The prevalence of pulmonary embolism in patients with COVID-19 and respiratory decline: A three-setting comparison

Thromb Res. 2020 Dec:196:486-490. doi: 10.1016/j.thromres.2020.10.012. Epub 2020 Oct 15.


Background: The risk of pulmonary embolism (PE) in patients with Coronavirus Disease 2019 (COVID-19) is recognized. The prevalence of PE in patients with respiratory deterioration at the Emergency Department (ED), the regular ward, and the Intensive Care Unit (ICU) are not well-established.

Objectives: We aimed to investigate how often PE was present in individuals with COVID-19 and respiratory deterioration in different settings, and whether or not disease severity as measured by CT-severity score (CTSS) was related to the occurrence of PE.

Patients/methods: Between April 6th and May 3rd, we enrolled 60 consecutive adult patients with confirmed COVID-19 from the ED, regular ward and ICU who met the pre-specified criteria for respiratory deterioration.

Results: A total of 24 (24/60: 40% (95% CI: 28-54%)) patients were diagnosed with PE, of whom 6 were in the ED (6/23: 26% (95% CI: 10-46%)), 8 in the regular ward (8/24: 33% (95% CI: 16-55%)), and 10 in the ICU (10/13: 77% (95% CI: 46-95%)). CTSS (per unit) was not associated with the occurrence of PE (age and sex-adjusted OR 1.06 (95%CI 0.98-1.15)).

Conclusion: The number of PE diagnosis among patients with COVID-19 and respiratory deterioration was high; 26% in the ED, 33% in the regular ward and 77% in the ICU respectively. In our cohort CTSS was not associated with the occurrence of PE. Based on the high number of patients diagnosed with PE among those scanned we recommend a low threshold for performing computed tomography angiography in patients with COVID-19 and respiratory deterioration.

Keywords: COVID-19 (coronavirus disease 2019); Computed tomography angiography; Pulmonary embolism; Thromboprophylaxis.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • COVID-19 / diagnostic imaging
  • COVID-19 / epidemiology*
  • Computed Tomography Angiography
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Prevalence
  • Prognosis
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / epidemiology*
  • Respiratory Insufficiency / diagnostic imaging
  • Respiratory Insufficiency / epidemiology*
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index