Long-term in-hospital mortality and chronic thromboembolic pulmonary hypertension after COVID-19-associated pulmonary embolism in France: a nationwide study.

Abstract

Background: Although long-term effects of coronavirus disease-2019 (COVID-19) such as dyspnoea are frequent, the mechanisms are often poorly understood. The endothelial effects of COVID-19, such as venous or arterial thrombosis, are also well documented. Thus, the incidence of chronic thromboembolic pulmonary hypertension (CTEPH) following COVID-19 is an issue with many implications, particularly for screening in patients with long COVID.

Methods: From the French National Hospital Discharge database (March 2020 to December 2021), we included all adults hospitalised for pulmonary embolism (PE). To study the hospital incidence of CTEPH, we excluded patients with previous pulmonary hypertension diagnoses. Then, in the 2 years following the admission for PE, we compared the hospital incidence of CTEPH between PE patients with COVID-19 (COVID-PE) and without (non-COVID-PE). We also studied in-hospital mortality.

Results: Among the 136 505 patients included, 1.68% were diagnosed with CTEPH in the following 2 years with a significant difference between COVID-PE and non-COVID-PE (0.77% versus 1.82%; p<0.0001). The 2-year in-hospital mortality was significantly lower in COVID-PE than in non-COVID-PE (4.82% versus 13.34%; p<0.0001). These results were confirmed by multivariate analyses. Among COVID-PE, we found no difference in the hospital incidence of CTEPH between 2020 and 2021, while after the initial discharge, in-hospital mortality was significantly higher in 2020 compared with 2021.

Conclusion: When investigating chronic dyspnoea in patients hospitalised for COVID-19 associated with PE, the risk of CTEPH should not be considered higher than for other PE. COVID-19 associated with hospitalised PE should not be considered an additional harmful factor if not associated with initial in-hospital mortality.