Acute Pulmonary Embolism in Patients with and without COVID-19

• Published in: Journal of clinical medicine Vol. 10; no. 10; p. 2045
• Main Authors: Trimaille, Antonin, Curtiaud, Anaïs, Matsushita, Kensuke, Marchandot, Benjamin, Von Hunolstein, Jean-Jacques, Sato, Chisato, Leonard-Lorant, Ian, Sattler, Laurent, Grunebaum, Lelia, Ohana, Mickaël, Ohlmann, Patrick, Jesel, Laurence, Morel, Olivier
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 11.05.2021; MDPI
• Subjects: Anticoagulants; Blood clots; Clinical medicine; Coronaviruses; COVID-19; Emerging diseases; Human health and pathology; Infectious diseases; Laboratories; Life Sciences; Localization; Lupus; Patients; Pulmonary embolisms; Pulmonology and respiratory tract; Reagents; Santé publique et épidémiologie; Thromboembolism; France; COVID-19; computed tomography pulmonary angiography; SARS-CoV-2; thrombosis; acute pulmonary embolism; inflammation
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm10102045

Introduction. Acute pulmonary embolism (APE) is a frequent condition in patients with COVID-19 and is associated with worse outcomes. Previous studies suggested an immunothrombosis instead of a thrombus embolism, but the precise mechanisms remain unknown. Objective. To assess the determinants and prognosis of APE during COVID-19. Methods. We retrospectively included all consecutive patients with APE confirmed by computed tomography pulmonary angiography hospitalized at Strasbourg University Hospital from 1 March to 31 May 2019 and 1 March to 31 May 2020. A comprehensive set of clinical, biological, and imaging data during hospitalization was collected. The primary outcome was transfer to the intensive care unit (ICU). Results. APE was diagnosed in 140 patients: 59 (42.1%) with COVID-19, and 81 (57.9%) without COVID-19. A 812% reduction of non-COVID-19 related APE was registered during the 2020 period. COVID-19 patients showed a higher simplified pulmonary embolism severity index (sPESI) score (1.15 ± 0.76 vs. 0.83 ± 0.83, p = 0.019) and were more frequently transferred to the ICU (45.8% vs. 6.2%, p < 0.001). No difference regarding the most proximal thrombus localization, Qanadli score (8.1 ± 6.9 vs. 9.0 ± 7.4, p = 0.45), the proportion of subsegmental (10.2% vs. 11.1%, p = 0.86), and segmental pulmonary embolism (35.6% vs. 24.7%, p = 0.16) was evidenced between COVID-19 and non-COVID-19 APE. In COVID-19 patients with subsegmental or segmental APE, thrombus was, in all cases (27/27 patients), localized in areas with COVID-19-related lung injuries. Marked inflammatory and prothrombotic biological markers were associated with COVID-19 APE. Conclusions. APE patients with COVID-19 have a particular clinico–radiological and biological profile and a dismal prognosis. Our results emphasize the preeminent role of inflammation and a prothrombotic state in these patients.