Venous thromboembolism (VTE) in patients with COVID-19 in intensive care units (ICU) is frequent, but risk factors (RF) remain unidentified. In this meta-analysis (CRD42020188764) we searched for observational studies from ICUs reporting the association between VTE and RF in Medline/Embase up to 15 April 2021. Reviewers independently extracted data in duplicate and assessed the certainty of the evidence using the GRADE approach. Analyses were conducted using the random-effects model and produced a non-adjusted odds ratio (OR). We analysed 83 RF from 21 studies (5296 patients). We found moderate-certainty evidence for an association between VTE and the D-dimer peak (OR 5.83, 95%CI 3.18–10.70), and length of hospitalization (OR 7.09, 95%CI 3.41–14.73) and intubation (OR 2.61, 95%CI 1.94–3.51). We identified low-certainty evidence for an association between VTE and CRP (OR 1.83, 95% CI 1.32–2.53), D-dimer (OR 4.58, 95% CI 2.52–8.50), troponin T (OR 8.64, 95% CI 3.25–22.97), and the requirement for inotropic drugs (OR 1.67, 95% CI 1.15–2.43). Traditional VTE RF (i.e., history of cancer, previous VTE events, obesity) were not found to be associated to VTE in COVID-19. Anticoagulation was not associated with a decreased VTE risk. VTE RF in severe COVID-19 correspond to individual illness severity, and inflammatory and coagulation parameters.

Diagnosing pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease (COPD) exacerbation is challenging due to similarities in clinical symptoms. The aim of this study was to evaluate predictors of PE and to derive and validate a COPD-specific PE diagnostic strategy. A post-hoc analysis of the PEP trial, a prospective multicenter study of patients with COPD hospitalized with acutely worsening respiratory symptoms, was conducted. The outcome predicted was PE at admission. Univariable and multivariable analyses were conducted to evaluate predictors of PE. Receiver operating characteristic curves were computed to determine the most discriminant D-dimer cut-offs. The COPD-specific PE diagnostic strategy was externally validated in the independent SLICE trial cohort. A total of 734 patients were included. At admission, the prevalence of PE and/or proximal deep venous thrombosis (DVT) was 6.5% (95%CI 5.0–8.6%). A COPD-specific PE diagnostic strategy consisting of a 3-item score (type of COPD exacerbation, alternative diagnosis less likely than PE, and clinical signs of DVT) combined with D-dimer at specific cut-offs (1,000 μg/L if 0 score item and 500 μg/L if 1 or 2 score items) was derived. The overall diagnostic failure rate was 0.9% (95%CI 0.4–1.9%) and 392 patients (53.4%) would need imaging to rule out PE. The external validation showed comparable results. A COPD-specific PE diagnostic strategy was derived specifically for patients with COPD and acutely worsening respiratory symptoms. Further prospective validation of this diagnostic algorithm is needed prior to integrating it in clinical practice.

The standard first-line treatment for metastatic non-small cell lung cancer (NSCLC) without oncogenic alterations and programmed death-ligand 1 (PD-L1) expression < 1% is a combination of chemotherapy (CT) and immunotherapy (IO). However, real-world overall survival (OS) appears more modest than in clinical trials, averaging 10–13 months. This retrospective study aimed to assess treatment patterns and real-world outcomes at the Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ). Patients diagnosed between January 2019 and December 2023 with advanced PD-L1 <1% NSCLC and treated with palliative intent at IUCPQ were included and categorized by first-line treatment. Progression-free survival (PFS) and OS of the CT + IO and CT groups were compared using Kaplan–Meier curves and Cox regression analyses. Data regarding regimen selection, adverse events and subsequent treatment lines were collected. Among 217 eligible patients, 82 (37.8%) received CT + IO, 32 (14.7%) CT alone, 16 (7.4%) targeted therapy, and 87 (40.1%) supportive care. Median PFS was 5.3 vs. 4.7 months (p = 0.5) and OS 14.4 vs. 13.5 months (p = 0.2) for CT + IO and CT alone, respectively. In the CT + IO group, treatment discontinuation was mainly due to disease progression (59.4%) or adverse events (36.2%). Immune-related adverse events occurred in 29.3%, most frequently pneumonitis (8.5%). Therefore, in this cohort, no statistically significant survival difference was observed between CT + IO and CT alone. However, these findings should be interpreted cautiously given the non-randomized design, baseline imbalances between groups, and the limited sample size of the CT alone cohort. Tolerability of CT + IO was consistent with that observed in clinical trials.