Husser, Daniela
[Author];
Hohenstein, Sven
[Author];
Pellissier, Vincent
[Author];
Ueberham, Laura
[Author];
König, Sebastian
[Author];
Hindricks, Gerhard
[Author];
Meier-Hellmann, Andreas
[Author];
Kuhlen, Ralf
[Author];
Bollmann, Andreas
[Author]
Potential Contributors to Increased Pulmonary Embolism Hospitalizations During the COVID-19 Pandemic: Insights From the German-Wide Helios Hospital Network
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Media type:
E-Article
Title:
Potential Contributors to Increased Pulmonary Embolism Hospitalizations During the COVID-19 Pandemic: Insights From the German-Wide Helios Hospital Network
Contributor:
Husser, Daniela
[Author];
Hohenstein, Sven
[Author];
Pellissier, Vincent
[Author];
Ueberham, Laura
[Author];
König, Sebastian
[Author];
Hindricks, Gerhard
[Author];
Meier-Hellmann, Andreas
[Author];
Kuhlen, Ralf
[Author];
Bollmann, Andreas
[Author]
imprint:
Lausanne: Frontiers Research Foundation, [2023]
Published in:Frontiers in Cardiovascular Medicine ; 8, (2021)
Description:
Background: After the first COVID-19 infection wave, a constant increase of pulmonaryembolism (PE) hospitalizations not linked with active PCR-confirmed COVID-19 wasobserved, but potential contributors to this observation are unclear. Therefore, weanalyzed associations between changes in PE hospitalizations and (1) the incidence ofnon-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 caseswith a hospital admission between May 6 and December 15, 2020 (PE surplus period),were analyzed and compared to corresponding periods covering the same weeks in2016–2019 (control period). We analyzed the number of PE cases in the target periodwith multivariable Poisson general linear mixed models (GLMM) including (a) cohorts of2020 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 ofPE cases in 2020 with the number of preceding SARS-CoV-2 infections in Germany, wecalculated the average number of daily infections (divided by 10,000) occurring between14 up to 90 days with increasing window sizes before PE cases and modeled the datawith 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 controlperiods (crude rate ratio [CRR] 1.10, 95% CI 1.05–1.15, P < 0.01). With the use ofmultivariable Poisson GLMM adjusted for age, sex, and volume depletion, PE caseswere 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). Theincrease 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 the2020 cohort, the number of preceding average daily COVID-19 infections was associatedwith increased PE case incidence in all investigated windows, i.e., including precedinginfections from 14 to 90 days. The best model (log likelihood −576) was with a windowsize of 4 days, i.e., average COVID-19 infections 14–17 days before PE hospitalizationhad 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 comparedto corresponding periods in 2016–2019. This surplus was significant even whencontrolling for changes in potential modulators such as demographics, volume depletion,non-COVID-19 pneumonia, CTPA use, and preceding COVID-19 infections. Futurestudies are needed (1) to investigate a potential causal link for increased risk ofdelayed PE with preceding SARS-CoV-2 infection and (2) to define optimal screeningfor SARS-CoV-2 in patients presenting with pneumonia and PE.