Buso Giacomo, Mazzolai Lucia, Rueda-Camino José Antonio, Fernández-Capitán Carmen, Jiménez David, Bikdeli Behnood, Lobo José Luis, Fernández-Reyes José Luis, Ciammaichella Maurizio, Monreal Manuel
Angiology Division, Heart and Vessels Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Department of Internal Medicine, Hospital Rey Juan Carlos, Madrid, Spain.
Semin Thromb Hemost. 2023 Feb;49(1):34-46. doi: 10.1055/s-0041-1740152. Epub 2021 Dec 13.
The clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) who develop pulmonary embolism (PE) in the full spectrum of patient care settings need to be elucidated. The aim of this study was to compare the clinical characteristics, treatment, and 90-day outcomes in patients diagnosed with PE while recovering from COVID-19 in the outpatient setting versus those who were diagnosed with PE while being hospitalized with COVID-19. Data from the international Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry were used. The major study outcomes were all-cause death, major bleeding, and venous thromboembolism (VTE) recurrences during the first 90 days after PE. From March 2020 to March 2021, 737 patients with COVID-19 experienced acute PE. Of these, 340 (46%) were recovering from COVID-19 as outpatients (267 patients who had been treated at home for COVID-19 and 73 discharged after being hospitalized with COVID-19). Compared with inpatients with COVID-19, those recovering in the outpatient setting upon PE were less likely to be men (odds ratio [OR]: 0.54; 95% confidence interval [CI]: 0.40-0.72) and less likely to have hypertension (OR: 0.55; 95% CI: 0.41-0.74) or diabetes (OR: 0.51; 95% CI: 0.33-0.76). At 90-day follow-up, eight patients (none recovering from COVID-19 as outpatient vs. 2.4% of inpatients with COVID-19) developed recurrent VTE, 34 (1.9 vs. 7.9%) had major bleeding, and 128 (10 vs. 24%) died. On multivariable analysis, inpatients with COVID-19 were at a higher risk of major bleeding (adjusted hazard ratio [HR]: 6.80; 95% CI: 1.52-30.4) or death (adjusted HR: 2.24; 95% CI: 1.40-3.58). In conclusion, using a large multinational registry of patients with COVID-19 who experienced PE, thromboembolic episodes occurring in those recovering from COVID-19 as outpatients were associated with less ominous outcomes than inpatients with COVID-19.
在全方位患者护理环境中发生肺栓塞（PE）的2019冠状病毒病（COVID-19）患者的临床特征和预后需要阐明。本研究的目的是比较在门诊从COVID-19康复过程中被诊断为PE的患者与因COVID-19住院时被诊断为PE的患者的临床特征、治疗情况和90天预后。使用了来自国际静脉血栓栓塞疾病信息登记处（RIETE）登记系统的数据。主要研究结局为PE后前90天内的全因死亡、大出血和静脉血栓栓塞（VTE）复发。2020年3月至2021年3月，737例COVID-19患者发生急性PE。其中，340例（46%）为门诊从COVID-19康复的患者（267例在家接受COVID-19治疗，73例COVID-19住院后出院）。与COVID-19住院患者相比，PE时在门诊康复的患者男性比例较低（比值比[OR]：0.54；95%置信区间[CI]：0.40-0.72），高血压（OR：0.55；95%CI：0.41-0.74）或糖尿病（OR：0.51；95%CI：0.33-0.76）的发生率也较低。在90天随访时，8例患者（门诊从COVID-19康复的患者无一例，而COVID-19住院患者为2.4%）发生VTE复发，34例（1.9%对7.9%）发生大出血，128例（10%对24%）死亡。多变量分析显示，COVID-19住院患者大出血（校正风险比[HR]：6.80；95%CI：1.52-30.4）或死亡（校正HR：2.24；95%CI：1.40-3.58）的风险更高。总之，通过一项大型跨国COVID-19合并PE患者登记研究发现，门诊从COVID-19康复过程中发生的血栓栓塞事件的预后比COVID-19住院患者的预后更乐观。
