Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 18;23(1):25.
doi: 10.1186/s12890-023-02323-9.

Acute phase characteristics and long-term complications of pulmonary embolism in COVID-19 compared to non-COVID-19 cohort: a large single-centre study

A Franco-Moreno  1 , D Brown-Lavalle  2 , M Campos-Arenas  3 , N Rodríguez-Ramírez  3 , C Muñoz-Roldán  3 , A I Rubio-Aguilera  3 , N Muñoz-Rivas  2 , J Bascuñana-Morejón de Girón  4 , E Fernández-Vidal  2 , E Palma-Huerta  2 , S Estévez-Alonso  2 , B Rodríguez-Gómez  2 , S Manzano-Valera  2 , R Pedrero-Tomé  5   6 , M Casado-Suela  2 , C Bibiano-Guillén  7 , M Mir-Montero  7 , J Torres-Macho  2 , A Bustamante-Fermosel  2 ; Infanta Leonor Thrombosis Research Group
Collaborators, Affiliations

Acute phase characteristics and long-term complications of pulmonary embolism in COVID-19 compared to non-COVID-19 cohort: a large single-centre study

A Franco-Moreno et al. BMC Pulm Med. .

Abstract

Background: To compare the severity of pulmonary embolism (PE) and the long-term complications between patients with and without COVID-19, and to investigate whether the tools for risk stratification of death are valid in this population.

Methods: We retrospectively included hospitalized patients with PE from 1 January 2016 to 31 December 2022. Comparisons for acute episode characteristics, risk stratification of the PE, outcomes, and long-term complications were made between COVID and non-COVID patients.

Results: We analyzed 116 (27.5%) COVID patients and 305 (72.4%) non-COVID patients. In patients with COVID-19, the traditional risk factors for PE were absent, and the incidence of deep vein thrombosis was lower. COVID patients showed significantly higher lymphocyte count, lactate dehydrogenase, lactic acid, and D-dimer levels. COVID patients had PE of smaller size (12.3% vs. 25.5% main pulmonary artery, 29.8% vs. 37.1% lobar, 44.7% vs. 29.5% segmental and 13.2% vs. 7.9% subsegmental, respectively; p < 0.001), less right ventricular dysfunction (7.7% vs. 17.7%; p = 0.007) and higher sPESI score (1.66 vs. 1.11; p < 0.001). The need for mechanical ventilation was significantly higher in COVID patients (8.6% vs. 1.3%; p < 0.001); However, the in-hospital death was less (5.2% vs. 10.8%; p = 0.074). The incidence of long-term complications was lower in COVID cohort (p < 0.001). PE severity assessed by high sPESI and intermediate and high-risk categories were independently associated with in-hospital mortality in COVID patients.

Conclusion: The risk of in-hospital mortality and the incidence of long-term complications were lower in COVID-19. The usual tools for risk stratification of PE are valid in COVID patients.

Keywords: COVID-19; Case-control study; Long-term complications; Pulmonary embolism; Risk stratification; Severity.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart. CTPA computed tomography pulmonary angiogram, PE pulmonary embolism
Fig. 2
Fig. 2
Imaging findings on computed tomography pulmonary angiogram in patients with pulmonary embolism, comparing COVID and non-COVID patients
Fig. 3
Fig. 3
PE images on CTPA in COVID and non-COVID patients: A–D correspond to axial and coronal images in two non-COVID patients where filling defects within the pulmonary vasculature are central (A and B in the right and left pulmonary arteries; C and D in the main trunk of the pulmonary artery (“saddle pulmonary embolism”); E–H represent peripheral pulmonary embolism in two COVID patients. Thrombi are seen in segmental arteries in right upper lobe in (E)–(F) and in segmental arteries of both lungs. In these two patients there were also parenchymal abnormalities (ground glass opacities and septal thickening) better seen in CT lung window (F). PE pulmonary embolism, CTPA computed tomography pulmonary angiogram
See this image and copyright information in PMC

References

    1. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb Res. 2020;191:148–50. doi: 10.1016/j.thromres.2020.04.041. - DOI - PMC - PubMed
    1. Gonzalez-Fajardo JA, Ansuategui M, Romero C, Comanges A, Gómez-Arbeláez D, Ibarra G, et al. Mortality of COVID-19 patients with vascular thrombotic complications. Med Clín Engl Ed. 2021;156(3):112–7. doi: 10.1016/j.medcle.2020.10.008. - DOI - PMC - PubMed
    1. Fabre O, Rebet O, Carjaliu I, Radutoiu M, Gautier L, Hysi I. Severe acute proximal pulmonary embolism and COVID-19: a word of caution. Ann Thorac Surg. 2020;110(5):e409–411. doi: 10.1016/j.athoracsur.2020.04.005. - DOI - PMC - PubMed
    1. Haberecker M, Schwarz EI, Steiger P, Frontzek K, Scholkmann F, Zeng X, et al. Autopsy-based pulmonary and vascular pathology: pulmonary endotheliitis and multi-organ involvement in COVID-19 associated deaths. Respiration. 2022;101(2):155–65. doi: 10.1159/000518914. - DOI - PMC - PubMed
    1. Rodríguez C, Luque N, Blanco I, Sebastian L, Barberà JA, Peinado VI, et al. Pulmonary endothelial dysfunction and thrombotic complications in patients with COVID-19. Am J Respir Cell Mol Biol. 2021;64(4):407–15. doi: 10.1165/rcmb.2020-0359PS. - DOI - PMC - PubMed