Pulmonary embolism in critically ill ICU patients with COVID-19: Retrospective study in the intensive care unit at Hassan II University Hospital in Fez, Morocco

Introduction:  Pulmonary embolism (PE) is the most frequent thromboembolic complication in COVID-19 patients in intensive care. It results from a hypercoagulable state linked to SARS-CoV-2, involving endothelial damage, systemic inflammation, and venous stasis. This study describes the clinical, radiological, and evolutionary characteristics of confirmed PE cases in a series of COVID-19 patients admitted to intensive care at Hassan II University Hospital in Fez.
Methods: This was a retrospective, descriptive, single-center study conducted in intensive care unit A1 between July 2020 and February 2021. Patients aged 16 years or older, hospitalized for respiratory distress due to confirmed SARS-CoV-2 infection, and presenting with pulmonary embolism (PE) confirmed by chest CT angiography, were included. Epidemiological, clinical, biological, therapeutic, and outcome data were analyzed.
Results: Among 480 admitted patients, 6 (1.25%) developed a confirmed pulmonary embolism (PE). The mean age was 68.8 years, with a male predominance (83.3%). The main comorbidities were diabetes and hypertension. The mean SpO₂ on admission was 80.3%. PEs were distributed as massive bilateral proximal (33%), lobar (33%), and segmental or subsegmental (33%). All patients received therapeutic anticoagulation without the need for thrombolysis. The mean length of stay was 5.6 days. Mechanical ventilation was required in one patient. The overall mortality rate was 33.3%.
Conclusion: Pulmonary embolism (PE) complicates a significant proportion of severe COVID-19 cases, with a high mortality rate. The frequency of severe forms underscores the importance of early preventive anticoagulation and systematic screening in intensive care units.