tetano
Editor, Senior Moderator
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[SUP] 1 [/SUP], Riccardo M Inciardi[SUP] 2 [/SUP], Mattia Di Pasquale[SUP] 2 [/SUP], Piergiuseppe Agostoni[SUP] 3 4 [/SUP], Antonio Bellasi[SUP] 5 [/SUP], Rita Camporotondo[SUP] 6 [/SUP], Claudia Canale[SUP] 1 [/SUP], Valentina Carubelli[SUP] 2 [/SUP], Stefano Carugo[SUP] 7 [/SUP], Francesco Catagnano[SUP] 6 8 [/SUP], Giambattista Danzi[SUP] 9 [/SUP], Laura Dalla Vecchia[SUP] 10 [/SUP], Stefano Giovinazzo[SUP] 1 [/SUP], Massimiliano Gnecchi[SUP] 6 [/SUP], Marco Guazzi[SUP] 11 [/SUP], Anita Iorio[SUP] 12 [/SUP], Maria Teresa La Rovere[SUP] 13 [/SUP], Sergio Leonardi[SUP] 6 [/SUP], Gloria Maccagni[SUP] 9 [/SUP], Massimo Mapelli[SUP] 3 4 [/SUP], Davide Margonato[SUP] 6 8 [/SUP], Marco Merlo[SUP] 14 [/SUP], Luca Monzo[SUP] 15 16 [/SUP], Andrea Mortara[SUP] 8 [/SUP], Vincenzo Nuzzi[SUP] 14 [/SUP], Massimo Piepoli[SUP] 17 18 [/SUP], Italo Porto[SUP] 1 [/SUP], Andrea Pozzi[SUP] 12 [/SUP], Giovanni Provenzale[SUP] 7 [/SUP], Filippo Sarullo[SUP] 19 [/SUP], Gianfranco Sinagra[SUP] 14 [/SUP], Chiara Tedino[SUP] 2 [/SUP], Daniela Tomasoni[SUP] 2 [/SUP], Maurizio Volterrani[SUP] 20 [/SUP], Gregorio Zaccone[SUP] 2 [/SUP], Carlo Mario Lombardi[SUP] 2 [/SUP], Michele Senni[SUP] 12 [/SUP], Marco Metra[SUP] 21 [/SUP]
Affiliations
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.
. 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[SUP] 1 [/SUP], Riccardo M Inciardi[SUP] 2 [/SUP], Mattia Di Pasquale[SUP] 2 [/SUP], Piergiuseppe Agostoni[SUP] 3 4 [/SUP], Antonio Bellasi[SUP] 5 [/SUP], Rita Camporotondo[SUP] 6 [/SUP], Claudia Canale[SUP] 1 [/SUP], Valentina Carubelli[SUP] 2 [/SUP], Stefano Carugo[SUP] 7 [/SUP], Francesco Catagnano[SUP] 6 8 [/SUP], Giambattista Danzi[SUP] 9 [/SUP], Laura Dalla Vecchia[SUP] 10 [/SUP], Stefano Giovinazzo[SUP] 1 [/SUP], Massimiliano Gnecchi[SUP] 6 [/SUP], Marco Guazzi[SUP] 11 [/SUP], Anita Iorio[SUP] 12 [/SUP], Maria Teresa La Rovere[SUP] 13 [/SUP], Sergio Leonardi[SUP] 6 [/SUP], Gloria Maccagni[SUP] 9 [/SUP], Massimo Mapelli[SUP] 3 4 [/SUP], Davide Margonato[SUP] 6 8 [/SUP], Marco Merlo[SUP] 14 [/SUP], Luca Monzo[SUP] 15 16 [/SUP], Andrea Mortara[SUP] 8 [/SUP], Vincenzo Nuzzi[SUP] 14 [/SUP], Massimo Piepoli[SUP] 17 18 [/SUP], Italo Porto[SUP] 1 [/SUP], Andrea Pozzi[SUP] 12 [/SUP], Giovanni Provenzale[SUP] 7 [/SUP], Filippo Sarullo[SUP] 19 [/SUP], Gianfranco Sinagra[SUP] 14 [/SUP], Chiara Tedino[SUP] 2 [/SUP], Daniela Tomasoni[SUP] 2 [/SUP], Maurizio Volterrani[SUP] 20 [/SUP], Gregorio Zaccone[SUP] 2 [/SUP], Carlo Mario Lombardi[SUP] 2 [/SUP], Michele Senni[SUP] 12 [/SUP], Marco Metra[SUP] 21 [/SUP]
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.