Predictors of Pulmonary Embolism in Hospitalized Patients with COVID-19

Abstract

Abstract BACKGROUND: High venous thromboembolism (VTE) rates have been described in critically ill patients with COVID-19. We hypothesized that specific clinical characteristics may help differentiate hypoxic COVID-19 patients with and without a diagnosed pulmonary embolism (PE). METHODS: We performed a retrospective observational case-control study of 158 consecutive patients hospitalized in one of four Mount Sinai Hospitals with COVID-19 between March 1 and May 8, 2020, who received a Chest CT Pulmonary Angiogram (CTA) to diagnose a PE. We analyzed demographic, clinical, laboratory, radiological, treatment characteristics, and outcomes in COVID-19 patients with and without PE. RESULTS: 92 patients were negative (CTA-), and 66 patients were positive of PE (CTA+). CTA+ had a longer time from symptom onset to admission (7 days vs 4 days, p=0.05), higher admission biomarkers, notably D-dimer (6.87 vs 1.59, p<0.0001), troponin (0.015 vs 0.01, p=0.01), and peak D-dimer (9.26 vs 3.8, p=0.0008). Predictors of PE included time from symptom onset to admission (OR=1.11, 95% CI 1.03-1.20, p=0.008), and PESI score at the time of CTA (OR= 1.02, 95% CI 1.01-1.04, p= 0.008). Predictors of mortality included age (HR 1.13, 95% CI 1.04-1.22, p=0.006), chronic anticoagulation (13.81, 95% CI 1.24-154, p=0.03), and admission ferritin (1.001, 95% CI 1-1.001, p=0.01). CONCLUSIONS: In 158 hospitalized COVID-19 patients with respiratory failure evaluated for suspected PE, 40.8% patients had a positive CTA. We identified clinical predictors of PE and mortality from PE, which may help with early identification and reduction of PE-related mortality in patients with COVID-19.