TY - JOUR
T1 - Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study
AU - Ameri, P.
AU - Inciardi, R.M.
AU - Di Pasquale, M.
AU - Agostoni, P.
AU - Bellasi, A.
AU - Camporotondo, R.
AU - Canale, C.
AU - Carubelli, V.
AU - Carugo, S.
AU - Catagnano, F.
AU - Danzi, G.
AU - Vecchia, L.D.
AU - Giovinazzo, S.
AU - Gnecchi, M.
AU - Guazzi, M.
AU - Iorio, A.
AU - La Rovere, M.T.
AU - Leonardi, S.
AU - Maccagni, G.
AU - Mapelli, M.
AU - Margonato, D.
AU - Merlo, M.
AU - Monzo, L.
AU - Mortara, A.
AU - Nuzzi, V.
AU - Piepoli, M.
AU - Porto, I.
AU - Pozzi, A.
AU - Provenzale, G.
AU - Sarullo, F.
AU - Sinagra, G.
AU - Tedino, C.
AU - Tomasoni, D.
AU - Volterrani, M.
AU - Zaccone, G.
AU - Lombardi, C.M.
AU - Senni, M.
AU - Metra, M.
N1 - Cited By :2
Export Date: 24 February 2021
Correspondence Address: Metra, M.; Cardiology, Italy; email: metramarco@libero.it
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.] © 2020, The Author(s).
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.] © 2020, The Author(s).
U2 - 10.1007/s00392-020-01766-y
DO - 10.1007/s00392-020-01766-y
M3 - Article
JO - Clin. Res. Cardiol.
JF - Clin. Res. Cardiol.
SN - 1861-0684
ER -