Acute phase characteristics and long-term complications of pulmonary embolism in COVID-19 compared to non-COVID-19 cohort: a large single-centre study.

BACKGROUND: To compare the severity of pulmonary embolism (PE) and the long-term complications between patients with and without COVID-19, and to investigate whether the tools for risk stratification of death are valid in this population. METHODS: We retrospectively included hospitalized patients with PE from 1 January 2016 to 31 December 2022. Comparisons for acute episode characteristics, risk stratification of the PE, outcomes, and long-term complications were made between COVID and non-COVID patients. RESULTS: We analyzed 116 (27.5%) COVID patients and 305 (72.4%) non-COVID patients. In patients with COVID-19, the traditional risk factors for PE were absent, and the incidence of deep vein thrombosis was lower. COVID patients showed significantly higher lymphocyte count, lactate dehydrogenase, lactic acid, and D-dimer levels. COVID patients had PE of smaller size (12.3% vs. 25.5% main pulmonary artery, 29.8% vs. 37.1% lobar, 44.7% vs. 29.5% segmental and 13.2% vs. 7.9% subsegmental, respectively; p < 0.001), less right ventricular dysfunction (7.7% vs. 17.7%; p = 0.007) and higher sPESI score (1.66 vs. 1.11; p < 0.001). The need for mechanical ventilation was significantly higher in COVID patients (8.6% vs. 1.3%; p < 0.001); However, the in-hospital death was less (5.2% vs. 10.8%; p = 0.074). The incidence of long-term complications was lower in COVID cohort (p < 0.001). PE severity assessed by high sPESI and intermediate and high-risk categories were independently associated with in-hospital mortality in COVID patients. CONCLUSION: The risk of in-hospital mortality and the incidence of long-term complications were lower in COVID-19. The usual tools for risk stratification of PE are valid in COVID patients.

Comparative profiles of routine and specialized biomarkers of coagulopathy and endotheliopathy in moderate and severe COVID-19 disease: A prospective observational study

Background: Endothelial injury and coagulation activation are prominent axis in coronavirus disease 19 (COVID-19) pathogenesis. However, only few studies have compared profiles of biomarkers of coagulopathy and endotheliopathy with regard to the initial severity of COVID-19 and the time course of the disease. Aim(s): The main objective of our study is to point profiles of biomarkers of coagulopathy and endotheliopathy associated with initial severity of COVID-19 and the time course of the disease. Method(s): In a prospective longitudinal study, we explored coagulation and endothelial function biomarkers at admission, at day 3 and at day 7 in two cohorts of severe and moderate COVID-19 patients and according to outcome. Result(s): We found that D-dimers, free tissue factor pathway inhibition (TFPI) and extracellular vesicles -tissue factor (EV-TF) at admission were associated with disease severity. Concerning outcome, TFPI, EV-TF and von Willebrand factor antigen (VWF)/ADAMTS13 ratio at admission, at day 3 and at day 7 were associated with not favorable outcome defined as the onset of death or need of invasive mechanical ventilation. TFPI with a cut-off value of 37.5 ng/ml had 87% sensitivity and 94% and specificity and EV-TF with a cut-off value of 13 fM had 87% sensitivity and 83% specificity. ROC curves analysis for severe outcome was significant with AUC = 0.90 for TFPI and AUC = 0.88 for EV-TF (p < 0.001 for both). Conclusion(s): We found a specific profile of specialized biomarkers of coagulopathy and endotheliopathy associated with severe form of COVID-19 and not favorable outcome. We identified free TFPI and EV-TF of potential interest to stratify patient's risk or to design specific treatment targeting coagulation pathways. Additional studies are warranted to confirm our results and study the interaction between these biomarkers' values and anticoagulation treatment. (Table Presented).