Predictors of pulmonary embolism in hospitalized patients with COVID-19

• Published in: Thrombosis journal Vol. 21; no. 1; p. 73
• Main Authors: Bahk, Jeeyune, Rehman, Abdul, Ho, Kam Sing, Narasimhan, Bharat, Ul, Hafiza Noor, Baloch, Ain, Zhang, Jiafang, Yip, Rowena, Lookstein, Robert, Steiger, David J
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03.07.2023; BioMed Central; BMC
• Subjects: Anticoagulants; Asthma; Care and treatment; Chi-square test; Chronic obstructive pulmonary disease; Coagulopathy; Coronavirus disease 2019; Coronaviruses; COVID-19; D-dimer; Ferritin; Health aspects; Hospital patients; Hospitalization; Hypoxia; Laboratories; Medical research; Medicine, Experimental; Mortality; Patients; Pulmonary embolism; Pulmonary embolisms; Regression analysis; Respiratory failure; Thromboembolism; Variables; Venous Thromboembolism; Vital signs; Pulmonary embolism; D-dimer; Venous Thromboembolism; Coronavirus disease 2019; Coagulopathy
• ISSN: 1477-9560; 1477-9560
• DOI: 10.1186/s12959-023-00518-y

High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE. 92 patients were negative (CTA-), and 66 patients were positive for PE (CTA+). CTA + had a longer time from symptom onset to admission (7 days vs. 4 days, p = 0.05), higher admission biomarkers, notably D-dimer (6.87 vs. 1.59, p < 0.0001), troponin (0.015 vs. 0.01, p = 0.01), and peak D-dimer (9.26 vs. 3.8, p = 0.0008). Predictors of PE included time from symptom onset to admission (OR = 1.11, 95% CI 1.03-1.20, p = 0.008), and PESI score at the time of CTA (OR = 1.02, 95% CI 1.01-1.04, p = 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04-1.22, p = 0.006), chronic anticoagulation (13.81, 95% CI 1.24-154, p = 0.03), and admission ferritin (1.001, 95% CI 1-1.001, p = 0.01). In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19.