Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome
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- Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona , Villarroel 170 , Barcelona 08036, Catalonia, Spain
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- Sònia Jiménez
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona , Villarroel 170 , Barcelona 08036, Catalonia, Spain
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- Alexandre Mebazaa
- Department of Anesthesiology, Burn and Critical Care, University Hospitals Saint-Louis—Lariboisière, AP-HP Rue Ambroise Paré, 75010 Paris, France
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- Yonathan Freund
- Emergency Department, HôpitalPitié-Salpêtrière, Assistance Publique—Hôpitaux 18 de Paris (APHP), Sorbonne Université , 47-83 Boulevard de l'Hôpital, 75013 Paris, France
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- Guillermo Burillo-Putze
- Emergency Department, Hospital Universitario de Canarias , Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
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- Alfonso Martín
- Emergency Department, Hospital Severo Ochoa , M-402, 8, 28914 Leganés, Madrid, Spain
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- Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutense Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
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- Eric Jorge García-Lamberechts
- Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutense Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
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- Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu I Sant Pau , Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
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- Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat , Barcelona, Spain
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- Pere Llorens
- Emergency Department, Hospital General de Alicante, University Miguel Hernández , Calle Pintor Baeza, 11, 03010 Alicante, Spain
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- Pascual Piñera
- Emergency Department, Hospital General Universitario Reina Sofía . Av. Intendente Jorge Palacios, 1, 30003 Murcia, Spain
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- Víctor Gil
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona , Villarroel 170 , Barcelona 08036, Catalonia, Spain
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- Josep Guardiola
- Emergency Department, Hospital de la Santa Creu I Sant Pau , Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
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- Carlos Cardozo
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona , Villarroel 170 , Barcelona 08036, Catalonia, Spain
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- Josep Maria Mòdol Deltell
- Emergency Department, Hospital Universitari Germans Trias i Pujol de Badalona , Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
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- Josep Tost
- Emergency Department, Hospital de Terrassa , Carretera Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
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- Alfons Aguirre Tejedo
- Emergency Department, Hospital del Mar , Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
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- Anna Palau-Vendrell
- Emergency Department, Hospital Universitari Joan XXIII , Carrer Dr. Mallafrè Guasch, 4, 43005 Tarragona, Spain
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- Lluís LLauger García
- Emergency Department, Hospital Universitari de Vic , Carrer de Francesc Pla el Vigatà, 1, 08500 Vic Barcelona, Spain
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- Maria Adroher Muñoz
- Emergency Department, Hospital Universitari de Girona Dr JosepTrueta, Avinguda de França, S/N, 17007 Girona, Spain
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- Carmen del Arco Galán
- Emergency Department, Hospital Universitario de la Princesa , Calle de Diego de León, 62, 28006 Madrid, Spain
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- Teresa Agudo Villa
- Emergency Department, Hospital Universitario Severo Ochoa, M-402, 8, 28914 Leganés , Madrid, Spain
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- Nieves López-Laguna
- Emergency Department, Clínica Universidad Navarra, Calle Marquesado de Sta. Marta, 1, 28027 Madrid , Spain
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- María Pilar López Díez
- Emergency Department, Hospital Universitario de Burgos . Av. Islas Baleares, 3, 09006 Burgos, Spain
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- Fahd Beddar Chaib
- Emergency Department, Complejo Asistencial de Soria , Paseo Sta. Bárbara, 42005 Soria, Spain
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- Eva Quero Motto
- Emergency Department, Hospital Clínico Universitario Virgen de la Arrixaca , Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain
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- Matilde González Tejera
- Emergency Department, Hospital General Universitario de Elche . Carrer Almazara, 11, 03203 Elche, Alicante, Spain
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- María Carmen Ponce
- Emergency Department, Hospital de la Vega Baja Orihuela. Carretera Orihuela - Almoradí, S/N, Orihuela, Alicante , Spain
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- Juan González del Castillo
- Emergency Department, Hospital Clínico San Carlos, IDISSC, UnivesdadComplutense Calle del Prof Martín Lagos, s/n, 28040 Madrid, Spain
抄録
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims</jats:title> <jats:p>We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results</jats:title> <jats:p>We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92‰). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population [35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51–9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65–1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97–2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66–4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE.</jats:p> </jats:sec>
収録刊行物
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- European Heart Journal
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European Heart Journal 42 (33), 3127-3142, 2021-06-24
Oxford University Press (OUP)