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Clin Res Cardiol
. 2020 Nov 3.
doi: 10.1007/s00392-020-01766-y. Online ahead of print.
Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study
Pietro Ameri 1 , Riccardo M Inciardi 2 , Mattia Di Pasquale 2 , Piergiuseppe Agostoni 3 4 , Antonio Bellasi 5 , Rita Camporotondo 6 , Claudia Canale 1 , Valentina Carubelli 2 , Stefano Carugo 7 , Francesco Catagnano 6 8 , Giambattista Danzi 9 , Laura Dalla Vecchia 10 , Stefano Giovinazzo 1 , Massimiliano Gnecchi 6 , Marco Guazzi 11 , Anita Iorio 12 , Maria Teresa La Rovere 13 , Sergio Leonardi 6 , Gloria Maccagni 9 , Massimo Mapelli 3 4 , Davide Margonato 6 8 , Marco Merlo 14 , Luca Monzo 15 16 , Andrea Mortara 8 , Vincenzo Nuzzi 14 , Massimo Piepoli 17 18 , Italo Porto 1 , Andrea Pozzi 12 , Giovanni Provenzale 7 , Filippo Sarullo 19 , Gianfranco Sinagra 14 , Chiara Tedino 2 , Daniela Tomasoni 2 , Maurizio Volterrani 20 , Gregorio Zaccone 2 , Carlo Mario Lombardi 2 , Michele Senni 12 , Marco Metra 21
Affiliations
- PMID: 33141251
- DOI: 10.1007/s00392-020-01766-y
Abstract
Background: Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited.
Methods: Data 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.
Results: The 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.
Conclusions: PE 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.
Keywords: Anticoagulant; COVID-19; Coagulopathy; D-dimer; Death; Thromboembolism.