One-third of COVID-19 patients in ICU study had acute PE

Nearly one-third of patients in intensive care with COVID-19 were diagnosed with acute pulmonary embolism, according to a small cohort study published on the non-peer-reviewed preprint server MedRxiv.

Welcome back to The Medical Republic‘s live COVID-19 blog.

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The latest

• Study finds one-third of patients in ICU with COVID-19 have acute pulmonary embolism.
• Frailty may not be such a liability in COVID-19, and may even be an asset.
• AMA slams the NRL’s plan for live crowds by July.

4.20pm, 26 May

• Nearly one-third of patients in intensive care with COVID-19 were diagnosed with acute pulmonary embolism, according to a small cohort study published on the non-peer-reviewed preprint server MedRxiv.
  A study of 23 patients admitted to intensive care over a four-week period found seven (30%) were diagnosed with acute clinically significant pulmonary embolism and one died from massive PE. In comparison, the incidence of symptomatic PE in a general medical ICU is 0.7%-6%.
  The authors found no significant early differences between patients who developed PE and those who didn’t.
  “Although D-dimer tended to rise during the hospitalisation relative to the control group, the results were inconsistent, and there were no other meaningful distinguishing features between the groups at the time of admission,” they wrote.

11.40am, 26 May

• Frailty does not appear to be associated with an increased risk of death in patients with COVID-19, and indeed the opposite may even be true, new research suggests.
  In a paper published on the non-peer-reviewed preprint server MedRxiv, researchers reported the outcome of a prospective cohort study involving 217 COVID-19 cases – with a mean age of 80 years – and 160 non-COVID-19 controls admitted to an urban hospital in the UK.
  Researchers used the Clinical Frailty Scale score to assess patients’ clinical state in the two weeks before admission to hospital and found that after adjusting for demographic variables such as ethnicity and deprivation, there was no significant association between frailty and all-cause mortality in COVID-19 patients.
  However the authors did see greater excess mortality from COVID-19 in fitter patients than in more frail patients.
  While stressing that theirs was just a single-centre study, the authors proposed that their reduced ability to mount such a drastic immune response might actually aid frail COVID-19 patients.
  “If baseline frailty and associated immune senescence influences the subsequent inflammatory response, this hints that different therapeutic strategies might be needed across the spectrum of frailty,” they wrote.

11.05am, 26 May

• The AMA has condemned the National Rugby League’s plan to have live crowds at suburban matches by July, describing it as an “absurd and dangerous” idea.
  NRL Commissioner Wayne Pearce said in a recent interview that the NRL would love to see some sort of crowds back in stadiums by July 1, but there wasn’t yet detail on how that might look.
  “You can’t have a packed stadium but you can certainly get some people in there and social distance them,” he said.
  However the AMA said this posed a huge risk to public health, and would put the game’s fans at risk.
  “Now is not the time for sporting codes to be considering having crowds at games,” said AMA President Dr Tony Bartone in a statement. “They must wait until the medical experts advise that it is absolutely safe to do so – and that will not be as early as July.”
  He pointed out that the AFL and other sporting codes were all waiting for expert medical advice before resuming games in front of live crowds, and that these decisions should be made by medical experts in consultation with the National Cabinet, “not by rugby league administrators”.

9am, 26 May

• Here are today’s confirmed COVID-19 infection figures from Australia, to 9pm yesterday. While the official figure for new infections in the 24 hours to that point is nine new infections, Queensland actually revised its overall total down by three, so in fact there were 12 new infections recorded in Australia at the end of yesterday: three in NSW, seven in WA and two in Victoria. Four of the new infections in WA are from one family recently returned from overseas, who are in quarantine.
  National – 7118, with 102 deaths and 6532 recovered
  ACT – 107
  NSW – 3090
  NT – 29
  QLD – 1056
  SA – 439
  TAS – 228
  VIC – 1605
  WA – 564

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