Association between pulmonary embolism and COVID-19 severe pneumonia: Experience from two centers in the core of the infection Italian peak

• Published in: European journal of radiology Vol. 137; p. 109613
• Main Authors: Valle, C., Bonaffini, P.A., Dal Corso, M., Mercanzin, E., Franco, P.N., Sonzogni, A., Vacca, G., Gianatti, A., Sironi, S.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-04-2021
• Subjects: COVID-19; Female; Humans; Italy - epidemiology; Male; Middle Aged; Pneumonia; Pulmonary embolism; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - epidemiology; Retrospective Studies; SARS-CoV-2; Italy; COVID-19; DD; Pulmonary embolism; SARS-CoV-2; Pneumonia; PE; VTE; ICU; IQR; ER; GGO; DIC
• DOI: 10.1016/j.ejrad.2021.109613
• EISSN: 1872-7727
• ISSN: 0720-048X

•Pulmonary embolism affects a large percentage of COVID-19 pneumonia patients.•D-dimer levels correlate with the occurrence and the extent of PE.•PE may manifest despite an ongoing anticoagulant therapy.•Pulmonary embolism does not seem to affect short-term mortality.
Pulmonary embolism (PE) in COVID-19 patients can play a key role in precipitating clinical conditions. We aimed to evaluate PE distribution on CTA and to investigate any possible association with D-dimer (DD), pulmonary stage of disease and prognosis.
COVID-19 patients of two affiliated Hospitals, undergone a CTA examination for PE suspicion, were retrospectively enrolled. Comorbidities, laboratory tests and clinical outcomes (hospitalization, discharge, death) were assessed. A parenchymal stage (early, progressive, peak, absorption) for lung involvement was assigned.
A cohort of 114 patients (mean age 61 years; 26.3 % females) with severe COVID-19 pneumonia were evaluated. At last follow-up 25 (21.9 %) were hospitalized, 72 (63.2 %) discharged, 17 (14.9 %) dead. Eighty-eight patients (77.2 %) had at least one comorbidity, being cardiovascular ones the most frequent (44.7 %). CTA revealed PE in 65 patients (57 %), with concomitant pulmonary trunk and/or main arteries involvement in 16.9 %. PE defects were ubiquitous in 18.5 % of cases. The predominant parenchymal stages were the progressive (24.6 %) and peak (67.7 %). DD levels showed a significant correlation with PE occurrence and extent in pulmonary branches, despite anticoagulant therapies; trend of correlation with pulmonary stages was also noted.
PE is a frequent complication in severe COVID-19 patients, particularly during central parenchymal stages and despite ongoing anticoagulant therapy. CTA and DD levels play a crucial role in the assessment of suspected PE, despite anticoagulant therapies, along with proper information about lung involvement extent.