Background:

Pulmonary embolism (PE) is a frequent disease generating important hemodynamic effects and high mortality rate, with great incidence in coronavirus disease (COVID-19).

Objective:

The aim of this study was to characterize the clinical, diagnostic, and prognostic behavior of patients with suspected PE before and during the SARS-CoV-2 pandemic.

Methods:

A prospective cohort study of adult patients with suspected PE undergoing computed tomography pulmonary angiography was carried out during two periods: a) the pre-COVID-19 phase: June 2018 to December 2019, and b) during the COVID-19 phase: June to December 2020. Bivariate analyses were conducted and ROC curves were built calculating the areas under the curve (AUC) for D-dimer PE diagnosis and clinical prediction rules.

Results:

Three-hundred and two pre-COVID-19 patients and 55 patients with COVID-19 were included in the study. D-dimer showed a moderate performance for the diagnosis of PE, with AUC 0.73 (95% CI 0.62-0.84) in pre-COVID-19 phase vs. 0.75 (95% CI 0.58-0.92) in COVID-19 phase. The AUC of each of the clinical prediction rules had moderate to low performance in the pre-COVID-19 phase (AUC 0.623 to 0.697), with a non-discriminatory AUC in the COVID-19 phase (0.355 to 0.450).

Conclusions:

Traditional risk factors were poorly prevalent in patients with COVID-19 and PE. Although D-dimer was higher in those with PE, the difference was not statistically significant. Clinical prediction rules for PE diagnosis showed low discriminative power in COVID-19 patients.