PE twice as prevalent in COVID-19 in case series report
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A case series published in Circulation by physicians at Lille University Hospital in France reported twice the prevalence of pulmonary embolism among patients with COVID-19 admitted to the ICU compared with patients admitted to the ICU the same time in 2019.
The report also detailed a twofold greater incidence of PE among patients with COVID-19 during their ICU stay compared with all influenza admissions to the ICU in 2019.
The hospital is located in the north of France, which is the second most densely populated region of the country and has a high number of patients with overweight, according to the study background.
Among the first 107 consecutive patients with confirmed COVID-19 admitted to the ICU for pneumonia between Feb. 27 and March 31, 20.6% developed PE during a median of 6 days after ICU admission (range, 1-18).
Researchers observed double the frequency of PE among patients with COVID-19 compared with all ICU admissions (n = 196) during the same period in 2019, despite similar severity score at admission (20.6% vs. 6.1%; absolute risk increase, 14.4%; 95% CI, 6.1-22.8).
According to the report, these findings were similar when investigators compared PE prevalence among patients with COVID-19 to the 40 patients in the ICU with influenza (7.5% with PE) admitted in 2019 (absolute risk increase, 13.1%; 95% CI, 1.9-24.3).
“Pulmonary embolism frequency has not yet been reported in the different series of COVID-19 patients,” Julien Poissy, MD, PhD, of the resuscitation center at Lille University Hospital, and colleagues wrote. “All our patients received thromboprophylaxis according to the current recommendations for critically ill medical patient. However, we suspect that the high obesity prevalence in our patient group contributes to the increased PE frequency.”
At ICU admission, measurements associated with elevated risk for PE included:
- D-Dimer (sub-HR per log-standard deviation [SD] increase = 1.81; 95% CI, 1.03-3.16);
- plasma factor VIII activity (sub-HR per log-SD increase = 1.73; 95% CI, 1.1-2.72); and
- von Willebrand factor antigen levels (sub-HR per log-SD increase = 1.69; 95% CI, 1.12-2.56).
“Indeed, during the H1N1-flu pandemic, some centers reported an increased thrombotic risk in severe patients with acute respiratory distress syndrome and suggested the use of higher doses of heparin,” the researchers wrote.
“There is an urgent need for replication in a much larger scale of our data on PE frequency in COVID-19 infection in ICU patients,” the researchers wrote. “Failure to identify and accurately manage this risk could worsen the prognosis of patients with COVID-19.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.
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