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Central pulmonary embolism in patients with Covid-19
Martin Nordberg1, Sara Bankler2, Åsa H Everhov1,3
1Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Insights
Central pulmonary embolism (PE) was common in COVID-19 patients, particularly in intensive care units (ICU). However, central PE showed no association with prophylactic anticoagulation or the severity of lung changes from COVID-19.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- COVID-19 (Coronavirus Disease 2019) is associated with an increased risk of thrombotic events.
- Pulmonary embolism (PE) is a significant complication in hospitalized COVID-19 patients.
- Understanding the characteristics of PE in COVID-19 is crucial for patient management.
Purpose of the Study:
- To evaluate the occurrence and characteristics of central pulmonary embolism (PE) in patients with COVID-19.
- To assess the association between central PE and radiological lung changes, prophylactic anticoagulation, and intensive care unit (ICU) admission.
Main Methods:
- Retrospective analysis of hospitalized patients with confirmed SARS-CoV-2 RNA.
- Diagnosis of PE confirmed by computed tomography pulmonary angiography.
- Assessment of COVID-19 related lung changes using a scoring system (max score 25).
- Evaluation of anticoagulant regimens and ICU status.
Main Results:
- A cumulative incidence of 3.5% for PE was observed in 1162 COVID-19 patients.
- Central PE accounted for 63.4% of all PE cases, with 46.3% diagnosed at admission.
- Central PE was significantly more frequent in ICU patients (82.4%) compared to non-ICU patients (50.0%).
- No significant association was found between central PE and prophylactic anticoagulation (p=.317) or the extent of radiological lung changes (p=.451).
Conclusions:
- A high proportion of central PE was observed in COVID-19 patients, especially those in the ICU.
- Central PE frequently occurred at the time of hospital admission.
- The extent of radiological lung changes and prophylactic anticoagulation did not correlate with the presence of central PE.
Background:
The purpose was to evaluate central pulmonary embolism (PE) in patients with Covid-19. The association with severe radiological pulmonary changes, prophylactic anticoagulation and ICU care was assessed.
Methods:
From 1 March until 31 May 2020, all in-hospital patients with a positive PCR for SARS-CoV-2-RNA and PE diagnosed with computed tomography pulmonary angiography were identified through diagnostic codes in medical charts. PE was characterised as central/peripheral and unilateral/bilateral. Covid-19 related lung changes were evaluated scoring the proportion of affected lung (max-score score 25) for all five lobes in both lungs. ICU and non-ICU patients were included and anticoagulant regimens were assessed.
Results:
Of 1162 patients with Covid-19, 41 were diagnosed with PE (cumulative incidence 3.5%), and of these 63.4% (=overall 2.2%) had central PE. PE on admission was present in 46.3%. No differences were seen in the distribution of central vs. peripheral PE in relation to prophylactic anticoagulation (p=.317). Of ICU patients 82.4% were diagnosed with central PE compared to 50.0% among non-ICU patients (p=.05). No association was observed between the presence of central PE and the extent of radiological Covid-19 changes (p=.451). Mild (0-12 p) and severe (13-25 p) pulmonary changes were seen in 63.4% and 36.6% of patients respectively.
Conclusions:
Overall, and especially in ICU-patients, a high proportion of central PE was seen and many were diagnosed at admission. No association between central PE and prophylactic anticoagulation, or the extent of pulmonary Covid-19 changes was observed.
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