Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study

• Published in: Clinical research in cardiology Vol. 110; no. 7; pp. 1020 - 1028
• Main Authors: Ameri, Pietro, Inciardi, Riccardo M., Di Pasquale, Mattia, Agostoni, Piergiuseppe, Bellasi, Antonio, Camporotondo, Rita, Canale, Claudia, Carubelli, Valentina, Carugo, Stefano, Catagnano, Francesco, Danzi, Giambattista, Dalla Vecchia, Laura, Giovinazzo, Stefano, Gnecchi, Massimiliano, Guazzi, Marco, Iorio, Anita, La Rovere, Maria Teresa, Leonardi, Sergio, Maccagni, Gloria, Mapelli, Massimo, Margonato, Davide, Merlo, Marco, Monzo, Luca, Mortara, Andrea, Nuzzi, Vincenzo, Piepoli, Massimo, Porto, Italo, Pozzi, Andrea, Provenzale, Giovanni, Sarullo, Filippo, Sinagra, Gianfranco, Tedino, Chiara, Tomasoni, Daniela, Volterrani, Maurizio, Zaccone, Gregorio, Lombardi, Carlo Mario, Senni, Michele, Metra, Marco
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2021; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Bleeding; Cardiology; Cohort Studies; Computed tomography; Congestive heart failure; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - mortality; COVID-19 - therapy; Dimers; Embolism; Embolisms; Female; Fibrin Fibrinogen Degradation Products - metabolism; Follow-Up Studies; Hemorrhage - epidemiology; Hospital Mortality; Hospitalization; Humans; Incidence; Italy; Kidney diseases; Lung diseases; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Pulmonary Embolism - epidemiology; Pulmonary Embolism - therapy; Pulmonary Embolism - virology; Pulmonary embolisms; Regression analysis; Renal failure; Respiration, Artificial - statistics & numerical data; Retrospective Studies; Risk Factors; Ritonavir; Tomography, X-Ray Computed; Transfusion; Ventilation; Viral diseases; Italy; COVID-19; Death; Anticoagulant; Thromboembolism; Coagulopathy; dimer; D-dimer
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-020-01766-y

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. Graphic abstract