Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
Por:
Miró Ò, Jiménez S, Mebazaa A, Freund Y, Burillo-Putze G, Martín A, Martín-Sánchez FJ, García-Lamberechts EJ, Alquézar-Arbé A, Jacob J, Llorens P, Piñera P, Gil V, Guardiola J, Cardozo C, Mòdol Deltell JM, Tost J, Aguirre Tejedo A, Palau-Vendrell A, LLauger García L, Adroher Muñoz M, Del Arco Galán C, Agudo Villa T, López-Laguna N, López Díez MP, Beddar Chaib F, Quero Motto E, González Tejera M, Ponce MC, González Del Castillo J and Spanish Investigators on Emergency Situations TeAm (SIESTA) network
Publicada:
1 sep 2021
Ahead of Print:
1 jun 2021
Categoría:
Cardiology and cardiovascular medicine
Resumen:
Aims We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization.
Methods and Results We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92 parts per thousand). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population [35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51-9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65-1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97-2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66-4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations.
Conclusions PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE.
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Filiaciones:
Miró Ò:
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
Jiménez S:
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
Mebazaa A:
Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis-Lariboisière, AP-HP Rue Ambroise Paré, 75010 Paris, France
Freund Y:
Emergency Department, HôpitalPitié-Salpêtrière, Assistance Publique-Hôpitaux 18 de Paris (APHP), Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
Burillo-Putze G:
Emergency Department, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
Martín A:
Emergency Department, Hospital Severo Ochoa, M-402, 8, 28914 Leganés, Madrid, Spain
Martín-Sánchez FJ:
Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutenseCalle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
García-Lamberechts EJ:
Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutenseCalle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
Alquézar-Arbé A:
Emergency Department, Hospital de la Santa Creu I Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
Jacob J:
Emergency Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
Llorens P:
Emergency Department, Hospital General de Alicante, University Miguel Hernández, Calle Pintor Baeza, 11, 03010 Alicante, Spain
Piñera P:
Emergency Department, Hospital General Universitario Reina Sofía. Av. Intendente Jorge Palacios, 1, 30003 Murcia, Spain
Gil V:
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
Guardiola J:
Emergency Department, Hospital de la Santa Creu I Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
Cardozo C:
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Catalonia, Spain
Mòdol Deltell JM:
Emergency Department, Hospital Universitari Germans Trias i Pujol de Badalona, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
Tost J:
Emergency Department, Hospital de Terrassa, Carretera Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
Aguirre Tejedo A:
Emergency Department, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
Palau-Vendrell A:
Emergency Department, Hospital Universitari Joan XXIII, Carrer Dr. Mallafrè Guasch, 4, 43005 Tarragona, Spain
LLauger García L:
Emergency Department, Hospital Universitari de Vic, Carrer de Francesc Pla el Vigatà, 1, 08500 Vic Barcelona, Spain
Adroher Muñoz M:
Emergency Department, Hospital Universitari de Girona Dr JosepTrueta, Avinguda de França, S/N, 17007 Girona, Spain
Del Arco Galán C:
Emergency Department, Hospital Universitario de la Princesa, Calle de Diego de León, 62, 28006 Madrid, Spain
Agudo Villa T:
Emergency Department, Hospital Universitario Severo Ochoa, M-402, 8, 28914 Leganés, Madrid, Spain
López-Laguna N:
Emergency Department, Clínica Universidad Navarra, Calle Marquesado de Sta. Marta, 1, 28027 Madrid, Spain
López Díez MP:
Emergency Department, Hospital Universitario de Burgos. Av. Islas Baleares, 3, 09006 Burgos, Spain
Beddar Chaib F:
Emergency Department, Complejo Asistencial de Soria, Paseo Sta. Bárbara, 42005 Soria, Spain
Quero Motto E:
Emergency Department, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
:
Emergency Department, Hospital General Universitario de Elche. Carrer Almazara, 11, 03203 Elche, Alicante, Spain
:
Emergency Department, Hospital de la Vega Baja Orihuela. Carretera Orihuela - Almoradí, S/N, Orihuela, Alicante, Spain
González Del Castillo J:
Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutenseCalle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
Green Published, Bronze
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