Acute pulmonary embolism in patients presenting pulmonary deterioration after hospitalization for non-critical COVID-19

BACKGROUND: Emerging evidence suggests an association between COVID-19 and acute pulmonary embolism (APE).AIMS: To assess the prevalence of APE in patients hospitalized for non-critical COVID-19 who presented clinical deterioration, and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE in these subjects.METHODS: All consecutive patients admitted to the internal medicine department of a general hospital with a diagnosis of non-critical COVID-19, who performed a Computer Tomography Pulmonary Angiography (CTPA) for respiratory deterioration in April 2020, were included in this retrospective cohort study.RESULTS: Study populations: 41 subjects, median(IRQ)age:71.7(63-76)years, CPTA confirmed APE=8(19.51%,CI95%:8.82%-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of D-dimer for predicting APE was 2454 ng/mL, sensitivity(CI95%):63(24-91), specificity:73(54-87), Positive Predictive Value:36(13-65), Negative Predictive Value: 89(71-98) and AUC:0.62(0.38-0.85). The standard and age-adjusted D-dimer cut-offs, and the Wells score >2 did not associate with confirmed APE, albeit a cut-off value of D-dimer=2454 ng/mL showed an RR:3.21;CI95%:0.92-13.97;p=0.073. Heparin at anticoagulant doses was used in 70.73% of patients before performing CTPA.CONCLUSION: Among patients presenting pulmonary deterioration after hospitalization for non-critical COVID-19, the prevalence of APE is high. Traditional diagnostic tools to identify high APE pre-test probability patients do not seem to be clinically useful. These results support the use of a high index of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.