Prevalence of Pulmonary Embolism in COVID-19: a Pooled Analysis
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COVID-19
Prevalence of Pulmonary Embolism in COVID-19: a Pooled Analysis Rupak Desai 1 & Zainab Gandhi 2 & Sandeep Singh 3 & Sonali Sachdeva 4 & Pritika Manaktala 5 & Sejal Savani 6 & Virmitra Desai 7 & Rajesh Sachdeva 1,8,9 & Gautam Kumar 1,10 Accepted: 19 October 2020 # Springer Nature Switzerland AG 2020
Abstract There remains a high risk of thrombosis in patients affected by the SARS-CoV-2 virus and recent reports have shown pulmonary embolism (PE) as a cause of sudden death in these patients. However, the pooled rate of this deadly and frequently underdiagnosed condition among COVID-19 patients remains largely unknown. Given the frequency with which pulmonary embolism has been reported as a fatal complication of severe coronavirus disease, we sought to ascertain the actual prevalence of this event in COVID-19 patients. Using PubMed/Medline, EMBASE, and SCOPUS, a thorough literature search was performed to identify the studies reporting rate of PE among COVID-19. Random effects models were obtained to perform a meta-analysis, and I2 statistics were used to measure inter-study heterogeneity. Among 3066 COVID-19 patients included from 9 studies, the pooled prevalence of PE was 15.8% (95% CI (6.0–28.8%), I2 = 98%). The pooled rate in younger cohort (age < 65 years) showed a higher prevalence of 20.5% (95% CI (17.6–24.8%)) as compared to studies including relatively older cohort (age > 65 years) showing 14.3% (95% CI (2.9–30.1%)) (p < 0.05). Single-center studies showed a prevalence of 12.9% (95% CI 1.0–30.2%), while that of multicenter studies was 19.5% (95% CI 14.9–25.2%) (p < 0.05). Pulmonary embolism is a common complication of severe coronavirus disease and a high degree of clinical suspicion for its diagnosis should be maintained in critically ill patients. Keywords Pulmonary embolism . Infectious disease . SARS-CoV-2 . COVID-19
Introduction COVID-19 is a multisystem disease which increases risk of coagulopathy and thus, venous thromboembolism (VTE) and pulmonary embolism (PE) in critically ill patients. The incidence rate for VTE and arterial thrombosis and related thrombo-embolic complications remain very high in COVID-19 patients [1]. There are three possible mechanisms
associated with this observation: (1) through cytokine storm by interleukin-1, interleukin-6, tumor necrosis factor-alpha and others leading to endothelial activation and widespread thrombosis as seen in pulmonary vessels in acute respiratory distress syndrome; (2) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown an affinity for angiotensin-converting enzyme 2 located at alveolar epithelial cells, endothelial cells of extrapulmonary tissues leading to
This article is part of the Topical Collection on COVID-19 * Rupak Desai [email protected]; [email protected] 1
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Division of Cardiology, Atlanta VA Medical Center, Decatur, GA 30033, USA Department of Internal Medicine, Geisinger Community Medical Center, Scranton, PA, USA Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic M
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