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. 2024 Sep 30;16(9):6161-6170.
doi: 10.21037/jtd-23-1674. Epub 2024 Sep 26.

Increased risk of pulmonary embolism and deep vein thrombosis with COVID-19 pneumonia in comparison to influenza pneumonia: insights from the National Inpatient Sample database

Kavin Raj #  1 , Harris Majeed #  2 , Sanya Chandna  3 , Akshit Chitkara  1 , Abu Baker Sheikh  2 , Ashish Kumar  4 , Karthik Gangu  5 , Keerthana Jyotheeswara Pillai  6 , Ankit Agrawal  7 , Santhosh K Sadashiv  8 , Ankur Kalra  9
Affiliations

Increased risk of pulmonary embolism and deep vein thrombosis with COVID-19 pneumonia in comparison to influenza pneumonia: insights from the National Inpatient Sample database

Kavin Raj et al. J Thorac Dis. .

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily a respiratory virus causing coronavirus disease 2019 (COVID-19) pneumonia, induces a hypercoagulable state. Previous studies comparing the prevalence of venous thromboembolism (VTE) in patients with COVID-19 pneumonia and those with influenza pneumonia revealed a higher risk of pulmonary embolism (PE) and deep vein thrombosis (DVT) associated with COVID-19 pneumonia. However, these studies have not adequately accounted for the severity and acuity of the presenting viral pneumonia.

Methods: In this retrospective study, we rigorously adjusted for critical illness using a nationally representative dataset to investigate whether COVID-19 pneumonia is independently linked to a higher risk of PE and DVT.

Results: After comprehensive multivariate adjustment, our findings demonstrated that patients with COVID-19 pneumonia maintained significantly higher odds of developing acute inpatient PE [adjusted odds ratio (aOR): 2.48; 95% confidence interval (CI): 2.16-2.86; P<0.01] and DVT (aOR: 1.66; 95% CI: 1.41-1.96; P<0.01) during the early pandemic compared to patients with influenza pneumonia. Furthermore, we identified congenital heart disease and malnutrition as novel risk factors for acute PE in COVID-19 patients.

Conclusions: Our study suggests that the higher prevalence of acute inpatient PE over DVT in patients with COVID-19 pneumonia may support a "thrombus in situ" mechanism of SARS-CoV-2-mediated pulmonary thrombosis. Consequently, clinicians should maintain a high index of suspicion for PE, even in the absence of DVT, among patients with COVID-19 pneumonia and should follow evidence-based guidelines for diagnosis and management.

Keywords: Coronavirus disease 2019 (COVID-19); deep vein thrombosis (DVT); influenza; pulmonary embolism (PE); venous thromboembolism (VTE).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-1674/coif). The series “Thoracic Diseases and Big Data” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

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