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Background The clinical characteristics of noncritically ill patients with coronavirus disease 2019 (COVID-19) who develop pulmonary embolism (PE) and the prevalence of concomitant proximal deep-vein thrombosis (DVT) of the lower limbs have not been evaluated consistently.Methods We identified nonintensive care unit (non-ICU) patients admitted with COVID-19 who were diagnosed with PE at a single center in northwest Spain. Point-of-care compression ultrasonography (CUS) of the lower limbs was performed to screen for concomitant proximal DVT. Clinical data were analyzed retrospectively.Results From April 2 to April 17, 2020, 8 patients with COVID-19 and PE were identified. PE was diagnosed a median of 19 (interquartile range [IQR], 17–23) days after onset of COVID-19 symptoms and a median of 13 (IQR, 8–15) days after admission. All patients received thromboprophylaxis with enoxaparin or biosimilar at a median dose of 40 mg. All tested patients had high levels of D-dimer (≥2000 ng/mL), serum ferritin (≥300 mg/dL) and IL-6 (≥5 pg/mL) at PE diagnosis. Six (75%) and 7 (87.5%) patients had high C-reactive-protein (≥1 mg/dL) and lactate dehydrogenase (≥250 U/L) levels, respectively. All PE events were segmental or subsegmental, with lobar involvement in only one. None of these patients had concomitant proximal DVT of the lower limbs on CUS.Conclusions Non-ICU hospitalized patients with COVID-19 diagnosed with PE had mainly segmental or subsegmental events without concomitant proximal DVT of the lower limbs. Our findings suggest a predominance of small-vessel thrombosis secondary to inflammatory and immune responses in these patients.

Background: The relationship between clinical judgment and the pneumonia severity index (PSI) score in deciding the site of care for patients with community-acquired pneumonia (CAP) has not been well investigated. The objective of the study was to determine the clinical factors that influence decision-making to hospitalize low-risk patients (PSI ≤2) with CAP. Methods: An observational, prospective, multicenter study of consecutive CAP patients was performed at five hospitals in Spain. Patients admitted with CAP and a PSI ≤2 were identified. Admitting physicians completed a patient-specific survey to identify the clinical factors influencing the decision to admit a patient. The reason for admission was categorized into 1 of 6 categories. We also assessed whether the reason for admission was associated with poorer clinical outcomes [intensive care unit (ICU) admission, 30-day mortality or readmission]. Results: One hundred and fifty-five hospitalized patients were enrolled. Two or more reasons for admission were seen in 94 patients (60.6%), including abnormal clinical test results (60%), signs of clinical deterioration (43.2%), comorbid conditions (28.4%), psychosocial factors (28.4%), suspected H1N1 pneumonia (20.6%), and recent visit to the emergency department (ED) in the past 2 weeks (7.7%). Signs of clinical deterioration and abnormal clinical test results were associated with poorer clinical outcomes (P < 0.005). Conclusions: Low-risk patients with CAP and a PSI ≤2 are admitted to the hospital for multiple reasons. Abnormal clinical test results and signs of clinical deterioration are two specific reasons for admission that are associated with poorer clinical outcomes in low risk CAP patients.