Background: After the first COVID-19 infection wave, a constant increase of pulmonary
embolism (PE) hospitalizations not linked with active PCR-confirmed COVID-19 was
observed, but potential contributors to this observation are unclear. Therefore, we
analyzed associations between changes in PE hospitalizations and (1) the incidence of
non-COVID-19 pneumonia, (2) the use of computed tomography pulmonary angiography
(CTPA), (3) volume depletion, and (4) preceding COVID-19 infection numbers in Germany.
Methods: Claims data of Helios hospitals in Germany were used, and consecutive cases
with a hospital admission between May 6 and December 15, 2020 (PE surplus period),
were analyzed and compared to corresponding periods covering the same weeks in
2016–2019 (control period). We analyzed the number of PE cases in the target period
with multivariable Poisson general linear mixed models (GLMM) including (a) cohorts of
2020 versus 2016–2019, (b) the number of cases with pneumonia, (c) CTPA, and (d)
volume depletion and adjusted for age and sex. In order to associate the daily number of
PE cases in 2020 with the number of preceding SARS-CoV-2 infections in Germany, we
calculated the average number of daily infections (divided by 10,000) occurring between
14 up to 90 days with increasing window sizes before PE cases and modeled the data
with Poisson regression.
Results: There were 2,404 PE hospitalizations between May 6 and December 15,
2020, as opposed to 2,112–2,236 (total 8,717) in the corresponding 2016–2019 control
periods (crude rate ratio [CRR] 1.10, 95% CI 1.05–1.15, P < 0.01). With the use of
multivariable Poisson GLMM adjusted for age, sex, and volume depletion, PE cases
were significantly associated with the number of cases with pneumonia (CRR 1.09, 95%
CI 1.07–1.10, P < 0.01) and with CTPA (CRR 1.10, 95% CI 1.09–1.10, P < 0.01). The
increase of PE cases in 2020 compared with the control period remained significant
(CRR 1.07, 95% CI 1.02–1.12, P < 0.01) when controlling for those factors. In the
2020 cohort, the number of preceding average daily COVID-19 infections was associated
with increased PE case incidence in all investigated windows, i.e., including preceding
infections from 14 to 90 days. The best model (log likelihood −576) was with a window
size of 4 days, i.e., average COVID-19 infections 14–17 days before PE hospitalization
had a risk of 1.20 (95% CI 1.12–1.29, P < 0.01).
Conclusions: There is an increase in PE cases since early May 2020 compared
to corresponding periods in 2016–2019. This surplus was significant even when
controlling for changes in potential modulators such as demographics, volume depletion,
non-COVID-19 pneumonia, CTPA use, and preceding COVID-19 infections. Future
studies are needed (1) to investigate a potential causal link for increased risk of
delayed PE with preceding SARS-CoV-2 infection and (2) to define optimal screening
for SARS-CoV-2 in patients presenting with pneumonia and PE.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:84278 |
| Date | 24 March 2023 |
| Creators | Husser, Daniela, Hohenstein, Sven, Pellissier, Vincent, Ueberham, Laura, König, Sebastian, Hindricks, Gerhard, Meier-Hellmann, Andreas, Kuhlen, Ralf, Bollmann, Andreas |
| Publisher | Frontiers Research Foundation |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English, German |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 2297-055X, 715761 |
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