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RESEARCH PRODUCT

Incidence, risk factors, and thrombotic load of pulmonary embolism in patients hospitalized for COVID-19 infection

Ainhoa CarreresGrace OsculloAna FerrandoAndrés Briones-gómezEnrique ZaldivarRaquel López-reyesRaúl MéndezSoledad ReyesMiguel ÁNgel Martínez-garcíaJosé Daniel Gómez-olivasLuis Martí-bonmatíCarmen MorataAlberto García-ortegaLaura Trilles-olasoPaula González-jiménezPilar CalvilloGabriel AngueraAmina BekkiRosario MenéndezR. GilLaura FecedCarlos F Muñoz-núñezCarles FonfríaJuan Pablo Reig-mezquidaNuria Toledo-pons

subject

Male0301 basic medicineCTPA Computed tomography pulmonary angiographyAUC-ROC Area under curve ROCPCR polymerase chain reaction0302 clinical medicineRisk FactorsspO2 Oxygen saturationIL6 Interleukin-6Pulmonary angiographySD Standard deviationMedicineProspective Studies030212 general & internal medicineProspective cohort studyComputed tomographyFramingham Risk ScoreIncidenceIncidence (epidemiology)RV Right ventricleHazard ratioVenous ThromboembolismMiddle AgedAo Aortic arteryPulmonary embolismCXR chest X-rayHospitalizationInfectious DiseasesCohortCRP C-reactive proteinFemalePA Pulmonary artery trunkMicrobiology (medical)medicine.medical_specialty030106 microbiologysPESI Simplified Pulmonary Embolism Severity IndexBMI Body mass indexPE Pulmonary embolismLV Left ventricleVTE Venous thromboembolismFibrin Fibrinogen Degradation Products03 medical and health sciencesInternal medicineHumansICU Intensive care unitsACE2 Angiotensin converting enzyme-2AgedInflammationLDH Lactate dehydrogenaseSARS-CoV-2 Severe acute respiratory syndrome coronavirus 2CI Confidence intervalbusiness.industryPulmonary embolismCOVID-19AnticoagulantsThrombosisRR Respiratory ratemedicine.diseaseConfidence intervalCHOD CRP concentration + Heart rate + Oxygen saturation + D-dimer levelsSpainHR Hazard RatioCommentarybusiness

description

Summary Objective To determine the incidence, characteristics, and risk factors of pulmonary embolism (PE) among patients hospitalized for COVID-19. Patients and Methods We performed a prospective observational study of a randomly selected cohort of consecutive patients hospitalized for COVID-19 infection between March 8, 2020 through April 25, 2020. All eligible patients underwent a computed tomography pulmonary angiography independently of their PE clinical suspicion and were pre-screened for a baseline elevated D-dimer level. Results 119 patients were randomly selected from the 372 admitted to one tertiary hospital in Valencia (Spain) for COVID-19 infection during the period of study. Seventy-three patients fulfilled both the inclusion criteria and none of the exclusion criteria and were finally included in the study. Despite a high level of pharmacological thromboprophylaxis (89%), the incidence of PE was 35.6% (95% confidence interval [CI], 29.6 to 41.6%), mostly with a peripheral location and low thrombotic load (Qanadli score 18.5%). Multivariate analysis showed that heart rate (Hazard Ratio [HR], 1.04), room-air oxygen saturation (spO2) (HR, 0.87), D-dimer (HR, 1.02), and C-reactive protein (CRP) levels (HR, 1.01) at the time of admission were independent predictors of incident PE during hospitalization. A risk score was constructed with these four variables showing a high predictive value of incident PE (AUC-ROC: 0.86; 95% CI: 0.80 to 0.93). Conclusions Our findings confirmed a high incidence of PE in hospitalized COVID-19 patients. Heart rate, spO2, D-dimer, and CRP levels at admission were associated with higher rates of PE during hospitalization.

yearjournalcountryeditionlanguage
2021-02-01Journal of Infection
10.1016/j.jinf.2021.01.003http://dx.doi.org/10.1016/j.jinf.2021.01.003