Pulmonary Thrombosis or Embolism in a Large Cohort of Hospitalized Patients With Covid-19
Natividad Benito, David Filella, José Mateo, Ana Fortuna, Juan E. Gutierrez-Alliende, Nerea González Hernandez, Ana Giménez, Virginia Pomar, I. Castellví, Hèctor Corominas, Jordi Casademont, Peré Domingo
Abstract
Objective. We sought to analyze the incidence and predictive factors of pulmonary embolism (PE) in hospitalized patients with Covid-19. Methods. We prospectively collected data from all consecutive patients with laboratory-confirmed Covid-19 admitted to the Hospital de la Santa Creu i Sant Pau, a university hospital in Barcelona, between March 9 and April 15, 2020. Patients with suspected PE, according to standardized guidelines, underwent CT pulmonary angiography (CTPA). Results. A total of 1275 patients with Covid-19 were admitted to hospital. CTPA was performed on 76 inpatients and a diagnosis of PE was made in 32 (2.6% [95CI 1.7%-3.5%]). Patients with PE were older, had lower PaO2:FiO2 ratios and higher levels of D-dimer and C-reactive protein (CRP). They more often required admission to ICU and mechanical ventilation and had longer hospital stays, although in-hospital mortality was no greater than in patients without PE. High CRP and D-dimer levels at admission (≥ 150 mg/L and ≥ 1000 ng/ml, respectively), and a peak D-dimer ≥ 6000 ng/ml during hospital stay were independent factors associated with PE. Prophylactic low molecular weight heparin did not appear to prevent PE. Increased CRP levels correlated with increased D-dimer levels and both correlated with a lower PaO2:FiO2. Conclusions. The 2.6% incidence of PE in Covid-19 hospitalized patients is clearly high. Higher doses of thromboprophylaxis may be required to prevent PE, particularly in patients at increased risk, such as those with high levels of CRP and D-dimer at admission. These findings should be validated in future studies.