Racial disparities in COVID-19 associated pulmonary embolism: A multicenter cohort study

Background

Thromboembolism is a recognized component of severe coronavirus disease 2019 (COVID-19) disease. However, research into racial disparities in COVID-19-related pulmonary embolism is limited.

Materials and methods

In this retrospective cohort study, we examined adults diagnosed with COVID-19 between January 20 and September 30, 2020, using a multicenter electronic health record dataset of over 73 million patients (TriNetX), mostly in the USA. The main study outcomes were development of pulmonary embolism or mortality within 30 days of COVID-19 diagnosis. Secondary outcome analysis included hospitalization, mechanical ventilation, and ICU admission within 30 days of diagnosis, as well as lab values within 0–1 days of diagnosis. Sociodemographic and clinical variables were used to create balanced cohorts via propensity matching.

Results

346,953 patients were identified, with 56.0% non-Hispanic white and 14.7% non-Hispanic black; the mean age was 47.6 years. 3879 patients developed PE, with 2036 (1.30% of 157,049) white and 1088 (2.16% of 50,376) black patients. After propensity matching, black race was associated with higher mortality (risk ratio 1.890 [95% CI 1.727–2.067]) and PE (RR 1.537 [1.380–1.711]; p < 0.0001). Both races had higher mortality with COVID-associated PE than COVID or PE alone (RR 1.575–1.627 and 3.000–5.389 respectively; p < 0.0001). Black patients with COVID-19 and PE had a higher rate of mortality compared to white patients (RR 1.397 [1.059–1.844]; p = 0.0174).

Interpretation

Black race was associated with higher risk of pulmonary embolism and mortality after COVID-19. Additionally, black patients with COVID-19 and PE had a higher mortality compared to white patients.

A MEST up classification? Review of the re-classification of mixed epithelial and stromal tumor and adult cystic nephroma for the abdominal radiologist

Mixed epithelial and stromal tumor (MEST) and the tumor formerly known as adult cystic nephroma (ACN) are uncommon renal tumors that have historically been described as separate entities in terms of histologic and imaging findings. However, these entities share many epidemiologic, radiologic, and pathologic features. While recent surgical and pathological literature has supported classifying MEST and ACN within the same tumor family, most radiologists and radiology texts continue to describe MEST and ACN as separate entities.