Rouen University Hospital, FHU REMOD-VHF, F-76000 Rouen, France.
Centre Hospitalier Régional Universitaire de Nancy, 54511 Vandoeuvre-Les-Nancy, France.
Eur Heart J. 2020 Jul 1;41(32):3058-3068. doi: 10.1093/eurheartj/ehaa500.
While pulmonary embolism (PE) appears to be a major issue in COVID-19, data remain sparse. We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of COVID-19 patients.
In a retrospective multicentre observational study, we included consecutive patients hospitalized for COVID-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit (ICU) were excluded. Among 1240 patients (58.1% men, mean age 64 ± 17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both P < 0.001). In an univariable analysis, traditional venous thrombo-embolic risk factors were not associated with PE (P > 0.05), while patients under therapeutic dose anticoagulation before hospitalization or prophylactic dose anticoagulation introduced during hospitalization had lower PE occurrence [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.14-0.91, P = 0.04; and OR 0.11, 95% CI 0.06-0.18, P < 0.001, respectively]. In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95% CI 1.003-1.069, P = 0.04), anticoagulation with a prophylactic dose (OR 0.83, 95% CI 0.79-0.85, P < 0.001) or a therapeutic dose (OR 0.87, 95% CI 0.82-0.92, P < 0.001), C-reactive protein (OR 1.03, 95% CI 1.01-1.04, P = 0.001), and time from symptom onset to hospitalization (OR 1.02, 95% CI 1.006-1.038, P = 0.002).
PE risk factors in the COVID-19 context do not include traditional thrombo-embolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.
虽然肺栓塞（PE）似乎是 COVID-19 的一个主要问题，但数据仍然很少。我们旨在描述 COVID-19 患者队列中 PE 患者的危险因素和基线特征。
在一项回顾性多中心观察性研究中，我们纳入了连续住院治疗 COVID-19 的患者。排除了未行计算机断层扫描肺动脉造影（CTPA）证实的 PE 诊断且直接转入重症监护病房（ICU）的患者。在 1240 例患者（58.1%为男性，平均年龄 64 ± 17 岁）中，103 例（8.3%）患者经 CTPA 证实存在 PE。PE 组的 ICU 转科和机械通气明显更高（均 P < 0.001）。在单变量分析中，传统静脉血栓栓塞危险因素与 PE 无关（P > 0.05），而住院前接受治疗剂量抗凝或住院期间预防性剂量抗凝的患者 PE 发生率较低[比值比（OR）0.40，95%置信区间（CI）0.14-0.91，P = 0.04；和 OR 0.11，95% CI 0.06-0.18，P < 0.001]。在多变量分析中，以下在单变量分析中也具有统计学意义的变量与 PE 相关：男性（OR 1.03，95% CI 1.003-1.069，P = 0.04）、接受预防性剂量（OR 0.83，95% CI 0.79-0.85，P < 0.001）或治疗剂量抗凝（OR 0.87，95% CI 0.82-0.92，P < 0.001）、C 反应蛋白（OR 1.03，95% CI 1.01-1.04，P = 0.001）和从症状发作到住院的时间（OR 1.02，95% CI 1.006-1.038，P = 0.002）。
COVID-19 背景下的 PE 危险因素不包括传统的血栓栓塞危险因素，而是入院时独立的临床和生物学发现，包括对炎症的重大贡献。
