Pulmonary embolism in hospitalized COVID-19 patients: Short- and long-term clinical outcomes

Abstract

Introduction: Pulmonary embolism (PE) is a frequent complication in COVID-19. However, the influence of PE on the prognosis of COVID-19 remains unclear as previous studies were affected by misclassification bias. Therefore, we evaluated a cohort of COVID-19 patients whom all underwent systematic screening for PE (thereby avoiding misclassification) and compared clinical outcomes between patients with and without PE.

Materials and methods: We included all COVID-19 patients who were admitted through the ED between April 2020 and February 2021. All patients underwent systematic work-up for PE in the ED using the YEARS-algorithm. The primary outcome was a composite of in-hospital mortality and ICU admission. We also evaluated long-term outcomes including PE occurrence within 90 days after discharge and one-year all-cause mortality.

Results: 637 ED patients were included in the analysis. PE was diagnosed in 46 of them (7.2%). The occurrence of the primary outcome did not differ between patients with PE and those without (28.3% vs. 26.9%, p = 0.68). The overall rate of PE diagnosed in-hospital (after an initial negative PE screening in the ED) and in the first 90 days after discharge was 3.9% and 1.2% respectively. One-year all-cause mortality was similar between patients with and without PE (26.1% vs. 24.4%, p = 0.83).

Conclusions: In a cohort of COVID-19 patients who underwent systematic PE screening in the ED, we found no differences in mortality rate and ICU admissions between patients with and without PE. This may indicate that proactive PE screening, and thus timely diagnosis and treatment of PE, may limit further clinical deterioration and associated mortality in COVID-19 patients.

Keywords: COVID-19; Clinical outcomes; Pulmonary embolism.

Fig. 1

Flowchart of the study population. ¹D-dimer cut-off ≥500 μg/L if ≥ 1 YEARS items; D-dimer cut-off is increased to 1000 μg/L if 0 YEARS items. ED, emergency department; CTPA; computed tomography pulmonary angiogram; PE, pulmonary embolism.

Fig. 2

Kaplan-Meier time-to-event curve for the composite endpoint of ICU admission or in-hospital death (from any cause) in patients with PE (red line) and without PE (blue line). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Kaplan-Meier time-to-event curve for (A) 30-day survival, and (B) one-year survival, in patients with PE (red line) and without PE (blue line). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)