BackgroundPulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited.MethodsData were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models.ResultsThe study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involve-ment, and higher admission d-dimer [4344 (1099–15,118) vs. 818.5 (417–1460) ng/mL, p < 0.001]. They also received more frequently darunavir/ritonavir, tocilizumab and ventilation support. Furthermore, they faced more bleeding episodes requiring transfusion (15.6% vs. 5.1%, p < 0.001) and non-significantly higher in-hospital mortality (34.6% vs. 22.9%, p = 0.06). In multivariate regression, only d-dimer was associated with PE (HR 1.72, 95% CI 1.13–2.62; p = 0.01). The rela-tion between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer < 500 ng/mL.ConclusionsPE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of d-dimer in this population need to be clarified.

Pulmonary embolism in patients with COVID‑19: characteristics and outcomes in the Cardio‑COVID Italy multicenter study / P. Ameri, R.M. Inciardi, M. Di Pasquale, P. Agostoni, A. Bellasi, R. Camporotondo, C. Canale, V. Carubelli, S. Carugo, F. Catagnano, G. Danzi, L. Dalla Vecchia, S. Giovinazzo, M. Gnecchi, M. Guazzi, A. Iorio, M. Teresa La Rovere, ·. Sergio Leonardi, G. Maccagni, M. Mapelli, D. Margonato, ·. Marco Merlo, L. Monzo, C.A. Mortara, V. Nuzzi· Massimo Piepoli, I. Porto, A. Pozzi, G. Provenzale, F. Sarullo, G. Sinagra, C. Tedino, D. Tomasoni, M. Volterrani, G. Zaccone, C. Mario Lombardi, M. Senni, M. Metra. - In: CLINICAL RESEARCH IN CARDIOLOGY. - ISSN 1861-0684. - 110:7(2021 Jul), pp. 1020-1028. [10.1007/s00392-020-01766-y]

Pulmonary embolism in patients with COVID‑19: characteristics and outcomes in the Cardio‑COVID Italy multicenter study

P. Agostoni;A. Bellasi;S. Carugo;M. Guazzi;M. Mapelli;C.A. Mortara;G. Provenzale;
2021-07

Abstract

BackgroundPulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited.MethodsData were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between d-dimer levels and PE incidence was evaluated using restricted cubic splines models.ResultsThe study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9–24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involve-ment, and higher admission d-dimer [4344 (1099–15,118) vs. 818.5 (417–1460) ng/mL, p < 0.001]. They also received more frequently darunavir/ritonavir, tocilizumab and ventilation support. Furthermore, they faced more bleeding episodes requiring transfusion (15.6% vs. 5.1%, p < 0.001) and non-significantly higher in-hospital mortality (34.6% vs. 22.9%, p = 0.06). In multivariate regression, only d-dimer was associated with PE (HR 1.72, 95% CI 1.13–2.62; p = 0.01). The rela-tion between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer < 500 ng/mL.ConclusionsPE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of d-dimer in this population need to be clarified.
COVID-19; Thromboembolism; d-dimer; Coagulopathy; Anticoagulant; Death;
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
3-nov-2020
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/783099
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