TY - JOUR
T1 - Pulmonary embolism in patients with COVID-19
T2 - characteristics and outcomes in the Cardio-COVID Italy multicenter study
AU - Ameri, Pietro
AU - Inciardi, Riccardo M.
AU - Di Pasquale, Mattia
AU - Agostoni, Piergiuseppe
AU - Bellasi, Antonio
AU - Camporotondo, Rita
AU - Canale, Claudia
AU - Carubelli, Valentina
AU - Carugo, Stefano
AU - Catagnano, Francesco
AU - Danzi, Giambattista
AU - Vecchia, Laura Dalla
AU - Giovinazzo, Stefano
AU - Gnecchi, Massimiliano
AU - Guazzi, Marco
AU - Iorio, Anita
AU - La Rovere, Maria Teresa
AU - Leonardi, Sergio
AU - Maccagni, Gloria
AU - Mapelli, Massimo
AU - Margonato, Davide
AU - Merlo, Marco
AU - Monzo, Luca
AU - Mortara, Andrea
AU - Nuzzi, Vincenzo
AU - Piepoli, Massimo
AU - Porto, Italo
AU - Pozzi, Andrea
AU - Provenzale, Giovanni
AU - Sarullo, Filippo
AU - Sinagra, Gianfranco
AU - Tedino, Chiara
AU - Tomasoni, Daniela
AU - Volterrani, Maurizio
AU - Zaccone, Gregorio
AU - Lombardi, Carlo Mario
AU - Senni, Michele
AU - Metra, Marco
N1 - Funding Information:
Open access funding provided by Università degli Studi di Brescia within the CRUI-CARE Agreement. Acknowledgements
Publisher Copyright:
© 2020, The Author(s).
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020
Y1 - 2020
N2 - 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. Graphic abstract: [Figure not available: see fulltext.]
AB - 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. Graphic abstract: [Figure not available: see fulltext.]
KW - Anticoagulant
KW - Coagulopathy
KW - COVID-19
KW - d-dimer
KW - Death
KW - Thromboembolism
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U2 - 10.1007/s00392-020-01766-y
DO - 10.1007/s00392-020-01766-y
M3 - Article
AN - SCOPUS:85094938331
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
SN - 1861-0684
ER -