Published 2021
| Version v1
Publication
Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study
Creators
- 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
Contributors
Others:
- 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
Description
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.
Additional details
Identifiers
- URL
- http://hdl.handle.net/11567/1096395
- URN
- urn:oai:iris.unige.it:11567/1096395