Patients with COVID-19 at high risk for symptomatic VTE
Click Here to Manage Email Alerts
Patients hospitalized with severe and non-severe COVID-19 appeared at increased risk for symptomatic venous thromboembolism, according to study results published in Journal of Thrombosis and Haemostasis.
“High incidence of asymptomatic VTE has been observed in [patients with severe COVID-19], but the characteristics of symptomatic VTE in [the general population of patients with COVID-19] have not been described,” the researchers wrote. “To our knowledge, this is the largest multicenter study that systematically investigated the risk of, and predicting factors for, symptomatic VTE in hospitalized [patients with COVID-19].”
Investigators assessed the prevalence of and risk factors and prediction models for symptomatic VTE among 2,779 patients hospitalized with COVID-19 across three centers in China between Jan. 1 and March 31, 2020. Among these patients, 1,139 had non-severe COVID-19 and 1,640 had severe COVID-19.
Forty-two patients developed symptomatic VTE during hospitalization.
Researchers compared the COVID-19 cohort with a historical cohort of 23,434 hospitalized patients (median age, 61.5 years; 53.3% men) without COVID-19 enrolled at the same centers during the same period in 2018.
Results showed a greater likelihood of developing symptomatic VTE among hospitalized patients with severe COVID-19 (OR = 5.94; 95% CI, 3.91-10.09), as well as those hospitalized with non-severe COVID-19 (OR = 2.79; 95% CI, 1.43-5.6), compared with the historical cohort.
Researchers then used a case-control study design to compare 104 patients (median age, 66 years) with COVID-19 and a symptomatic VTE event (deep vein thrombosis, n = 88; pulmonary embolism, n = 16) during hospitalization across 16 centers in China with 208 COVID-19-severity-matched patients without VTE (median age, 60.5 years).
Upon hospital admission, patients with VTE had a higher median white blood cell count and median neutrophil count, in addition to higher C-reactive protein and D-dimer levels and lower fibrinogen concentrations.
Nine patients with DVT, six with PE and 17 without VTE died. The rate of in-hospital mortality was highest among patients with PE (OR = 6.74; 95% CI, 2.18-20.81).
Median time to symptomatic VTE was 21 days (interquartile range [IQR], 13.2-31) after COVID-19 onset and 11 days (IQR, 8-20.7) after hospitalization. Compared with a median 5 days from illness onset to hospital admission among patients without VTE, median time to admission was 10 days among those with VTE. In addition, patients with VTE had a longer duration of hospitalization (median, 39 days vs. 22 days). However, median time from COVID-19 onset to virus clearance was comparable between the two groups.
Results of multivariable analysis showed D-dimer increment of 1.5-fold or greater was the most common independent risk factor for symptomatic VTE (OR = 14.18; 95% CI, 6.25-32.18), followed by higher D-dimer level on admission (OR = 1.33; 95% CI, 1.17-1.5) and lower fibrinogen level on admission (OR = 0.64; 95% CI, 0.49-0.83).
Researchers included these coagulation variables in a novel risk-assessment model that demonstrated accuracy for prediction of symptomatic VTE (area under the curve = 0.86; 95% CI, 0.82-0.9; sensitivity, 0.93; specificity, 0.71).
“This ‘three-factor’ model can aid in early identification of [patients with COVID-19] who are at high risk for symptomatic VTE,” the researchers wrote.
Researchers noted several limitations of the study, including its retrospective design, lack of regular dynamic clinical laboratory data, small sample size and the potential for genetic factors, which were not examined, to play an important role in VTE.
Collapse
Read more about
Click Here to Manage Email Alerts