Acute Pulmonary Embolism and COVID-19

Poyiadji N, Cormier P, Patel PY, et al. Radiology. 2020 May 14:201955.  [CrossRef] [PubMed]

Patients with COVID-19 with a body mass index (BMI) >30 kg/m² have increased odds of developing pulmonary embolism (PE), according to an online research letter. The authors assessed the clinical characteristics of COVID-19 patients who developed PE in a retrospective analysis involving 328 COVID-19 patients who underwent pulmonary computed tomography (CT) angiography. Thy found that 22 percent of the patients had PE. Patients with a BMI >30 kg/m² were observed more often in the PE versus the non-PE group (58 versus 44 percent). Compared with the non-PE cohort, fewer patients with PE were on statin therapy prior to admission (27 versus 46 percent). In a multivariate model, patients taking statin therapy prior to admission had significantly reduced odds of developing PE (adjusted odds ratio, 0.4), while those with a BMI >30 kg/m² had an adjusted odds ratio of 2.7. The odds ratio was 4.8 for PE with a 6 µg/mL increase in D-dimer. The area under the receiver operating characteristic curve (AUC) was 0.86 for the multivariable model. A D-dimer of 3.11 µg/mL had sensitivity and specificity of 78 and 81 percent, respectively, for development of PE (AUC, 0.85). The authors advocate for early evaluation with pulmonary CT angiography in COVID-19 patients who are at increased risk for developing pulmonary embolism based on demographic, clinical, and laboratory variables.