PB0079 - Severity of pulmonary embolism among hospitalized COVID-19 patients in Salvador-Brazil

Background: Venous thromboembolism (VTE) is common in COVID-19 but pulmonary embolism (PE) events seem to be less severe than in other patient groups.

Aims: To evaluate the severity of PE among hospitalized COVID-19 patients based on simplified-Pulmonary-Embolism-Severity-Index (sPESI), troponin I levels and echocardiogram findings.

Methods: A retrospective evaluation of 517 COVID-19 patients admitted to a hospital from March 2020 to September 2021 for whom 309 venous ultrasounds for deep venous thrombosis (DVT) and 377 pulmonary CT angiographies for PE were performed. The sPESI includes age >80, cancer, heart failure or chronic respiratory insufficiency, heart rate ≥110 bpm, systolic blood pressure (SBP) < 100 mmHg and arterial oxygen saturation < 90%. Characteristics are shown as percentages and compared between PE + PE/DVT and DVT-only.

Results: 96 patients had VTE (18.6%): 37 PE, 11 PE + DVT, 56 DVT of legs,12 of upper extremities and 6 central venous catheter (CVC)-thrombosis. Clinical characteristics are shown in table 1. Among 48 PE, 7 were central, 23 lobar, 37 segmentar, 34 subsegmentar, and 50% bilateral. More DVT-only than PE patients received mechanical ventilation, 62.5% vs. 25% (p < 0.0001), CVC 64.6% vs. 29.2% (p < 0.001), had longer hospital-stay 33.5 vs. 15.2 days, (p < 0.001), recent surgery, 31.3 vs. 8.3% (p=0.009) and died 39.6% vs. 8.3% (p < 0.001). sPESI was positive (≥1) in 95.8% of patients, mainly due to low SBP (79%) or low saturation (58%). 41/48 patients had echocardiograms; right ventricular dysfunction was not registred in any; elevated PSAP was seen in 17% and elevated troponin in 26.7% of patients.

Conclusion(s): More patients with DVT than with PE had longer hospital-stay, markers of critical illness and died. PE were mostly segmentar or subsegmentar. Although ecocardiogram did not show right ventricular strain, troponin was elevated in one quarter and sPESI was ≥1 in the vast majority of COVID-19 patients with PE.