Pulmonary embolism post-Covid-19 infection: physiopathological mechanisms and vascular damage biomarkers

Abstract

Covid-19 infection is characterized by several acute complications, as well long-term sequelae, mostly sustained by endothelial dysfunction; several studies show that complications as pulmonary embolism (PE) are described both in the acute phase and after negativization. Aim of research was to evaluate anthropometric, bio-humoral, instrumental parameters in a group of patients affected by PE after recent Covid-19 infection compared to PE patients without previous Covid-19 infection. We enrolled 72 consecutive patients (35M, 37F) with acute PE, distinguished in relation to previous acute Covid-19 infection: 54 pts without previous acute Covid-19 infection and 18 pts with previous Covid-19 infection within negativity at least 2 months before PE diagnosis; 44 healthy subjects (21M, 23F) were recruited as control group. Patients who had previously developed Covid-19 needed hospitalization in high percentage (84%); this group showed significantly higher prevalence of diabetes mellitus than Covid-19-free PE patients, reduced serum levels of C-reactive protein, sST2 and PESI score. In post-Covid-19 PE group, we observed higher mean IMPROVE risk score, whereas in Covid-19-free group lower P/F ratio, higher radiological severity, and worse PESI score and severity index. Covid-19 infection affects not just the lung parenchyma but also other organs; endothelial damage plays pivotal role in long-term alterations; in high thrombotic risk group (recent hospitalization due to acute Covid-19 infection), we have described thrombotic complications characterized by persistent prothrombotic state after recovery, highlighted by well-known markers as PCR and D-Dimer as well as novel vascular marker (sST2).

Keywords: Endothelium damage; Post-COVID-19; Pulmonary embolism; sST2 biomarker.

Fig. 1

Radiological severity of Pulmonary Embolism dividing EP Covid-19-free and EP post-Covid-19; values of sST2 behaviors in specific group. *p < 0.01 versus Segmental group; °p < 0.01 versus Sub-massive group post-Covid-19 EP

Fig. 2

sST2 behaviors (mean ± sd) in the control group and in the PE groups (EP Covid-19-free and EP post-Covid-19), distinguished according to PESI score: low (I–II class, < 85), intermediate (III class, 86–105) and high IV–V class, > 106). *p < 0.01 versus all EP Covid-19-free and EP post-Covid-19; °p: 0.03 versus high—EP post-Covid-19; °°p: 0.01 versus Intermediate—EP post-Covid-19; °°°p: 0.09 versus low—EP post-Covid-19