Acute pulmonary embolism and COVID-19 pneumonia: A multicenter case-control study

BACKGROUND: Several studies have described hypercoagulability and high incidence of thromboembolic events in COVID-19 patients. We aimed to evaluate the prevalence of acute pulmonary embolism [APE] and to explore which factors were associated with APE in COVID-19 patients. We propose an algorithm for the management of anticoagulation therapy. METHODS: This study is an observational retrospective multicenter study which include all consecutive patients with a diagnosis of COVID-19 and who experienced a diagnosis of APE using computerized tomography pulmonary angiography or cardiac echography. Relevant clinical, laboratory and radiological features were collected. RESULTS: Sixty-seven patients out of 205 (32.7%) (median age 68 [57–81], 17/67 [25%] females) had a COVID-19 pneumonia complicated with APE. The median duration from the onset of first COVID-19 symptoms to the diagnosis of APE was 8 [3.5–11.5] days. Medical past history, comorbidities and thromboembolic risk factors of were not different among patients with or without APE. Thirty percent of patients with APE had no thromboembolic risk factor. Higher levels of eosinophils, CRP and D-dimers and lower pH levels constituted the best model to predict this complication with an area under curve [AUC] of 0.90. Association of D-dimers > 3000 ng/L and CRP > 90 mg/L had a predictive positive value of 0.84 and this predictive model had an AUC of 0.88 (0.83–0.93). CONCLUSION: APE is a frequent complication of COVID-19 pneumonia. Patient history is not associated with the risk of APE. The combination of D-dimers and CRPs greater than 3000 mg/L and 90 mg/L respectively has a PPV of 84%.