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
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
