Early mortality predictors in COVID-19 pneumonia complicated with pulmonary embolism- unicentre analysis

Covid-19 took an huge death-toll in the era of its pandemic widespread in scale of the whole world imposing a new and still not completely understood not resolved threat to public health. Beyond the severity of lungs affliction and the subsequent respiratory failure thromboembolic complications with their crucial form of pulmonary embolism (PE) are seen as responsible of this high numbers of fatalities.

We aim to find predictors of in hospital death in subgroup of patients with COVID-19 pneumonia diagnosed simultaneously with CT-angiography of pulmonary embolism.

Our group included 39 patients from 42 to 95 year old (mean age 67±13, 27 males and 12 females) hospitalized in Internal Disease and Clinical Pharmacology Department since October 2020 to June 2021 with the diagnosis of SARS COV2 pneumonia and pulmonary embolism detected with CT angiography during the analysed hospitalization. We compared clinical, laboratory and treatment data between group who died during hospitalization (G1) and those who survived the early period of at least 1 month after disease onset (G2).

During hospitalization and in extended to 1 month follow-up 12 deaths occurred, 8 in men (30%) and 4 in women (33%), however this difference did not reach statistical significance and moreover women were older than men among all PE patients (73±12 vs 64±13 years respectively, p=0.049). The compared groups did not differ significantly according to age (although some trend to higher age in G1), the prevalence of hypertension, diabetes, chronic obstructive pulmonary disease as well as provided treatment including heparin, oxygen therapy, remdesivir, tocilizumab and dexamethasone or heart rate, creatinine, troponin or NT-proBNP level, see Table. They differ, however, according to IL-6 concentration significantly higher in group with fatal outcome (108 (77-240) vs 52 (41-98) pg/ml, p =0.0162) as well as according to surprisingly higher lymphocyte count (0.95 (0.75-1.55) vs 0.6 (0.4-0.7) count X 1000, p=0.0058). Both these parameter showed significant predictive value of early death in studied group with sensitivity of 75% for both parameters and specificity of 74% for IL-6 > 91 and 78% for lymphocytes above 700/µl.