Abstract
Background
While pulmonary embolism (PE) appears to be a major issue in Covid-19, data remain sparse.
Purpose
We aimed to describe the risk factors and baseline characteristics of patients with PE in a large cohort of Covid-19 patients.
Methods
In a retrospective multicentric observational study, we included consecutive hospitalised patients for Covid-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis, those who were directly admitted to an intensive care unit (ICU), and those still hospitalised without PE experience were excluded.
Results
Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer requirement and mechanical ventilation requirement were significantly higher in the PE group (P < 0.001 and P < 0.001, respectively). In an univariable analysis, traditional venous thromboembolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic-dose anticoagulation before hospitalisation or prophylaxis-dose anticoagulation introduced during hospitalisation had lower PE occurrence (OR 0.40, 95%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 prophylaxis-dose (OR 0.83, 95%CI(0.79-0.85), P < 0.001) or 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 hospitalisation (OR 1.02, 95%CI(1.006-1.038), P = 0.002) (Table 1).
Conclusion
Pulmonary embolism risk factors in Covid-19 context do not include traditional thromboembolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.
Table 1.
Multivariable analysis for prediction of PE occurrence.
| Odds Ratio | 95 %CI | P value | |
|---|---|---|---|
| Male | 1.03 | 1.003-1.069 | 0.04 |
| Age | 1.00 | 1.00-1.00 | 0.52 |
| Smoking | 0.96 | 0.91-1.00 | 0.08 |
| Malignancy | 0.98 | 0.93-1.03 | 0.46 |
| Venous thromboembolic disease | 1.03 | 0.96-1.09 | 0.43 |
| Time from illness onset to hospitalisation, days | 1.02 | 1.006-1.038 | 0.002 |
| C-reactive protein | 1.03 | 1.01-1.04 | 0.001 |
| Anticoagulation prophylaxis-dose | 0.83 | 0.79-0.85 | < 0.001 |
| Anticoagulation therapeutic-dose | 0.87 | 0.82-0.92 | < 0.001 |
Disclosure of interest
The authors declare that they have no competing interest.