019 (COVID-19) is a global pandemic, which is associated with venous thromboembolism and pulmonary embolism (PE). This study aimed to estimate the pooled incidence of PE among patients hospitalized with COVID-19 within the published literature. Search terms included "COVID 19", "SARSCoV-2”, "coronavirus disease 2019", "2019-nCoV", "Wuhan coronavirus", “Pulmonary embolism”, "pulmonary thromboembolism", “Pulmonary embol*”, “pulmonary thrombo*” and “PE”.
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