Pulmonary Embolism in Patients with COVID-19: A Systematic review and Meta-analysis

  1. Omar Hamam
  2. Ahmed Goda
  3. Radwa Awad
  4. Amr Ussama
  5. Moustafa Eldalal
  6. Ahmed Fayez
  7. Karim Elyamany
  8. Renu Bhandari
  9. Waleed Ikram
  10. Abdelrhman Elbaz
  11. Smarika Baral
  12. Yomna Elbandrawy
  13. Alexander Egbe
  14. Iraida Sharina

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

There is an increasing evidence that COVID-19 could be complicated by coagulopathy which may lead to death; especially in severe cases. Hence, this study aimed to build concrete evidence regarding the incidence and mortality of pulmonary embolism (PE) in patients with COVID-19.

Methods

We performed a systematic search for trusted databases/search engines including PubMed, Scopus, Cochrane library and Web of Science. After screening, the relevant data were extracted and the incidences and mortality rates from the different included studies were pooled for meta-analysis.

Results

Twenty studies were finally included in our study consisting of 1896 patients. The results of the meta-analysis for the all included studies showed that the incidence of PE in patients with COVID-19 was 17.6% with the 95% confidence interval (CI) of 12.7 to 22.5%. There was significant heterogeneity ( I 2 □=□91.17%). Additionally, the results of meta-analysis including 8 studies showed that the mortality in patients with both PE and COVID-19 was 43.1% with the 95% confidence interval (CI) of 19 to 67.1%. There was significant heterogeneity ( I 2 □=□86.96%).

Conclusion

PE was highly frequent in patients with COVID-19. The mortality in patients with both COVID-19 and PE was remarkable representing almost half of the patients. Appropriate prophylaxis and management are vital for better outcomes.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.10.09.20209965: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We searched PubMed, Web of Science, Scopus, and Cochrane Library for relevant articles to be included.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)
    An additional online and manual search was performed on Google Scholar and Preprint Servers to ensure adequate inclusion of all studies.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    Values of I2 >50 and P<0.1 are significant markers of heterogeneity among studies according to Cochrane’s handbook13.
    Cochrane’s
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, this study suffered from several limitations. The included studies were all observational retrospective cohort studies and case series and this type of studies has its own known limitations. Additionally, there was a wide variation among the reported items in the included studies, which leaded to limitation in pooling more of the expected common data for analysis. To recapitulate, PE was highly frequent in patients with COVID-19 and observed in 17.6% of them. The mortality in patients with both PE and COVID-19 was remarkable reaching 43.1%. Appropriate prophylaxis and management are vital for better outcomes.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.10.09.20209965v2 on medRxiv
  3. Version published to 10.1101/2020.10.09.20209965v1 on medRxiv