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

Hernan Polo Friz; Elia Gelfi; Annalisa Orenti; Elena Motto; Laura Primitz; Tino Donzelli; Marcello Intotero; Paolo Scarpazza; Giuseppe Vighi; Claudio Cimminiello; Patrizia Boracchi

doi:10.1111/imj.15307

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

Intern Med J. 2021 Aug;51(8):1236-1242. doi: 10.1111/imj.15307.

Affiliations

¹ Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy.
² Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics Epidemiology and Biometry 'G. A. Maccacaro', University of Milan, Milan, Italy.
³ Radiology, Diagnostic Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy.
⁴ Pulmonology, Medical Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy.
⁵ Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia ePatologia Vascolare, SIAPAV), Milan, Italy.

Abstract

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.

Keywords: d-dimer; COVID-19; CT angiography; pulmonary embolism; venous thromboembolism.

MeSH terms

Aged
COVID-19*
Fibrin Fibrinogen Degradation Products
Hospitalization
Humans
Pulmonary Embolism* / diagnostic imaging
Pulmonary Embolism* / epidemiology
Retrospective Studies
SARS-CoV-2

Substances

Fibrin Fibrinogen Degradation Products