Zuin Marco, Bilato Claudio, Quadretti Laura, Vatrano Marco, Navaro Monica, Rigatelli Gianluca, Zuliani Giovanni, Roncon Loris
Sezione di Medicina Interna e Cardio-Respiratoria, Dipartimento di Medicina Traslazionale, Università degli Studi, Ferrara.
U.O.C. Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Arzignano (VI).
G Ital Cardiol (Rome). 2022 Apr;23(4):233-243. doi: 10.1714/3766.37530.
Acute pulmonary embolism (PE) represents a frequent and prognostically relevant complication of COVID-19.
We performed a systematic review and meta-analysis, according to the PRISMA guidelines to determine the in-hospital incidence of acute PE, based on Italian studies published on this issue. We searched PubMed and Scopus to locate all articles published between February 2020 to October 15, 2021, reporting the incidence of acute PE in Italian COVID-19 patients. The pooled in-hospital incidence of acute PE was calculated using a random-effect model and presented with relative 95% confidence interval (CI).
We analysed data from 3287 Italian COVID-19 patients (mean age 65.7 years) included in 20 studies. The pooled in-hospital incidence of acute PE was 20% (95% CI 13.4-28.7%; I2 = 95.1%); the incidence was lower among patients hospitalized in intensive care unit (ICU) (32.3%; 95% CI 20.2-44.0%; I2 = 77.2%) compared to those admitted in general wards (47.6%; 95% CI 18.7-78.2%; I2 = 94.4%). Meta-regression showed a significant direct correlation of acute PE incidence using age, male gender and previous coronary artery disease as moderating variables. Conversely, an inverse correlation was observed in relation to the use of anticoagulation at therapeutic dose. Prophylactic and therapeutic anticoagulation was administered in 80.2% of patients (95% CI 72.5-86.2%; I2 = 91.0%); the former regimen was more frequently used compared to the latter (63.5% vs 14.3%; p<0.001). Computed tomography angiography (CTPA) was used only in 10.7% of infected patients across 7 studies.
One in five COVID-19 patients experienced acute PE as complication of the infection during hospitalization. The in-hospital incidence of acute PE was lower in ICU compared to general wards. CTPA was scantly used. Early prophylactic anticoagulation was associated with a lower incidence of acute PE.
急性肺栓塞（PE）是新型冠状病毒肺炎（COVID-19）常见且与预后相关的并发症。
我们根据PRISMA指南进行了一项系统评价和荟萃分析，以确定基于意大利发表的关于此问题的研究的急性PE住院发病率。我们检索了PubMed和Scopus，以查找2020年2月至2021年10月15日期间发表的所有报道意大利COVID-19患者急性PE发病率的文章。使用随机效应模型计算急性PE的合并住院发病率，并给出相对95%置信区间（CI）。
我们分析了20项研究中纳入的3287例意大利COVID-19患者（平均年龄65.7岁）的数据。急性PE的合并住院发病率为20%（95%CI 13.4 - 28.7%；I2 = 95.1%）；与入住普通病房的患者（47.6%；95%CI 18.7 - 78.2%；I2 = 94.4%）相比，重症监护病房（ICU）住院患者的发病率较低（32.3%；95%CI 20.2 - 44.0%；I2 = 77.2%）。Meta回归显示，以年龄、男性性别和既往冠状动脉疾病作为调节变量，急性PE发病率存在显著正相关。相反，观察到与治疗剂量抗凝药物的使用呈负相关。80.2%的患者接受了预防性和治疗性抗凝（占比95%CI 72.5 - 86.2%；I2 = 91.0%）；与后者相比，前者方案使用更频繁（63.5%对14.3%；p<0.001）。在7项研究中，仅10.7%的感染患者使用了计算机断层扫描血管造影（CTPA）。
五分之一的COVID-19患者在住院期间发生急性PE，作为感染的并发症。与普通病房相比，ICU中急性PE的住院发病率较低。CTPA使用较少。早期预防性抗凝与急性PE发病率较低相关。
