Pulmonary embolism in COVID-19 pneumonia patients: analysis from a dedicated outpatient setting post-hospitalization

Abstract

Background: COVID-19 (CV19) is a multisystem disease associated with increased risk of coagulopathy and thus, pulmonary embolism (PE). However, detailed PE data remains largely understudied, mainly after hospital discharge. Aim: Evaluate PE occurrence among CV19 pneumonia pts and describe their risk factors and clinical characteristics. Methods: We performed a retrospective analysis (using descriptive statistics, t-Student, Mann-Whitney and Chi-Square tests) of 86 consecutive CV19 pneumonia pts followed in an outpatient setting (CV19 Pulmonology Consultation) post-hospitalization, between 05/2020 and 01/2021. PE diagnosis was based on international guidelines, regardless of the documentation by CT pulmonary angiogram. Clinical, laboratory, radiological and respiratory support data were analysed. Results: Mean age was 57±14 years and the majority was male (54; 63%). PE was diagnosed in 27 cases (31%), with a median time of 9 IQR 6-11 days since CV19 symptoms onset. At PE diagnosis, most pts (16; 59%) were not receiving prophylactic/therapeutic anticoagulant therapy. Patients in PE-group showed higher D-dimers level [1201 IQR 663-7246 vs 834 IQR 554-1317 ng/ml; p <0.016] and more often required high-flow nasal oxygen therapy (HFNO) (OR 9.8; 95% CI 1.88-51.15). Several data, including BMI, comorbidities, CT pneumonia findings and severity, CV19 severity and hospitalization duration did not differ between groups. Mortality rates did not differ 3 months after hospitalization. Conclusion: PE was a common complication in CV19 pneumonia, and PE pts required more frequently HFNO. Several findings diverge from previous literature which emphasizes the need for future studies.