Risk factors for pulmonary embolism in patients with COVID-19: a systemic review and meta-analysis

Purpose: To detect the risk factors for pulmonary embolism (PE) in patients with COVID-19. Methods: Studies were searched for in PubMed, Cochrane Library, Web of Science, and EMBASE. Two authors independently screened articles and extracted data. The data were pooled by meta-analysis and three subgroup analyses were performed. Results: Of the 2210 articles identified, 27 studies were included. Pooled analysis suggested that males (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.26 -1.75, P = 0.0 0 0), obesity (OR 1.37, 95% CI 1.03 -1.82, P = 0.033), mechanical ventilation (OR 3.34, 95% CI 1.90 -5.86, P = 0.0 0 0), severe parenchymal abnormalities (OR 1.92, 95% CI 1.43 -2.58, P = 0.0 0 0), ICU admission (OR 2.44, 95% CI 1.48 -4.03, P = 0.0 0 0), and elevated D-dimer and white blood cell values (at two time points: hospital admission or closest to computed tomography pulmonary angiography) ( P = 0.0 0 0) correlated with a risk for PE occurrence in COVID-19 patients. However, age and common comorbidities had no association with PE occurrence. Computed tomography pulmonary angiography, unclear-ratio/low-ratio, and hospitalization subgroups had consistent risk factors with all studies; however, other subgroups had fewer risk factors for PE. Conclusions: Risk factors for PE in COVID-19 were different from the classic risk factors for PE and are likely to differ in diverse study populations. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)