Pulmonary Embolism Significantly Increases Death Risk From COVID-19

human lung tissue with pulmonary embolism
How does concomitant COVID-19 and PE affect patient mortality rates, and what patient characteristics influence outcomes? A large German study explored these questions.

The combination of COVID-19 and pulmonary embolism (PE) may be life-threatening; the fatality rate among patients with PE and COVID-19 was significantly greater than the fatality rate in patients with only 1 of these conditions. These were among the study findings published recently in the European Respiratory Journal.

PE is known to be a frequent and relevant complication of COVID-19 infection. To better understand the relationship between these 2 conditions, researchers analyzed patients with COVID-19 and PE in Germany to identify patient characteristics, outcomes, and changes in PE prevalence and case-fatality over time.

The retrospective study used the German nationwide inpatient sample, which included 176,137 COVID-19 hospitalizations in 2020. The sample comprised patients at least 70 years of age, with 52.3% men. The researchers performed multiple analyses of these data as well as data on patients with pulmonary embolism, both from 2019 (98,485 patients) and 2020 (97,718 patients).

The researchers found that in 2020, 1.9% (3362) of patients with COVID-19 had PE and that 28.7% of these patients died, whereas the mortality rate for those with COVID-19 only was 17.7%.  

To explore the effect of the pandemic on PE rates, the investigators compared data on PE from 2019 vs 2020. The researchers found that PE-related hospitalizations were virtually equivalent and that case-fatality rate of patients with PE increased slightly between 2019 and 2020 (from 12.7% to 13.1%; P <.001). The researchers further noted that the increase in case fatality rates between the 2019 and 2020 was greatest for November and December (11.7% and 13.4%, respectively, in 2019 vs 13.9% and 15.5%, respectively, in 2020), suggesting that the increase in PE fatality may be related to “the second wave of COVID-19” in late 2020.

In analyzing the overall effect of COVID-19 on in-hospital death rates among patients with PE in 2020 alone, the researchers found a significant difference in case fatality between PE patients with COVID-19 (28.7%) and PE patients without COVID-19 (12.5%; P <.001), corresponding to a 3.1-fold increased risk of PE-related mortality (odds ratio 3.16; 95% CI, 2.91- 3.42; P <.001) among patients with PE and COVID-19.

With respect to patient characteristics, researchers found that: (1) male sex, obesity, and cancer were independently associated with a greater risk for PE in patients with COVID-19 infection; (2) patients with both COVID-19 and PE were more likely to have acute respiratory distress syndrome and had a higher rate of ICU admission, mechanical ventilation, dialysis, and extracorporeal membrane oxygenation than patients with COVID-19 without PE; (3) patients with PE who also had COVID-19 infection had a higher incidence of right-ventricular dysfunction, shock, cardiopulmonary resuscitation and case-fatality than those with PE without COVID-19 (28.7% vs. 13.1%, respectively).

Study limitations include the retrospective design, the potential for misclassification or inconsistencies in the data set, the inability to form a hypothesis based on the findings, and the possible exclusion of relevant patients from the data set.

Researchers concluded that although the prevalence of PE-related hospitalizations was similar between 2019 and 2020, “the fatality rate among patients with both COVID-19 and PE was substantially higher than that in those with only one of these diseases, suggesting a life-threatening additive prognostic impact of the COVID-PE combination.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Hobohm L, Sagoschen I, Barco S, et al. COVID-19 infection and its impact on case-fatality in patients with pulmonary embolism. Eur Respir J. Published online August 18, 2022. doi:10.1183/13993003.00619-2022