Acute pulmonary embolism in patients presenting pulmonary deterioration after hospitalisation for non‐critical COVID‐19

• Published in: Internal medicine journal 2021-08, Vol.51 (8), p.1236-1242
• Main Authors: Polo Friz, Hernan, Gelfi, Elia, Orenti, Annalisa, Motto, Elena, Primitz, Laura, Donzelli, Tino, Intotero, Marcello, Scarpazza, Paolo, Vighi, Giuseppe, Cimminiello, Claudio, Boracchi, Patrizia
• Format: Article
• Language: English
• Subjects: Angiography; COVID-19; CT angiography; Diagnosis; d‐dimer; Embolism; Heparin; Original; Patients; Population studies; pulmonary embolism; Pulmonary embolisms; venous thromboembolism
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.15307

Background Emerging evidence suggests an association between COVID‐19 and acute pulmonary embolism (APE). Aims To assess the prevalence of APE in patients hospitalised for non‐critical COVID‐19 who presented clinical deterioration, and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE in these subjects. Methods All consecutive patients admitted to the internal medicine department of a general hospital with a diagnosis of non‐critical COVID‐19, who performed a computer tomography pulmonary angiography (CTPA) for respiratory deterioration in April 2020, were included in this retrospective cohort study. Results Study populations: 41 subjects, median (interquartile range) age: 71.7 (63–76) years, CPTA confirmed APE = 8 (19.51%, 95% confidence interval (CI): 8.82–34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut‐off value of d‐dimer for predicting APE was 2454 ng/mL, sensitivity (95% CI): 63 (24–91), specificity: 73 (54–87), positive predictive value: 36 (13–65), negative predictive value: 89 (71–98) and AUC: 0.62 (0.38–0.85). The standard and age‐adjusted d‐dimer cut‐offs, and the Wells score ≥2 did not associate with confirmed APE, albeit a cut‐off value of d‐dimer = 2454 ng/mL showed an relative risk: 3.21; 95% CI: 0.92–13.97; P = 0.073. Heparin at anticoagulant doses was used in 70.73% of patients before performing CTPA. Conclusion Among patients presenting pulmonary deterioration after hospitalisation for non‐critical COVID‐19, the prevalence of APE is high. Traditional diagnostic tools to identify high APE pre‐test probability patients do not seem to be clinically useful. These results support the use of a high index of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.