Comparison of Thrombotic Events and Mortality in Patients with Community-Acquired Pneumonia and COVID-19: A Multicenter Observational Study

Author(s): Roberto Cangemi, Camilla Calvieri, Marco Falcone, Francesco Cipollone, Giancarlo Ceccarelli, Pasquale Pignatelli, Damiano D’Ardes, Matteo Pirro, Francesco Alessandri, Miriam Lichtner, Gabriella D’Ettorre, Alessandra Oliva, Raissa Aronica, Monica Rocco, Mario Venditti, Giulio Francesco Romiti , Giusy Tiseo, Gloria Taliani, Francesco Menichetti, Francesco Pugliese, Claudio Maria Mastroianni, Francesco Violi
Source: Thromb Haemost 2022; 122(02): 257-266 DOI: 10.1055/a-1692-9939
Lucio Gordan MD

Dr. Gordan's Thoughts

The burden of thrombosis and related-complications for severe Covid-19 infection is impressive. Aggressive thromboprophylaxis and early detection of thrombotic and bleeding complications are of paramount importance.

ABSTRACT

BACKGROUND

It is still unclear if patients with community-acquired pneumonia (CAP) and coronavirus disease 2019 (COVID-19) have different rate, typology, and impact of thrombosis on survival.

METHODS

In this multicenter observational cohort study, 1,138 patients, hospitalized for CAP (n = 559) or COVID-19 (n = 579) from seven clinical centers in Italy, were included in the study. Consecutive adult patients (age ≥ 18 years) with confirmed COVID-19-related pneumonia, with or without mechanical ventilation, hospitalized from March 1, 2020 to April 30, 2020, were enrolled. COVID-19 was diagnosed based on the World Health Organization interim guidance. Patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events including ischemic/embolic events.

RESULTS

During the in-hospital stay, 11.4% of CAP and 15.5% of COVID-19 patients experienced thrombotic events (p = 0.046). In CAP patients all the events were arterial thromboses, while in COVID-19 patients 8.3% were venous and 7.2% arterial thromboses.

During the in-hospital follow-up, 3% of CAP patients and 17% of COVID-19 patients died (p < 0.001). The highest mortality rate was found among COVID-19 patients with thrombotic events (47.6 vs. 13.4% in thrombotic-event-free patients; p < 0.001). In CAP, 13.8% of patients experiencing thrombotic events died versus 1.8% of thrombotic event-free ones (p < 0.001). A multivariable Cox-regression analysis confirmed a higher risk of death in COVID-19 patients with thrombotic events (hazard ratio: 2.1; 95% confidence interval: 1.4–3.3; p < 0.001).

CONCLUSION

Compared with CAP, COVID-19 is characterized by a higher burden of thrombotic events, different thrombosis typology and higher risk of thrombosis-related in-hospital mortality.

Author Affiliations

Roberto Cangemi Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy Camilla Calvieri Department of Clinical Internal, I Clinica Medica, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy Marco Falcone Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy Francesco Cipollone Department of Medicine and Aging, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy Giancarlo Ceccarelli Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Pasquale Pignatelli Department of Clinical Internal, I Clinica Medica, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy 6   Mediterranea Cardiocentro, Naples, Italy Damiano D’Ardes 4   Department of Medicine and Aging, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy Matteo Pirro 7   Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy Francesco Alessandri 8   Department of General Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy Miriam Lichtner 9   Infectious Diseases Unit, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy Gabriella D’Ettorre 5   Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Alessandra Oliva 5   Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Raissa Aronica 5   Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Monica Rocco 10   Department of Clinical and Surgical Translational Medicine, Sant’ Andrea Hospital, Sapienza University of Rome, Rome, Italy Mario Venditti 5   Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Giulio Francesco Romiti  1   Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy Giusy Tiseo 3   Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy Gloria Taliani 1   Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy Francesco Menichetti 3   Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy Francesco Pugliese 8   Department of General Surgery Paride Stefanini, Sapienza University of Rome, Rome, Italy Claudio Maria Mastroianni 5   Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Francesco Violi 2   Department of Clinical Internal, I Clinica Medica, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy 6   Mediterranea Cardiocentro, Naples, Italy

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