Charles Fauvel1, Orianne Weizman2,3, Antonin Trimaille4, Delphine Mika5, Thibaut Pommier6, Nathalie Pace2, Amine Douair7, Eva Barbin8, Antoine Fraix2, Océane Bouchot7, Othmane Benmansour8, Guillaume Godeau9, Yasmine Mecheri8, Romane Lebourdon10, Cédric Yvorel11, Michael Massin2, Tiphaine Leblon12, Chaima Chabbi8, Erwan Cugney2, Léa Benabou10, Matthieu Aubry13, Camille Chan10, Ines Boufoula8, Clement Barnaud8, Léa Bothorel8, Baptiste Duceau3, Willy Sutter3, Victor Waldmann3,14, Guillaume Bonnet3,14, Ariel Cohen15, Théo Pezel16. 1. Rouen University Hospital, FHU REMOD-VHF, F-76000 Rouen, France. 2. Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France. 3. Université de Paris, PARCC, INSERM, 75015 Paris, France. 4. Nouvel Hôpital Civil, Centre Hospitalier Régional Universitaire de Strasbourg, 67000 Strasbourg, France. 5. Université Paris-Saclay, Inserm, UMR-S 1180, 92296 Chatenay-Malabry, France. 6. Centre hospitalier Universitaire de Dijon, 21000 Dijon, France. 7. Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France. 8. Centre Hospitalier Régionnal de Orléans, 45100 Orléans, France. 9. Institut Cardiovasculaire Paris Sud, 91300 Massy, France. 10. Centre Hospitalier Universitaire de Bordeaux, 33076 Bordeaux, France. 11. Centre Hospitalier Universitaire de Saint-Etienne, 42270 Saint-Priest-en-Jarez, France. 12. Centre Hospitalier Universitaire de Lille, Université Catholique de Lille, 59000 Lille, France. 13. Hospices Civils de Lyon, Centre Hospitalier Universitaire, 69003 Lyon, France. 14. Hôpital Européen Georges Pompidou, Université de Paris, 75015 Paris, France. 15. Saint Antoine Hospital, 75012 Paris, France. 16. Lariboisiere hospital, APHP, University of Paris, 75010 Paris, France.
Abstract
AIMS: While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients. METHODS AND RESULTS: In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14-0.91, P = 0.04; and OR 0.11, 95% CI 0.06-0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003-1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79-0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82-0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01-1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006-1.038, P = 0.002). CONCLUSION: PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19patients. METHODS AND RESULTS: In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14-0.91, P = 0.04; and OR 0.11, 95% CI 0.06-0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003-1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79-0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82-0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01-1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006-1.038, P = 0.002). CONCLUSION: PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation. Published on behalf of the European Society of Cardiology. All rights reserved.
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