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Meta-Analysis
. 2020 Dec:82:29-37.
doi: 10.1016/j.ejim.2020.09.006. Epub 2020 Sep 17.

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis

Loris Roncon  1 , Marco Zuin  2 , Stefano Barco  3 , Luca Valerio  4 , Giovanni Zuliani  5 , Pietro Zonzin  6 , Stavros V Konstantinides  7
Affiliations
Meta-Analysis

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis

Loris Roncon et al. Eur J Intern Med. 2020 Dec.

Abstract

Background: Acute pulmonary embolism (PE) has been described as a frequent and prognostically relevant complication of COVID-19 infection.

Aim: We performed a systematic review and meta-analysis of the in-hospital incidence of acute PE among COVID-19 patients based on studies published within four months of COVID-19 outbreak.

Material and methods: Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in abstracting data and assessing validity. We searched Medline, Scopus and Web of Science to locate all articles published up to August 1, 2020 reporting the incidence of acute PE (or lung thrombosis) in COVID-19 patients. The pooled in-hospital incidence of acute PE among COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI). Statistical heterogeneity was measured using the Higgins I2 statistic.

Results: We analysed data from 7178 COVID-19 patients [mean age 60.4 years] included in twenty-three studies. Among patients hospitalized in general wards and intensive care unit (ICU), the pooled in-hospital incidence of PE (or lung thrombosis) was 14.7% of cases (95% CI: 9.9-21.3%, I2=95.0%, p<0.0001) and 23.4% (95% CI:16.7-31.8%, I2=88.7%, p<0.0001), respectively. Segmental/sub-segmental pulmonary arteries were more frequently involved compared to main/lobar arteries (6.8% vs18.8%, p<0.001). Computer tomography pulmonary angiogram (CTPA) was used only in 35.3% of patients with COVID-19 infection across six studies.

Conclusions: The in-hospital incidence of acute PE among COVID-19 patients is higher in ICU patients compared to those hospitalized in general wards. CTPA was rarely used suggesting a potential underestimation of PE cases.

Keywords: Covid-19; Epidemiology; Meta-analysis; Pulmonary embolism.

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Conflict of interest statement

S.B. reports personal fees from Biocompatibles Group UK and Bayer HealthCare, non-financial support from Bayer HealthCare and Daiichi Sankyo, outside the submitted work.

S.V.K. reports grants and non-financial support from Bayer AG; grants and personal fees from Boehringer Ingelheim, personal fees from Bayer AG, grants and personal fees from Actelion, grants and personal fees from Daiichi-Sankyo, grants and personal fees from Biocompatibles Group UK, personal fees from Pfizer—Bristol-Myers Squibb, grants and personal fees from MSD, outside the submitted work

The other authors have no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Flow diagram of selected studies for the meta-analysis according to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA).
Fig. 2
Fig. 2
Forest plots investigating the pooled incidence of acute pulmonary embolism in COVID-19 patients hospitalized in ICU (A) and in general wards (B).
Fig. 3
Fig. 3
Comparison of the proximal and distal distribution of intraluminal pulmonary arterial filling defects.
See this image and copyright information in PMC

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