Predictors and outcomes of acute pulmonary embolism in COVID-19; insights from US National COVID cohort collaborative

• Published in: Respiratory research 2023-02, Vol.24 (1), p.59-59, Article 59
• Main Authors: Gul, Muhammad H, Htun, Zin Mar, de Jesus Perez, Vinicio, Suleman, Muhammad, Arshad, Samiullah, Imran, Muhammad, Vyasabattu, Mahender, Wood, Jeremy P, Anstead, Michael, Morris, Peter E
• Format: Article
• Language: English
• Subjects: Accuracy; Acute pulmonary embolism; Anemia; Atherosclerosis; Cardiac arrhythmia; Care and treatment; Chest; Chest Pain; Chronic obstructive pulmonary disease; Collaboration; COVID-19; d-Dimer; Demographics; Diabetes; Diagnosis; Dimers; Embolism; Embolisms; Forecasts and trends; Heart failure; Heart rate; Hospitalization; Humans; Hypertension; Hypothyroidism; Intubation; Kidneys; Laboratories; Molecular weight; Morbidity; Mortality; Pain; Predictive Value of Tests; Pulmonary embolism; Pulmonary Embolism - diagnosis; Pulmonary embolisms; Regression analysis; Retrospective Studies; Risk factors; SARS-CoV-2; Sensitivity analysis; Sepsis; Sleep apnea; Statistical analysis; Steroids; Thromboembolism; Thrombosis; United States; Veins & arteries
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-023-02369-7

To investigate whether COVID-19 patients with pulmonary embolism had higher mortality and assess the utility of D-dimer in predicting acute pulmonary embolism. Using the National Collaborative COVID-19 retrospective cohort, a cohort of hospitalized COVID-19 patients was studied to compare 90-day mortality and intubation outcomes in patients with and without pulmonary embolism in a multivariable cox regression analysis. The secondary measured outcomes in 1:4 propensity score-matched analysis included length of stay, chest pain incidence, heart rate, history of pulmonary embolism or DVT, and admission laboratory parameters. Among 31,500 hospitalized COVID-19 patients, 1117 (3.5%) patients were diagnosed with acute pulmonary embolism. Patients with acute pulmonary embolism were noted to have higher mortality (23.6% vs.12.8%; adjusted Hazard Ratio (aHR) = 1.36, 95% CI [1.20-1.55]), and intubation rates (17.6% vs. 9.3%, aHR = 1.38[1.18-1.61]). Pulmonary embolism patients had higher admission D-dimer FEU (Odds Ratio(OR) = 1.13; 95%CI [1.1-1.15]). As the D-dimer value increased, the specificity, positive predictive value, and accuracy of the test increased; however, sensitivity decreased (AUC 0.70). At cut-off D-dimer FEU 1.8 mcg/ml, the test had clinical utility (accuracy 70%) in predicting pulmonary embolism. Patients with acute pulmonary embolism had a higher incidence of chest pain and history of pulmonary embolism or deep vein thrombosis. Acute pulmonary embolism is associated with worse mortality and morbidity outcomes in COVID-19. We present D-dimer as a predictive risk tool in the form of a clinical calculator for the diagnosis of acute pulmonary embolism in COVID-19.