Intermediate-high and high risk acute pulmonary embolism during home confinement due to coronavirus-19 pandemic: description in a second level hospital
Authors: Sanz Ortega I , Chasco Eguilaz L , Ballaz Quincoces A , Jodar Samper A , Rodriguez Sanchez I , Velasco Del Castillo S , Salcedo Arruti A , Espana Yandiola PP 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
To stop Coronavirus-19 pandemic, Spanish government ordained home confinement in Basque Country from 13th March to 11th May, although some people had previously confined themselves. In this period, a decrease in cardiovascular admissions, except pulmonary embolism has been reported, speculating about viral activation of coagulation. As patients could not receive the standard care, augmented mortality of non-Covid pathologies could happen.

Methods
We, selected patients admitted with intermediate-high and high risk from 1st March to 30th June. Other risks or those occurred during a hospitalization were excluded. Several characteristics were reported.

Results
Among 21 cases (13 women), there were 3 Covid-positive (2 women). All presented an intermediate-high risk, except 2. 16 cases happened in March and April. Mean age was 72,5 years (range 30-94). Mean total stay length was 7,24 days (range 3-12). 14 patients presented original Pulmonary Embolism Severity Index (PESI) class ≥ III and mean simplified PESI (sPESI) was 1.43 points (range 0-4). On average, patients presented 1,95 risk factors for pulmonary embolism (range 0-6), mainly weak ones. Average Troponin T was 130.15 ng/L (range 15-1099, one case unknown). Average NT-proBNP was 6690.42 pg/ml (range 267-35000, 2 cases unknown). Fibrinolytic therapy and vasopressors were only used in intensive care unit (ICU), in 2 and 1 patients respectively. 2 patients were on Unfractionated Heparin, the rest received low-molecular-weight heparin. All patients admitted in ICU were transferred later to ward, except 1 that was transfer to Intermediate respiratory care unit (IRCU). There were no mortality during hospitalization. There were 3 complications that not required intensive therapy. 8 were admitted in ICU (50% women, mean age 61,2 years (range 30-78), average sPESI 1,4 (range 0-4), 6 patients PESI class ≥ III, average troponin 109,25 ng/L (19-259) and NT-proBNP 7219.86 pg/ml (446-15787), 1,88 risk factors on average, stay length 8,25 days (6-11)). The rest were admitted in ward (4 in IRCU) (62% women, mean age 79.46 years (66-94), average sPESI 1,46 (0-4), 8 patients PESI class ≥ III, average troponin 144,08 ng/L (15-1099) and NT-proBNP 6351.58 pg/ml (439-35000), 2 risk factors on average, stay length 6,62 days (3-12)).

Conclusions
Probably coronavirus-19 is not a risk factor for admission due to severe pulmonary embolism. Home confinement may be a risk factor, and if it happened again, advice against sedentary lifestyle should be given to population. Despite a possible delay in diagnosis or treatment, there were no mortality or severe complications, irrespectively of age or site of admission, although patients in intensive care tend to be younger, presented more frequently PESI class &gt; III and stay more time in hospital. Studies are needed to determine which patients would benefit from admission in intensive care units, especially if resources are limited again. Abstract Figure. Number of cases per month