The impact of pulmonary embolism on health outcomes of COVID-19 at 3 months after hospitalization

• Published in: Research and practice in thrombosis and haemostasis Vol. 8; no. 7; p. 102573
• Main Authors: Visser, Chantal, Berentschot, Julia C., de Jong, Cindy M.M., Antoni, M. Louisa, Bek, L. Martine, van den Berg-Emons, Rita J.G., van den Borst, Bram, ten Cate, Hugo, ten Cate-Hoek, Arina J., Braeken, Dionne C.W., Geelhoed, J.J. Miranda, Heijenbrok-Kal, Majanka H., van Kuijk, Sander M.J., Kroft, Lucia J.M., Leentjens, Jenneke, Roukens, Anna H.E., Cannegieter, Suzanne C., Klok, Frederikus A., Kruip, Marieke J.H.A., Hellemons, Merel E.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-10-2024
• Subjects: COVID-19; patient reported outcome measures; pulmonary embolism; quality of life; respiratory function tests; COVID-19; patient reported outcome measures; pulmonary embolism; quality of life; respiratory function tests
• ISSN: 2475-0379
• DOI: 10.1016/j.rpth.2024.102573

COVID-19 patients frequently experience pulmonary embolism (PE), but its long-term consequences remain uncertain.
To assess the impact of PE in COVID-19 patients on health outcomes at 3 months after hospitalization.
In this multicenter cross-sectional study, we aggregated data from existing databases to evaluate the impact of PE on health outcomes at 3 months after hospitalization. We assessed 1) questionnaires on health-related quality of life (5-level EuroQol 5-dimensional questionnaire [EQ-5D-5L] questionnaire), anxiety, depression, cognitive failure, and posttraumatic stress disorder; 2) pulmonary function tests (diffusing capacity of the lungs for carbon monoxide [DLCO] and spirometry); and 3) radiological abnormalities. We developed 3 models to assess the association between PE and the EQ-5D-5L index and the percentage of predicted DLCO (DLCO%): a crude model (model 1), adjusted for age, sex, and presence of comorbidities (model 2), and model 2 additionally adjusted for intensive care unit admission (model 3).
We included 465 patients who had been hospitalized for COVID-19, of whom 102 (21.9%) had developed a PE during admission. Patients with PE had poorer EQ-5D-5L index values, more impairment in pulmonary functions, and more frequent radiological abnormalities than patients without PE. Symptoms of anxiety, depression, cognitive failure, and posttraumatic stress disorder did not differ between the 2 groups. In model 2, PE was associated with lower EQ-5D-5L index and lower DLCO%. After additionally adjusting for intensive care unit admission, the association between PE and lower EQ-5D-5L index (mean difference = −0.069, [95% CI, −0.12 to −0.017]) remained but not between PE and DLCO%.
Our findings suggest that PE in COVID-19 patients is associated with reduced health-related quality of life at 3 months after hospitalization. While PE may be a marker of COVID-19 severity, its presence during hospitalization could indicate potential long-term health issues, which may be considered during follow-up care.
•The clinical impact of pulmonary embolism (PE) in COVID-19 patients remains unclear.•This multicenter study assessed health outcomes 3 months after discharge in COVID-19 patients.•Patients with PE had lower quality of life and impaired lung function 3 months after discharge.•PE may be a marker of COVID-19 severity and could indicate potential long-term health issues.