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

Observational Study. J Infect. 2021 Feb;82(2):261-269. doi: 10.1016/j.jinf.2021.01.003. Epub 2021 Jan 10.

Fecha de la publicación: 01/02/2021

Autor: Alberto García-Ortega (1), Grace Oscullo (2), Pilar Calvillo (3), Raquel López-Reyes (2), Raúl Méndez (2), José Daniel Gómez-Olivas (4), Amina Bekki (4), Carles Fonfría (3), Laura Trilles-Olaso (3), Enrique Zaldívar (2), Ana Ferrando (4), Gabriel Anguera (5), Andrés Briones-Gómez (4), Juan Pablo Reig-Mezquida (5), Laura Feced (2), Paula González-Jiménez (2), Soledad Reyes (4), Carlos F Muñoz-Núñez (3), Ainhoa Carreres (3), Ricardo Gil (6), Carmen Morata (6), Nuria Toledo-Pons (7), Luis Martí-Bonmati (8), Rosario Menéndez (9), Miguel Ángel Martínez-García (10)

Palabras clave: Computed tomography, COVID-19, Inflammation, Pulmonary embolism; Thrombosis

PMID

PMID: 33440207

PMCID: PMC7834386

DOI: 10.1016/j.jinf.2021.01.003

Free PMC article

Affiliations

1 Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Medical Research Institute Hospital La Fe (IISLAFE), Valencia, Spain. Electronic address: albortgva@gmail.com.

2 Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Medical Research Institute Hospital La Fe (IISLAFE), Valencia, Spain.

3 Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

4 Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

5 Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Lung Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

6 Internal Medicine, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

7 Department of Pneumology, University Hospital Son Espases, Palma de Mallorca, Spain.

8 Radiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Biomedical Imaging Research Group (GIBI230), Instituto de Investigación Sanitaria La Fe, Valencia, Spain.

9 Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Medical Research Institute Hospital La Fe (IISLAFE), Valencia, Spain; Medicine Faculty, University of Valencia, Valencia, Spain; CIBER de enfermedades respiratorias, Instituto Carlos III, Madrid, Spain.

10 Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Medical Research Institute Hospital La Fe (IISLAFE), Valencia, Spain; CIBER de enfermedades respiratorias, Instituto Carlos III, Madrid, Spain.

Abstract

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.

Keywords: COVID-19; Computed tomography; Inflammation; Pulmonary embolism; Thrombosis.

Copyright © 2021. Published by Elsevier Ltd.