Pulmonary Embolism in Hospitalized Patients with COVID-19: A Multicenter Study

Background: Pulmonary embolism (PE) commonly complicates SARS-CoV-2 infection, but incidence and mortality reported insingle-center studies, along with risk factors, vary. Purpose: To determine the incidence of PE in patients with COVID-19 and its associations with clinical and laboratory parameters. Materials and Methods: In this HIPAA-compliant study, electronic medical records were searched retrospectively for demographic,clinical, and laboratory data and outcomes among patients with COVID-19 admitted at four hospitals from March through June 2020. PE found at CT pulmonary angiography and perfusion scintigraphy was correlated with clinical and laboratory parameters.The d-dimer level was used to predict PE, and the obtained threshold was externally validated among 85 hospitalized patients with COVID-19 at a fifth hospital. The association between right-sided heart strain and embolic burden was evaluated in patients with PE undergoing echocardiography. Results: A total of 413 patients with COVID-19 (mean age, 60 years( )+/- 16 [standard deviation]; age range, 20-98 years; 230 men)were evaluated. PE was diagnosed in 102 (25%; 95% CI: 21, 29) of 413 hospitalized patients with COVID-19 who underwent CT pulmonary angiography or perfusion scintigraphy. PE was observed in 21 (29%; 95% CI: 19, 41) of 73 patients in the intensive care unit (ICU) versus 81 (24%; 95% CI: 20, 29) of 340 patients who were not in the ICU (P =.37). PE was associated with male sex(odds ratio [OR], 1.74; 95% CI: 1.1, 2.8; P =.02); smoking (OR, 1.86; 95% CI: 1.0, 3.4; P =.04); and increased d-dimer (P<.001), lactate dehydrogenase (P<.001), ferritin (P =.001), and interleukin-6 (P =.02) levels. Mortality in hospitalized patients was similar between patients with PE and those without PE (14% [13 of 102]; 95% CI: 8, 22] vs 13% [40 of 311]; 95% CI: 9, 17; P =.98), suggesting that diagnosis and treatment of PE were not associated with excess mortality. The d-dimer levels greater than 1600 ng/mL [8.761 nmol/L] helped predict PE with 100% sensitivity and 62% specificity in an external validation cohort. Embolic burden was higher in patients with right-sided heart strain among the patients with PE undergoing echocardiography (P =.03). Conclusion: Pulmonary embolism (PE) incidence was 25% in patients hospitalized with COVID-19 suspected of having PE. Ad-dimer level greater than 1600 ng/mL [8.761 nmol/L] was sensitive for identification of patients who needed CT pulmonary angiography. (C) RSNA, 2021

Automated summary

This study aimed to determine the incidence of PE in patients with COVID-19, revealing that 25% of COVID-19 patients were diagnosed with PE. The study also found that PE was associated with male sex, smoking, as well as increased levels of d-dimer, lactate dehydrogenase, ferritin, and interleukin-6. Additionally, d-dimer levels greater than 1600 ng/mL showed high sensitivity in identifying patients who required CT pulmonary angiography.