Open Access

Pulmonary embolism in COVID-19 patients: a French multicentre cohort study

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Date: 13 July 2020
Journal: European Heart Journal , Volume 41 , Issue 32 , Pages 3058 - 3068
Topic: CORONARY ARTERY DISEASE, ACUTE CORONARY SYNDROMES, ACUTE CARDIAC CARE, Acute Coronary Syndromes, IMAGING, Cardiac Computed Tomography (CT), VALVULAR, MYOCARDIAL, PERICARDIAL, PULMONARY, CONGENITAL HEART DISEASE, Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure, BASIC SCIENCE
Authors: Y. Mecheri , R. Lebourdon , C. Yvorel , M. Massin , T. Leblon , C. Chabbi , E. Cugney , L. Benabou , M. Aubry , C. Chan , I. Boufoula , C. Fauvel , C. Barnaud , O. Weizman , L. Bothorel , A. Trimaille , B. Duceau , D. Mika , W. Sutter , T. Pommier , V. Waldmann , G. Bonnet , A. Cohen , T. Pezel , . , N. Pace , A. Douair , E. Barbin , A. Fraix , O. Bouchot , O. Benmansour , G. Godeau

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AbstractAims

While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients.

Methods and results

In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14–0.91, P = 0.04; and OR 0.11, 95% CI 0.06–0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003–1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79–0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82–0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01–1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006–1.038, P = 0.002).

Conclusion

PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.

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About the contributors

Yasmine Mecheri

Role: Author

Romane Lebourdon

Role: Author

Cédric Yvorel

Role: Author