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Meta-Analysis
. 2022 May 15:171:159-164.
doi: 10.1016/j.amjcard.2022.01.051. Epub 2022 Mar 8.

Prevalence of Acute Pulmonary Embolism at Autopsy in Patients With COVID-19

Marco Zuin  1 , Matthias M Engelen  2 , Claudio Bilato  3 , Thomas Vanassche  4 , Gianluca Rigatelli  4 , Peter Verhamme  2 , Christophe Vandenbriele  2 , Giovanni Zuliani  5 , Loris Roncon  4
Affiliations
Meta-Analysis

Prevalence of Acute Pulmonary Embolism at Autopsy in Patients With COVID-19

Marco Zuin et al. Am J Cardiol. .

Abstract

To date, the actual prevalence of acute pulmonary embolism (PE) in patients with SARS-CoV-2 infection remains unknown, as systematic screening for PE is cumbersome. We performed a systematic review and meta-analysis on autoptic data to estimate the prevalence of histopathologic findings of acute PE and its relevance as a cause of death on patients with COVID-19. We searched MEDLINE-PubMed and Scopus to locate all articles published in the English language, up to August 10, 2021, reporting the autoptic prevalence of acute PE and evaluating PE as the underlying cause of death in patients with COVID-19. The pooled prevalence for both outcomes was calculated using a random-effects model and presenting the related 95% confidence interval (CI). Statistical heterogeneity was measured using the Higgins I2 statistic. We analyzed autoptic data of 749 patients with COVID-19 (mean age 63.4 years) included in 14 studies. In 10 studies, based on 526 subjects (mean age 63.8 years), a random-effect model revealed that autoptic acute PE findings were present in 27.5% of cases (95% CI 15.0 to 45.0%, I2 89.9%). Conversely, in 429 COVID-19 subjects (mean age 64.0 years) enrolled in 9 studies, acute PE was the underlying cause of death in 19.9% of cases (95% CI 11.0 to 33.3%, I2 83.3%). Autoptic findings of acute PE in patients with COVID-19 are present in about 30% of subjects, whereas a venous thromboembolic event represents the underlying cause of death in about 1 of 4 patients.

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Figures

Figure 1
Figure 1
Flow diagram of selected studies for the meta-analysis according to the PRISMA. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Number of patients receiving a WBA or a PCT/MIA. PCT/MIA = percutaneous/minimally invasive autopsy; WBA = whole-body autopsy.
Figure 3
Figure 3
(A) Forest plots investigating the pooled prevalence of autoptic histopathologic findings of acute pulmonary embolism in patients with COVID-19. (B) Forest plots investigating acute pulmonary embolism as underlying cause of death at autopsy in patients with COVID-19.
See this image and copyright information in PMC

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