Does Pulmonary Embolism in Critically Ill COVID-19 Patients Worsen the In-Hospital Mortality: A Meta-Analysis

Mir, Tanveer; Attique, Hassan Bin; Sattar, Yasar; Regmi, Neelambuj; Khan, Muhammad Zubair; Youns, Haris; Qayoom, Basharat; Jerger, Michael; Alraies, M. Chadi

doi:10.1016/j.carrev.2020.11.024

Cited by 9 publications

(9 citation statements)

References 13 publications

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“…In our cohort, PE was more frequent in severe/critical and deceased patients, but PE diagnosis did not predict mortality in both Cox classical survival and multi-state models. Other observational studies in severe and critical patients reported similar results [ 13 , 30 ]. This can be reasonable if we consider most of PE in COVID-19 patients without overt DVT as a marker of disease severity rather than a severe VTE complication [ 31 ].…”

Section: Discussionsupporting

confidence: 72%

“…Therefore, despite the improvement in our knowledge about the antithrombotic strategy for preventing VTE and mortality in COVID-19 patients, some questions remain unanswered. For example, it is uncertain the effective preventive dose of heparin for hospitalized patients according to disease severity [ 10 ], the role of a PE diagnosis on mortality [ 11 – 13 ], or the usefulness of d-dimer levels to guide timing and dosing of heparin treatment [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of heparin treatment on pulmonary embolism and in-hospital death in unvaccinated COVID-19 patients without overt deep vein thrombosis

Bais¹,

Sozio

Silvestri³

et al. 2022

Thrombosis J

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Background Pulmonary embolism (PE) without overt deep vein thrombosis (DVT) was common in hospitalized coronavirus-induced disease (COVID)-19 patients and represented a diagnostic, prognostic, and therapeutic challenge. The aim of this study was to analyze the prognostic role of PE on mortality and the preventive effect of heparin on PE and mortality in unvaccinated COVID-19 patients without overt DVT. Methods Data from 401 unvaccinated patients (age 68 ± 13 years, 33% females) consecutively admitted to the intensive care unit or the medical ward were included in a retrospective longitudinal study. PE was documented by computed tomography scan and DVT by compressive venous ultrasound. The effect of PE diagnosis and any heparin use on in-hospital death (primary outcome) was analyzed by a classical survival model. The preventive effect of heparin on either PE diagnosis or in-hospital death (secondary outcome) was analyzed by a multi-state model after having reclassified patients who started heparin after PE diagnosis as not treated. Results Median follow-up time was 8 days (range 1–40 days). PE cumulative incidence and in-hospital mortality were 27% and 20%, respectively. PE was predicted by increased D-dimer levels and COVID-19 severity. Independent predictors of in-hospital death were age (hazards ratio (HR) 1.05, 95% confidence interval (CI) 1.03–1.08, p < 0.001), body mass index (HR 0.93, 95% CI 0.89–0.98, p = 0.004), COVID-19 severity (severe versus mild/moderate HR 3.67, 95% CI 1.30–10.4, p = 0.014, critical versus mild/moderate HR 12.1, 95% CI 4.57–32.2, p < 0.001), active neoplasia (HR 2.58, 95% CI 1.48–4.50, p < 0.001), chronic obstructive pulmonary disease (HR 2.47; 95% CI 1.15–5.27, p = 0.020), respiratory rate (HR 1.06, 95% CI 1.02–1.11, p = 0.008), heart rate (HR 1.03, 95% CI 1.01–1.04, p < 0.001), and any heparin treatment (HR 0.35, 95% CI 0.18–0.67, p = 0.001). In the multi-state model, preventive heparin at prophylactic or intermediate/therapeutic dose, compared with no treatment, reduced PE risk and in-hospital death, but it did not influence mortality of patients with a PE diagnosis. Conclusions PE was common during the first waves pandemic in unvaccinated patients, but it was not a negative prognostic factor for in-hospital death. Heparin treatment at any dose prevented mortality independently of PE diagnosis, D-dimer levels, and disease severity.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Effect of heparin treatment on pulmonary embolism and in-hospital death in unvaccinated COVID-19 patients without overt deep vein thrombosis

Bais¹,

Sozio

Silvestri³

et al. 2022

Thrombosis J

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“…The publication bias was illustrated graphically with Harbord’s weighted linear regression [ 18 ]. "The vertical axis of the plot used standard error to estimate the sample size of the study, plotting large population studies on top and smaller at the bottom" [ 5 ]. "The horizontal spread reflected the power and effect size of the included studies" [ 5 ].…”

Section: Resultsmentioning

confidence: 99%

“…"The vertical axis of the plot used standard error to estimate the sample size of the study, plotting large population studies on top and smaller at the bottom" [ 5 ]. "The horizontal spread reflected the power and effect size of the included studies" [ 5 ]. Harbord’s weighted linear regression indicated the absence of publication bias among the 10 studies [t=-0.08, p=0.48 (95% CI: -0.80-0.41)] (Figure 6 ).…”

Section: Resultsmentioning

confidence: 99%

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The Use of Vancomycin Versus Teicoplanin in Treating Febrile Neutropenia: A Meta-Analysis and Systematic Review

Kaur

Mir

Dixit

et al. 2021

Cureus

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Background and objective The efficacy of vancomycin vs. teicoplanin for the successful treatment of febrile neutropenia (FN) has been a subject of debate in the medical community. In light of this, we performed a systematic review and meta-analysis to compare these two medications in the treatment of patients with FN in terms of treatment success and adverse events. Data source and study design We conducted a search of major electronic databases [MEDLINE (PubMed, Ovid), Google Scholar, clinicaltrial.org ], which returned 10 studies with 1,630 patients (vancomycin: 788; teicoplanin: 842) for analysis. An unadjusted odds ratio (OR) with a 95% confidence interval (CI) was calculated for all studies, as well as separate sub-analyses of randomized controlled trials (RCTs) and retrospective studies. Results The average age of patients ranged from 37 to 57 years in the vancomycin group and 31 to 57 years in the teicoplanin group (n=9 studies). Over half of the patients in both groups were male (vancomycin: 55.6%; teicoplanin: 57.7%; n=9 studies). Both overall evaluation and sub-analyses revealed that both treatments were comparable in terms of treatment success, nephrotoxicity, and red man syndrome. The vancomycin group was more likely to develop skin rashes (OR: 2.49; 95% CI: 1.28-4.83). The heterogeneity for all analyses ranged from 0-47.4%. Conclusion Our analysis showed that vancomycin and teicoplanin showed comparable results in terms of successful treatment of FN. Adverse effects such as nephrotoxicity and red man syndrome were also comparable between the two treatment groups.

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Pulmonary embolism impacts clinical outcomes of intubated patients with acute respiratory distress syndrome related to COVID-19

Primmaz,

Rochat Negro,

Suh

et al. 2024

Anaesthesia Critical Care & Pain Medicine

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Does Pulmonary Embolism in Critically Ill COVID-19 Patients Worsen the In-Hospital Mortality: A Meta-Analysis

Cited by 9 publications

References 13 publications

Effect of heparin treatment on pulmonary embolism and in-hospital death in unvaccinated COVID-19 patients without overt deep vein thrombosis

Effect of heparin treatment on pulmonary embolism and in-hospital death in unvaccinated COVID-19 patients without overt deep vein thrombosis

The Use of Vancomycin Versus Teicoplanin in Treating Febrile Neutropenia: A Meta-Analysis and Systematic Review

Pulmonary embolism impacts clinical outcomes of intubated patients with acute respiratory distress syndrome related to COVID-19

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