Pulmonary Embolism in Hospitalized Patients with COVID-19: A Multicenter Study

Sadjad Riyahi, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Hreedi Dev, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Ashkan Behzadi, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Jinhye Kim, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Hanieh Attari, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Syed I. Raza, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Daniel J. Margolis, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Ari Jonisch, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Ayah Megahed, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Anas Bamashmos, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Kareem Elfatairy, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).
Martin R. Prince, From the Departments of Radiology of Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (S.R., H.D., J.K., H.A., S.I.R., D.J.M., A.J., M.R.P.); Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Conn (A. Behzadi, A.M., A. Bamashmos, K.E.); and Columbia College of Physicians and Surgeons, New York, NY (M.R.P.).

Document Type

Article

Publication Title

Radiology

Abstract

Background Pulmonary embolism (PE) commonly complicates SARS-CoV-2 infection, but incidence and mortality reported in single-center studies, along with risk factors, vary. Purpose To determine the incidence of PE in patients with COVID-19 and its associations with clinical and laboratory parameters. Materials and Methods In this HIPAA-compliant study, electronic medical records were searched retrospectively for demographic, clinical, and laboratory data and outcomes among patients with COVID-19 admitted at four hospitals from March through June 2020. PE found at CT pulmonary angiography and perfusion scintigraphy was correlated with clinical and laboratory parameters. The d-dimer level was used to predict PE, and the obtained threshold was externally validated among 85 hospitalized patients with COVID-19 at a fifth hospital. The association between right-sided heart strain and embolic burden was evaluated in patients with PE undergoing echocardiography. Results A total of 413 patients with COVID-19 (mean age, 60 years ± 16 [standard deviation]; age range, 20-98 years; 230 men) were evaluated. PE was diagnosed in 102 (25%; 95% CI: 21, 29) of 413 hospitalized patients with COVID-19 who underwent CT pulmonary angiography or perfusion scintigraphy. PE was observed in 21 (29%; 95% CI: 19, 41) of 73 patients in the intensive care unit (ICU) versus 81 (24%; 95% CI: 20, 29) of 340 patients who were not in the ICU (P = .37). PE was associated with male sex (odds ratio [OR], 1.74; 95% CI: 1.1, 2.8; P = .02); smoking (OR, 1.86; 95% CI: 1.0, 3.4; P = .04); and increased d-dimer (P < .001), lactate dehydrogenase (P < .001), ferritin (P = .001), and interleukin-6 (P = .02) levels. Mortality in hospitalized patients was similar between patients with PE and those without PE (14% [13 of 102]; 95% CI: 8, 22] vs 13% [40 of 311]; 95% CI: 9, 17; P = .98), suggesting that diagnosis and treatment of PE were not associated with excess mortality. The d-dimer levels greater than 1600 ng/mL [8.761 nmol/L] helped predict PE with 100% sensitivity and 62% specificity in an external validation cohort. Embolic burden was higher in patients with right-sided heart strain among the patients with PE undergoing echocardiography (P = .03). Conclusion Pulmonary embolism (PE) incidence was 25% in patients hospitalized with COVID-19 suspected of having PE. A d-dimer level greater than 1600 ng/mL [8.761 nmol/L] was sensitive for identification of patients who needed CT pulmonary angiography. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Ketai in this issue.

First Page

E426

Last Page

E433

DOI

10.1148/radiol.2021210777

Publication Date

12-1-2021

Identifier

34254850 (pubmed); PMC8294351 (pmc); 10.1148/radiol.2021210777 (doi)

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