Critically ill patients with coronavirus disease 2019 (COVID-19) who also experienced concurrent pulmonary embolism (PE) did not have increased mortality compared with those without PE, according to study results published in the Cardiovascular Revascularization Medicine.

Outcomes were assessed in critically ill patients with COVID-19 following a retrospective search of electronic databases. The primary outcome of interest, mortality, was compared between groups of patients with COVID-19 with or without concurrent PE.

Initially, 187 records were identified via database search. Following examination of full-text articles for study eligibility, a total of 3 studies were included in the qualitative and quantitative analysis. These 3 studies represented 439 critically ill patients, 82 with PE and 357 without PE. Mean patient age was 60.67(±3.43) and 63.3(±3.43) years in each group, respectively, and patients were mostly men (77%). Baseline characteristics, including diabetes, hypertension, and renal replacement requirement, had no statistically significant association on PE status (odds ratios [OR], 0.77, 0.73, and 1.37, respectively); male sex, however, was more associated with PE (OR, 1.98).


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Overall mortality was higher among patients with PE than without (OR, 1.54; 95% CI, 0.36-6.61; P <.05), but was not statistically significant. Heterogeneity of the test was 75%.

The primary study limitations included the small patient population and relative underpowered data to assess mortality outcomes. Investigators were also unable to perform a stratified subgroup analysis based on different selection criteria, and the data were relatively heterogeneous.

 “The unavailability of randomized data calls for caution when interpreting the results of this meta-analysis,” the researchers concluded. “Future [randomized controlled trials] with larger patient populations might provide data to allow for more robust results and help to eventually reach a definitive conclusion.”

Reference

Mir T, Attique HB, Sattar Y, et al. Does pulmonary embolism in critically ill COVID-19 patients worsen the in-hospital mortality: a meta-analysis. Published online November 25, 2020. Cardiovasc Revasc Med. doi:10.1016/j.carrev.2020.11.024