Prevalence and effects of pulmonary embolism on hospital outcomes among COVID-19 patients

OBJECTIVE: Venous thromboembolism is a well-established and prevalent complication of COVID-19, prompting clinical guidelines to recommend systematic risk stratification and the administration of pharmacologic thromboprophylaxis to mitigate subsequent complications, including pulmonary embolism (PE). Nonetheless, findings from a small autopsy series demonstrated a significant incidence of both macro- and microvascular pulmonary thromboses in COVID-19 patients, despite the implementation of prophylactic anticoagulation. We investigated the prevalence and the relationship between PE and COVID-19 related hospital outcomes using data from State Inpatient Database.

RESULTS: We assessed 94,114 hospitalizations due to COVID-19, of which 1,798 (1.9%) developed PE. Patients who were male, have either a coagulation disorder or liver disease, or had a greater comorbidity burden were more likely to develop PE. Individuals with both COVID-19 and PE had significantly higher odds for hospital mortality (Odds Ratio (OR) = 1.94; 95% Confidence Interval (CI): [1.75–2.26]), prolonged length of stay (OR = 1.62; 95%CI: [1.47–1.79]), vasopressor use (OR = 2.19; 95%CI: [1.94–2.48]), mechanical ventilation (OR = 1.98, 95%CI: [1.57–2.51]), and ICU admission (OR = 2.16, 95%CI: [1.91–2.45]). Our study showed that patients with COVID-19 and PE need aggressive measures to limit the development of adverse outcomes. Future research should work to assess the efficacy of anti-coagulant treatment protocols in reducing the risk of mortality.