Raj, KavinMajeed, HarrisChandna, SanyaChitkara, AkshitSheikh, Abu BakerKumar, AshishGangu, KarthikPillai, Keerthana JyotheeswaraAgrawal, AnkitSadashiv, Santhosh K.Kalra, Ankur2024-11-132024-11-132024Raj K, Majeed H, Chandna S, et al. Increased risk of pulmonary embolism and deep vein thrombosis with COVID-19 pneumonia in comparison to influenza pneumonia: insights from the National Inpatient Sample database. J Thorac Dis. 2024;16(9):6161-6170. doi:10.21037/jtd-23-1674https://hdl.handle.net/1805/44539Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily a respiratory virus causing coronavirus disease 2019 (COVID-19) pneumonia, induces a hypercoagulable state. Previous studies comparing the prevalence of venous thromboembolism (VTE) in patients with COVID-19 pneumonia and those with influenza pneumonia revealed a higher risk of pulmonary embolism (PE) and deep vein thrombosis (DVT) associated with COVID-19 pneumonia. However, these studies have not adequately accounted for the severity and acuity of the presenting viral pneumonia. Methods: In this retrospective study, we rigorously adjusted for critical illness using a nationally representative dataset to investigate whether COVID-19 pneumonia is independently linked to a higher risk of PE and DVT. Results: After comprehensive multivariate adjustment, our findings demonstrated that patients with COVID-19 pneumonia maintained significantly higher odds of developing acute inpatient PE [adjusted odds ratio (aOR): 2.48; 95% confidence interval (CI): 2.16-2.86; P<0.01] and DVT (aOR: 1.66; 95% CI: 1.41-1.96; P<0.01) during the early pandemic compared to patients with influenza pneumonia. Furthermore, we identified congenital heart disease and malnutrition as novel risk factors for acute PE in COVID-19 patients. Conclusions: Our study suggests that the higher prevalence of acute inpatient PE over DVT in patients with COVID-19 pneumonia may support a "thrombus in situ" mechanism of SARS-CoV-2-mediated pulmonary thrombosis. Consequently, clinicians should maintain a high index of suspicion for PE, even in the absence of DVT, among patients with COVID-19 pneumonia and should follow evidence-based guidelines for diagnosis and management.en-USAttribution-NonCommercial-NoDerivatives 4.0 InternationalCoronavirus disease 2019 (COVID-19)InfluenzaVenous thromboembolism (VTE)Deep vein thrombosis (DVT)Pulmonary embolism (PE)Article