Yonathan Freund1,2, Marie Drogrey2, Òscar Miró3, Alessio Marra4, Anne-Laure Féral-Pierssens5,6, Andrea Penaloza7, Barbara A Lara Hernandez8, Sebastien Beaune9, Judith Gorlicki10,11, Prabakar Vaittinada Ayar12,13,14, Jennifer Truchot15, Barbara Pena16, Alfons Aguirre17, Florent Fémy18,19, Nicolas Javaud20, Anthony Chauvin21,22, Tahar Chouihed23,24, Emmanuel Montassier25,26, Pierre-Géraud Claret27, Céline Occelli28,29, Mélanie Roussel30, Fabien Brigant31, Sami Ellouze32, Pierrick Le Borgne33,34, Said Laribi35, Tabassome Simon1,36, Olivier Lucidarme1,37, Marine Cachanado38, Ben Bloom39. 1. From, Sorbonne Université, Paris, France. 2. the, Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), APHP.SU, Paris, France. 3. the, Emergency Departement, Hospital Clínic, Barcelona, Catalonia, Spain. 4. the, Emergency Department, Centro EAS-Emergenza Alta Specializzazione, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy. 5. the, Charles Lemoyne-Saguenay Lac Saint-Jean Research Center on Health Innovations (CR CSIS), Sherbrooke University, Longueuil, Québec, Canada. 6. the, Emergency Department, European Georges Pompidou hospital, APHP, Paris, France. 7. the, Service des Urgences, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain-la-Neuve, Belgium. 8. the, Emergency Medicine Section, Pontificia Universidad Católica de Chile, Santiago, Chile. 9. the, Emergency Department, Hôpital Ambroise-Paré, APHP, Boulogne, INSERM UMR 1144, Université Paris Centre, Paris, France. 10. the, Emergency Department, SAMU 93, Avicenne University Hospital, APHP.HUPSSD, Bobigny, France. 11. INSERM UMR-S 942, Sorbonne Paris Nord University, Bobigny, France. 12. the, Emergency Department, University Hospital of Beaujon, APHP, Clichy, France. 13. UMR-S 942, INSERM, MASCOT, Paris, France. 14. University, Paris, France. 15. the, Emergency Department, Cochin Hospital, Hôpitaux Universitaire Paris Centre, APHP, Paris, France. 16. the, Emergency Department, Hospital General Universitario de Alicante, Alicante, Spain. 17. the, Emergency Department, Hospital del Mar, Barcelona, Catalonia, Spain. 18. the, Emergency Department, Georges Pompidou European Hospital, APHP, Université de Paris, Paris, France. 19. the, Toxicology and Chemical Risks Department, French Armed Forces Biomedical Institute, Bretigny-Sur-Orges, France. 20. the, Emergency Department, Louis Mourier Hospital, University of Paris, APHP.North, Paris, France. 21. the, Emergency Department, Hopital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France. 22. the, Faculté de Médecine, Université de Paris, Paris, France. 23. the, Emergency Department, Université de Lorraine, University Hospital of Nancy, Centre d'Investigations Cliniques-1433, and INSERM UMR_S 1116, Nancy, France. 24. the, F-CRIN INI-CRCT, Nancy, France. 25. the, Department of Emergency Medicine, CHU Nantes, Nantes, France. 26. the, MiHAR Laboratory, Université de Nantes, Nantes, France. 27. the, Department of Anesthesia Resuscitation Pain Emergency Medicine, Nîmes University Hospital, Nîmes, France. 28. the, Emergency Department, CHU Pasteur 2, Nice, France. 29. the, University Nice Côte d'Azur, Nice, France. 30. the, Emergency Department, Rouen University Hospital, Rouen, France. 31. the, Emergency Department, Hôpital Saint-Antoine, APHP.SU, Paris, France. 32. the, Emergency Department, Hôpital Saint-Louis, APHP, Paris, France. 33. the, Emergency Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 34. the, INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, Strasbourg, France. 35. the, Emergency Department, School of Medicine and CHU Tours, Tours University, Tours, France. 36. the, Clinical Research Platform (URC-CRC-CRB), AP-HP Hôpital Saint-Antoine, Paris, France. 37. the, APHP-Sorbonne Universités, Pitié Salpêtrière Hospital, Radiology Department and UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France. 38. the, Emergency Department, Royal London Hospital, Barts Health NHS Trust, London, UK. 39. and the, Emergency Department, European Georges Pompidou Hospital, APHP, Paris, France.
Abstract
BACKGROUND: There have been reports of procoagulant activity in patients with COVID-19. Whether there is an association between pulmonary embolism (PE) and COVID-19 in the emergency department (ED) is unknown. The aim of this study was to assess whether COVID-19 is associated with PE in ED patients who underwent a computed tomographic pulmonary angiogram (CTPA). METHODS: A retrospective study in 26 EDs from six countries. ED patients in whom a CTPA was performed for suspected PE during a 2-month period covering the pandemic peak. The primary endpoint was the occurrence of a PE on CTPA. COVID-19 was diagnosed in the ED either on CT or reverse transcriptase-polymerase chain reaction. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period. RESULTS: A total of 3,358 patients were included, of whom 105 were excluded because COVID-19 status was unknown, leaving 3,253 for analysis. Among them, 974 (30%) were diagnosed with COVID-19. Mean (±SD) age was 61 (±19) years and 52% were women. A PE was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID-19 patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID-19 was not associated with higher risk of PE (adjusted odds ratio = 0.98, 95% confidence interval = 0.76 to 1.26). There was no association when limited to patients in the pandemic period. CONCLUSION: In ED patients who underwent CTPA for suspected PE, COVID-19 was not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID-19 in general.
BACKGROUND: There have been reports of procoagulant activity in patients with COVID-19. Whether there is an association between pulmonary embolism (PE) and COVID-19 in the emergency department (ED) is unknown. The aim of this study was to assess whether COVID-19 is associated with PE in ED patients who underwent a computed tomographic pulmonary angiogram (CTPA). METHODS: A retrospective study in 26 EDs from six countries. ED patients in whom a CTPA was performed for suspected PE during a 2-month period covering the pandemic peak. The primary endpoint was the occurrence of a PE on CTPA. COVID-19 was diagnosed in the ED either on CT or reverse transcriptase-polymerase chain reaction. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period. RESULTS: A total of 3,358 patients were included, of whom 105 were excluded because COVID-19 status was unknown, leaving 3,253 for analysis. Among them, 974 (30%) were diagnosed with COVID-19. Mean (±SD) age was 61 (±19) years and 52% were women. A PE was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID-19patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID-19 was not associated with higher risk of PE (adjusted odds ratio = 0.98, 95% confidence interval = 0.76 to 1.26). There was no association when limited to patients in the pandemic period. CONCLUSION: In ED patients who underwent CTPA for suspected PE, COVID-19 was not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID-19 in general.
Authors: Mayank Batra; Runxia Tian; Chongxu Zhang; Emile Clarence; Camila Sofia Sacher; Justin Nestor Miranda; Justin Rafa O De La Fuente; Megan Mathew; Desmond Green; Sayari Patel; Maria Virginia Perez Bastidas; Sara Haddadi; Mukunthan Murthi; Miguel Santiago Gonzalez; Shweta Kambali; Kayo H M Santos; Huda Asif; Farzaneh Modarresi; Mohammad Faghihi; Mehdi Mirsaeidi Journal: Sci Rep Date: 2021-02-10 Impact factor: 4.379