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Acute pulmonary embolism and COVID-19

Our take —

In this case series from Michigan, the authors report a high prevalence of pulmonary embolism among COVID-19 patients who received CT angiography, particularly among obese patients. This adds to the growing body of evidence of hypercoagulability and thrombotic complications in COVID-19. However, further studies are needed to establish the prevalence in the wider population of patients infected with SARS-CoV-2 along with any unique risk factors.

Study design

Case Series

Study population and setting

The study included 328 patients with laboratory-confirmed SARS-CoV-2 infection who received a pulmonary computed tomography (CT) angiography study between March 16 and April 18, 2020 within a Michigan health system. Imaging was obtained for clinical care rather than for research purposes. Laboratory measurements were obtained within two days of the CT angiogram.

Summary of Main Findings

22% (73/328) of COVID-19 patients with CT angiography had evidence of pulmonary emboli (PE) on imaging. Compared to those without detected PE, those with PE were more likely to be obese (BMI >30 kg/m2; 58% vs 44%), were less likely to be taking statin medications (27% vs 46%) and had higher serum levels of D-dimer. There were no differences in ICU admission or death based on the detection of a PE. Based on the independent risk factors, the authors developed a model to predict the presence of PE and included BMI, D-dimer, use of statins, and history of PE or hypertension.

Study Strengths

Relative to previous studies reporting pulmonary embolism in COVID-19 patients, the sample size was large.

Limitations

While the authors developed a predictive score for PE, the sample size likely limits its validity; no validation tests were performed. Laboratory values used for predictive purposes were obtained concurrently with, or in some cases, after, ascertainment of PE. Because CT angiography was obtained for clinical purposes, chiefly the diagnosis of PE, the reported prevalence is likely to be a large overestimate of the underlying prevalence of PE in the COVID-19 population.

Value added

This is one of largest studies to date investigating the prevalence of pulmonary emboli in patients with COVID-19.