Pulmonary embolism in COVID-19 patients: a French multicentre cohort study

Abstract Aims While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients. Methods and results In a retrospective multicentre observational study, we...

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Published in:	European heart journal Vol. 41; no. 32; pp. 3058 - 3068
Main Authors:	Fauvel, Charles, Weizman, Orianne, Trimaille, Antonin, Mika, Delphine, Pommier, Thibaut, Pace, Nathalie, Douair, Amine, Barbin, Eva, Fraix, Antoine, Bouchot, Océane, Benmansour, Othmane, Godeau, Guillaume, Mecheri, Yasmine, Lebourdon, Romane, Yvorel, Cédric, Massin, Michael, Leblon, Tiphaine, Chabbi, Chaima, Cugney, Erwan, Benabou, Léa, Aubry, Matthieu, Chan, Camille, Boufoula, Ines, Barnaud, Clement, Bothorel, Léa, Duceau, Baptiste, Sutter, Willy, Waldmann, Victor, Bonnet, Guillaume, Cohen, Ariel, Pezel, Théo
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 21-08-2020 Oxford University Press (OUP)
Subjects:	Betacoronavirus Computed Tomography Angiography - methods Coronavirus Infections - complications Coronavirus Infections - epidemiology COVID-19 FAST Track Clinical Research Female France - epidemiology Hospitalization - trends Humans Incidence Life Sciences Male Middle Aged Pandemics Pneumonia, Viral - complications Pneumonia, Viral - epidemiology Pulmonary Embolism - diagnosis Pulmonary Embolism - epidemiology Pulmonary Embolism - etiology Retrospective Studies Risk Factors SARS-CoV-2 Survival Rate - trends France COVID-19 Pulmonary embolism Computed tomography angiography Intensive care unit Risk factors
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Summary:	Abstract Aims While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients. Methods and results In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14–0.91, P = 0.04; and OR 0.11, 95% CI 0.06–0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003–1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79–0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82–0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01–1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006–1.038, P = 0.002). Conclusion PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation. Graphical Abstract Graphical Abstract
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 PMCID: PMC7528952 Guillaume Bonnet and Ariel Cohen contributed equally to this work. The list of the Critical Covid-19 France Investigators is given in Supplementary material, File 4.
ISSN:	0195-668X 1522-9645 1522-9645
DOI:	10.1093/eurheartj/ehaa500