Pulmonary Embolism During COVID Infection a Deadly Mix

HONOLULU — During the first year of the pandemic, patients with pulmonary embolism (PE) had higher in-hospital mortality rates when they also had concomitant COVID-19, according to a nationwide retrospective cohort study.

Using data from the 2020 National Inpatient Sample Database (NIS), 19.8% of patients with both PE and COVID died in the hospital compared with 7.1% of those with PE but without COVID (adjusted OR 3.16, 95% CI 3.07-3.25, P<0.001), reported Rana Prathap Padappayil, MBBS, of Upstate Medical University in Syracuse, New York, during the CHEST annual meeting hosted by the American College of Chest Physicians.

Patients with PE who had COVID were also more likely to require vasopressors (5.31% vs 2.66%; aOR 1.16, 95% CI 1.11-1.22) and extracorporeal membrane oxygenation (0.76% vs 0.30%; aOR 1.62, 95% CI 1.41-1.86), and had longer lengths of stay (7 vs 4 days; P<0.001).

Padappayil noted that acute PE is one of the most common causes of cardiovascular death, with in-hospital mortality rates of around 30%. Studies have shown that COVID is an independent risk factor for developing PE.

Of note, patients with both PE and COVID were less likely to receive certain procedures versus those without COVID, including systemic thrombolysis (2.83% vs 4.71%), catheter-directed thrombolysis (0.13% vs 0.49%), and thrombectomy (0.73% vs 1.94%; all P<0.001).

Because the study data are from 2020 — the first year of the pandemic — this may have played a role in the differences among procedure utilization, Padappayil said, noting that a lack of personal protective equipment, a high patient burden, and concerns about evidence likely resulted in patients with both PE and COVID receiving fewer interventions compared with those without COVID.

However, it is unclear if this lack of interventions resulted in higher mortality in patients with PE and COVID, he added.

For this study, the researchers used data from the NIS, which included 425,640 hospitalizations for acute PE (the admitting diagnosis); 11% of these patients also had a COVID-19 infection.

Median patient age was 65, and the majority were women (41.6% with COVID and 50.6% without COVID) and white (53.4% and 70%, respectively); 23% and 19% were African American and 16.4% and 6.7% were Hispanic.

Among the comorbidities present among the patient population were hypertension (62% in both groups), smoking (20% with COVID and 23% without), chronic obstructive pulmonary disease (COPD; 21.6% and 27%, respectively), congestive heart failure (16.5% and 24%), diabetes (13.7% and 10.7%), malignancy (4.1% and 16.6%), and history of venous thromboembolism (4.5% and 9.4%).

Padappayil and team noted that patients with PE and COVID were more likely to be men and non-white, and less likely to have comorbidities, including prior myocardial infarction, diabetes, congestive heart failure, COPD, chronic kidney disease, end-stage renal disease, malignancy, and history of venous thromboembolism.

Limitations to the study included the fact that the NIS database is subject to selection biases and ICD miscoding. In addition, the analysis was limited to in-hospital outcomes, which means the researchers were unable to assess long-term outcomes after discharge.

Padappayil stressed the need for further research using data from the subsequent years of the pandemic. As NIS data become available, his group will look into whether providers have been more willing to use thrombolysis and thrombectomy in patients with both PE and COVID.

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