Abstract
Objectives To investigate whether COVID-19 patients with pulmonary embolism had higher mortality and assess the utility of d-dimer in predicting acute pulmonary embolism.
Patients and methods Using the National Collaborative COVID-19 retrospective cohort, a cohort of hospitalized COVID-19 patients was studied to compare 90-day mortality and intubation outcomes in patients with and without pulmonary embolism in a multivariable cox regression analysis. The secondary measured outcomes in 1:4 propensity score-matched analysis included length of stay, chest pain incidence, heart rate, history of pulmonary embolism or DVT, and admission laboratory parameters.
Results Among 31,500 hospitalized COVID-19 patients, 1117 (3.5%) patients were diagnosed with acute pulmonary embolism. Patients with acute pulmonary embolism were noted to have higher mortality (23.6% vs.12.8%; adjusted Hazard Ratio (aHR) = 1.36, 95% CI [1.20–1.55]), and intubation rates (17.6% vs. 9.3%, aHR = 1.38[1.18–1.61]). Pulmonary embolism patients had higher admission D-dimer FEU (Odds Ratio(OR) = 1.13; 95%CI [1.1–1.15]). As the d-dimer value increased, the specificity, positive predictive value, and accuracy of the test increased; however, sensitivity decreased (AUC 0.70). At cut-off d-dimer FEU 1.8 mcg/ml, the test had clinical utility (accuracy 70%) in predicting pulmonary embolism. Patients with acute pulmonary embolism had a higher incidence of chest pain and history of pulmonary embolism or deep vein thrombosis.
Conclusions Acute pulmonary embolism is associated with worse mortality and morbidity outcomes in COVID-19. We present d-dimer as a predictive risk tool in the form of a clinical calculator for the diagnosis of acute pulmonary embolism in COVID-19.
Document Type
Article
Publication Date
2023
Digital Object Identifier (DOI)
https://doi.org/10.1186/s12931-023-02369-7
Funding Information
The study did not receive any funding directly from a grant. We acknowl- edge Dr. Philip Kern, James Aaron, and the CCTS University of Kentucky Department (funded by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998) for the help provided with the N3C database. The N3C enclave is supported by supported by NCATS U24 TR002306. This specific study did not receive any funding.
Repository Citation
Gul, Muhammad H.; Htun, Zin Mar; de Jesus Perez, Vinicio; Suleman, Muhammad; Arshad, Samiullah; Imran, Muhammad; Vyasabattu, Mahender; Wood, Jeremy P.; Anstead, Michael I.; and Morris, Peter E., "Predictors and outcomes of acute pulmonary embolism in COVID-19; insights from US National COVID cohort collaborative" (2023). Saha Cardiovascular Research Center Faculty Publications. 92.
https://uknowledge.uky.edu/cvrc_facpub/92
Notes/Citation Information
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