Background: Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. Methods: Data 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. Results: The 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 involvement, 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 relation between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer < 500 ng/mL. Conclusions: PE 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. Graphic abstract: [Figure not available: see fulltext.].

Ameri, P., Inciardi, R., Di Pasquale, M., Agostoni, P., Bellasi, A., Camporotondo, R., et al. (2021). Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study. CLINICAL RESEARCH IN CARDIOLOGY, 110(7), 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

Senni M;
2021

Abstract

Background: Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. Methods: Data 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. Results: The 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 involvement, 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 relation between d-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline d-dimer < 500 ng/mL. Conclusions: PE 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. Graphic abstract: [Figure not available: see fulltext.].
Articolo in rivista - Articolo scientifico
Scientifica
Anticoagulant; Coagulopathy; COVID-19; d-dimer; Death; Thromboembolism;
English
Ameri, P., Inciardi, R., Di Pasquale, M., Agostoni, P., Bellasi, A., Camporotondo, R., et al. (2021). Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study. CLINICAL RESEARCH IN CARDIOLOGY, 110(7), 1020-1028 [10.1007/s00392-020-01766-y].
Ameri, P; Inciardi, R; Di Pasquale, M; Agostoni, P; Bellasi, A; Camporotondo, R; Canale, C; Carubelli, V; Carugo, S; Catagnano, F; Danzi, G; Dalla Vecchia, L; Giovinazzo, S; Gnecchi, M; Guazzi, M; Iorio, A; La Rovere, M; Leonardi, S; Maccagni, G; Mapelli, M; Margonato, D; Merlo, M; Monzo, L; Mortara, A; Nuzzi, V; Piepoli, M; Porto, I; Pozzi, A; Provenzale, G; Sarullo, F; Sinagra, G; Tedino, C; Tomasoni, D; Volterrani, M; Zaccone, G; Lombardi, C; Senni, M; Metra, M
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/373134
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