Pulmonary embolism in COVID-19 patients in intensive care: Risk factors, management, and prognosis

Abstract

Background

While COVID-19 primarily affects the respiratory system, its impact extends far beyond. Increasing evidence highlights its role in triggering severe thrombotic complications, particularly pulmonary embolism. By worsening hypoxemia and further impairing respiratory function, PE can significantly deteriorate the prognosis of critically ill patients in intensive care. Understanding its incidence, risk factors, and clinical outcomes is essential to improving survival rates.

Objectives

Assess the incidence of PE in COVID-19 in intensive care, identify associated risk factors, and evaluate its impact on mortality.

Methods

A retrospective study was conducted in the ICU of CHU Ibn Rochd in Casablanca between 2020 and 2022. It included 108 patients hospitalized for severe COVID-19 confirmed by PCR, all undergoing clinical, biological, and radiological follow-up. PE was diagnosed through CT pulmonary angiography. D-dimer and other biological markers were analyzed, and statistical assessments were performed to examine correlations between thromboembolic complications and mortality.

Results

PE was diagnosed in 21 patients (19.6%), with 84% showing elevated D-dimer levels. The overall mortality rate was 60.2%, with PE directly involved in 15.7% of deaths. Multivariate analysis identified several independent mortality risk factors, including advanced age, male sex, acute respiratory distress syndrome, septic shock, and thromboembolic complications. While corticosteroid therapy helped reduce pulmonary inflammation, it was linked to worsening respiratory distress in 32.7% of patients.

Conclusion

PE is a severe complication in critical COVID-19 cases, with high mortality. Early monitoring of d-dimer levels and personalized anticoagulation are key to improving outcomes.