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Observational Study
. 2020 Jul 1;41(32):3058-3068.
doi: 10.1093/eurheartj/ehaa500.

Pulmonary embolism in COVID-19 patients: a French multicentre cohort study

Charles Fauvel  1 , Orianne Weizman  2   3 , Antonin Trimaille  4 , Delphine Mika  5 , Thibaut Pommier  6 , Nathalie Pace  2 , Amine Douair  7 , Eva Barbin  8 , Antoine Fraix  2 , Océane Bouchot  7 , Othmane Benmansour  8 , Guillaume Godeau  9 , Yasmine Mecheri  8 , Romane Lebourdon  10 , Cédric Yvorel  11 , Michael Massin  2 , Tiphaine Leblon  12 , Chaima Chabbi  8 , Erwan Cugney  2 , Léa Benabou  10 , Matthieu Aubry  13 , Camille Chan  10 , Ines Boufoula  8 , Clement Barnaud  8 , Léa Bothorel  8 , Baptiste Duceau  3 , Willy Sutter  3 , Victor Waldmann  3   14 , Guillaume Bonnet  3   14 , Ariel Cohen  15 , Théo Pezel  16 ; Critical Covid-19 France Investigators
Affiliations
Observational Study

Pulmonary embolism in COVID-19 patients: a French multicentre cohort study

Charles Fauvel et al. Eur Heart J. .

Abstract

Aims: While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients.

Methods and results: In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14-0.91, P = 0.04; and OR 0.11, 95% CI 0.06-0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003-1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79-0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82-0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01-1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006-1.038, P = 0.002).

Conclusion: PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.

Keywords: COVID-19; Computed tomography angiography; Intensive care unit; Pulmonary embolism; Risk factors.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flowchart for the Critical Covid-19 France Study. CT, computed tomography; CTPA, computed tomography pulmonary angiography.
Figure 2
Figure 2
Examples of axial CTPA images of PE in COVID-19 patients (lung windows: A–C; mediastinum windows: B–D). Patient 1: 42-year-old male with peripheral ground-glass opacities of 25–50% (A, arrows) with small areas of consolidation (arrowhead) and bilateral proximal PE (B, arrows). Patient 2: 57-year-old male with peripheral ground-glass opacities <25% (C, arrows) and right proximal PE (D, arrow). CTPA, computed tomography pulmonary angiography; PE, pulmonary embolism.
Take home figure
Take home figure
PE risk and protective factors in COVID-19 patients.
See this image and copyright information in PMC

Comment in

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