Clinical profile and outcomes of COVID-19-associated pulmonary thromboembolism in critically ill patients

A single-center cross-sectional study in Colombia

Abstract

Introduction: severe COVID-19 is associated with a hypercoagulable state and endothelial dysfunction that increases the risk of thromboembolic events like pulmonary embolism (PE), especially in critically ill patients in intensive care units (ICUs). The objective of this study was to describe the clinical, sociodemographic, and paraclinical characteristics of adult patients with PE and confirmed COVID-19, as well as to identify factors associated with mortality.

Methods: a cross-sectional descriptive study was conducted in the ICU of a quaternary care hospital in Bogotá, Colombia, from March 2020 to December 2021. Adult patients with SARSCoV- 2 infection (confirmed by RT-PCR) and PE (diagnosed by thoracic computed tomography angiography) were included. Clinical, laboratory and imaging variables were analyzed through descriptive statistics and bivariate analysis.

Results: 100 patients were included, with an average age of 59.3 ± 13.2 years; 70% were male. The most frequent comorbidities were hypertension (31%), diabetes mellitus (25%), and chronic obstructive pulmonary disease (13%). The overall mortality was 23% and was highest in patients with hypertension, diabetes, hemoptysis, the need for invasive mechanical ventilation and McConnell’s sign. In addition, elevated lactate dehydrogenase, creatinine, lactate and ultrasensitive troponin were associated with greater mortality.

Conclusions: patients with severe COVID-19 and PE had a high mortality rate, especially those with cardiovascular comorbidities and right ventricular dysfunction. Identifying clinical and paraclinical predictors can improve risk stratification and guide treatment decisions in critically ill patients.