Predictors of Impaired Treatment Outcome in COVID-19 Patients with Acute Pulmonary Embolism - Single Center Observational Study From Serbia

Background: COVID-19 disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is characterized by hypercoagulable state that results in an increased risk for embolic and thrombotic vascular complications. Incidence of pulmonary embolism (PE) in COVID-19 varies between 20-30%. Purpose: To determine predictors for treatment outcome in patients with COVID-19 and its associations with clinical and laboratory parameters. Materials and methods: A retrospective observational single-center study was conducted between 1 ^st of September 2021 and 24 ^th of December 2021 involving 2111 patients admitted to the COVID Hospital "Batajnica", University Clinical Center of Serbia, Belgrade. Among them, 100 patients (4.74%) got diagnosis of pulmonary embolism by computed tomography pulmonary angiography (CTPA). Patients were divided in two groups. Study group (100 patients) with COVID-19 and PE and control group (100 patients) with COVID-19 but without PE. Results: According to multivariate regression analysis, predictors of impaired outcome in COVID-19 patients are age (p<0.001, OR 1.134, 95% HR 1.062-1.211), C reactive protein level (CRP) (p=0.043, OR 1.006, 95% 1.000-1.013), invasive mechanical ventilation (p<0.001, OR 58.72, 95%HR 13.784-254.189), pulmonary embolism (p=0.025, OR 3.718, 95% HR 1.183-11.681), and hospitalization in intensive care unit (p=0.012, OR 9.673, 95% 1.660-56.363). Conclusion: We report increased mortality and mechanical ventilation rates in COVID-19 patients with acute PE. Older age, elevated level of CRP, hospitalization in ICU, and PE present independent predictors for impaired outcome in COVID-19 patients.