tetano
Editor, Senior Moderator
J Thorac Dis
. 2024 Sep 30;16(9):6161-6170.
doi: 10.21037/jtd-23-1674. Epub 2024 Sep 26. Increased risk of pulmonary embolism and deep vein thrombosis with COVID-19 pneumonia in comparison to influenza pneumonia: insights from the National Inpatient Sample database
Kavin Raj[SUP] #[/SUP][SUP] 1 [/SUP], Harris Majeed[SUP] #[/SUP][SUP] 2 [/SUP], Sanya Chandna[SUP] 3 [/SUP], Akshit Chitkara[SUP] 1 [/SUP], Abu Baker Sheikh[SUP] 2 [/SUP], Ashish Kumar[SUP] 4 [/SUP], Karthik Gangu[SUP] 5 [/SUP], Keerthana Jyotheeswara Pillai[SUP] 6 [/SUP], Ankit Agrawal[SUP] 7 [/SUP], Santhosh K Sadashiv[SUP] 8 [/SUP], Ankur Kalra[SUP] 9 [/SUP]
Affiliations
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily a respiratory virus causing coronavirus disease 2019 (COVID-19) pneumonia, induces a hypercoagulable state. Previous studies comparing the prevalence of venous thromboembolism (VTE) in patients with COVID-19 pneumonia and those with influenza pneumonia revealed a higher risk of pulmonary embolism (PE) and deep vein thrombosis (DVT) associated with COVID-19 pneumonia. However, these studies have not adequately accounted for the severity and acuity of the presenting viral pneumonia.
Methods: In this retrospective study, we rigorously adjusted for critical illness using a nationally representative dataset to investigate whether COVID-19 pneumonia is independently linked to a higher risk of PE and DVT.
Results: After comprehensive multivariate adjustment, our findings demonstrated that patients with COVID-19 pneumonia maintained significantly higher odds of developing acute inpatient PE [adjusted odds ratio (aOR): 2.48; 95% confidence interval (CI): 2.16-2.86; P<0.01] and DVT (aOR: 1.66; 95% CI: 1.41-1.96; P<0.01) during the early pandemic compared to patients with influenza pneumonia. Furthermore, we identified congenital heart disease and malnutrition as novel risk factors for acute PE in COVID-19 patients.
Conclusions: Our study suggests that the higher prevalence of acute inpatient PE over DVT in patients with COVID-19 pneumonia may support a "thrombus in situ" mechanism of SARS-CoV-2-mediated pulmonary thrombosis. Consequently, clinicians should maintain a high index of suspicion for PE, even in the absence of DVT, among patients with COVID-19 pneumonia and should follow evidence-based guidelines for diagnosis and management.
Keywords: Coronavirus disease 2019 (COVID-19); deep vein thrombosis (DVT); influenza; pulmonary embolism (PE); venous thromboembolism (VTE).
. 2024 Sep 30;16(9):6161-6170.
doi: 10.21037/jtd-23-1674. Epub 2024 Sep 26. Increased risk of pulmonary embolism and deep vein thrombosis with COVID-19 pneumonia in comparison to influenza pneumonia: insights from the National Inpatient Sample database
Kavin Raj[SUP] #[/SUP][SUP] 1 [/SUP], Harris Majeed[SUP] #[/SUP][SUP] 2 [/SUP], Sanya Chandna[SUP] 3 [/SUP], Akshit Chitkara[SUP] 1 [/SUP], Abu Baker Sheikh[SUP] 2 [/SUP], Ashish Kumar[SUP] 4 [/SUP], Karthik Gangu[SUP] 5 [/SUP], Keerthana Jyotheeswara Pillai[SUP] 6 [/SUP], Ankit Agrawal[SUP] 7 [/SUP], Santhosh K Sadashiv[SUP] 8 [/SUP], Ankur Kalra[SUP] 9 [/SUP]
Affiliations
- PMID: 39444888
- PMCID: PMC11494551
- DOI: 10.21037/jtd-23-1674
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily a respiratory virus causing coronavirus disease 2019 (COVID-19) pneumonia, induces a hypercoagulable state. Previous studies comparing the prevalence of venous thromboembolism (VTE) in patients with COVID-19 pneumonia and those with influenza pneumonia revealed a higher risk of pulmonary embolism (PE) and deep vein thrombosis (DVT) associated with COVID-19 pneumonia. However, these studies have not adequately accounted for the severity and acuity of the presenting viral pneumonia.
Methods: In this retrospective study, we rigorously adjusted for critical illness using a nationally representative dataset to investigate whether COVID-19 pneumonia is independently linked to a higher risk of PE and DVT.
Results: After comprehensive multivariate adjustment, our findings demonstrated that patients with COVID-19 pneumonia maintained significantly higher odds of developing acute inpatient PE [adjusted odds ratio (aOR): 2.48; 95% confidence interval (CI): 2.16-2.86; P<0.01] and DVT (aOR: 1.66; 95% CI: 1.41-1.96; P<0.01) during the early pandemic compared to patients with influenza pneumonia. Furthermore, we identified congenital heart disease and malnutrition as novel risk factors for acute PE in COVID-19 patients.
Conclusions: Our study suggests that the higher prevalence of acute inpatient PE over DVT in patients with COVID-19 pneumonia may support a "thrombus in situ" mechanism of SARS-CoV-2-mediated pulmonary thrombosis. Consequently, clinicians should maintain a high index of suspicion for PE, even in the absence of DVT, among patients with COVID-19 pneumonia and should follow evidence-based guidelines for diagnosis and management.
Keywords: Coronavirus disease 2019 (COVID-19); deep vein thrombosis (DVT); influenza; pulmonary embolism (PE); venous thromboembolism (VTE).