학술논문
Predictors of venous thromboembolism in patients with COVID-19 in an underserved urban population: A single tertiary center experience.
Document Type
Academic Journal
Author
Barnes DH; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Lo KB; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Bhargav R; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Gul F; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; DeJoy R 3rd; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Peterson E; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Salacup G; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Pelayo J; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Albano J; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Azmaiparashvili Z; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Rangaswami J; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.; Carpio AM; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Patarroyo-Aponte G; Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.; Pulmonary, Critical Care and Sleep Medicine, Einstein Medical Center, Philadelphia, PA, USA.
Source
Publisher: Blackwell Publishing Country of Publication: England NLM ID: 101315570 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1752-699X (Electronic) Linking ISSN: 17526981 NLM ISO Abbreviation: Clin Respir J Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Venous thromboembolism (VTE) is reported in up to 27% of patients with COVID-19 due to SARS-CoV-2 infection. Dysregulated systemic inflammation and various patient traits are presumed to underlie this anomaly. Optimal VTE prophylaxis in COVID-19 patients has not been established due to a lack of validated models for predicting VTE in this population. Our study aims to address this deficiency by identifying demographic and clinical characteristics of COVID-19 patients associated with increased VTE risk.
Methods: This study is a retrospective analysis of all adult patients (final sample, n = 355) hospitalized with confirmed COVID-19 at Einstein Medical Center Philadelphia between March 1 and April 24, 2020. Demographic and clinical patient data were collected and factors associated with VTE were identified and analyzed using t-tests, multivariable logistic regression, and receiver operating characteristic (ROC) curves.
Results: Thirty patients (8.5%) developed VTE. Patients with VTE had significantly higher D-dimer levels on admission (P = 0.045) and peak D-dimer levels (P < 0.0001), in addition to higher rates of vasopressor requirements (P = 0.038), intubation (P = 0.003), and death (P = 0.023). Age (OR 1.042), obstructive sleep apnea (OR 5.107), and need for intubation (OR 3.796) were associated with significantly increased odds of VTE. Peak D-dimer level was a good predictor of VTE (AUC 0.806, P < 0.0001) and a D-dimer cutoff of >6640 ng/mL had high (>70%) sensitivity and specificity for VTE.
Conclusion: Peak D-dimer level may be the most reliable clinical marker in COVID-19 patients for predicting VTE and future prospective studies should attempt to further validate this.
(© 2021 John Wiley & Sons Ltd.)
Methods: This study is a retrospective analysis of all adult patients (final sample, n = 355) hospitalized with confirmed COVID-19 at Einstein Medical Center Philadelphia between March 1 and April 24, 2020. Demographic and clinical patient data were collected and factors associated with VTE were identified and analyzed using t-tests, multivariable logistic regression, and receiver operating characteristic (ROC) curves.
Results: Thirty patients (8.5%) developed VTE. Patients with VTE had significantly higher D-dimer levels on admission (P = 0.045) and peak D-dimer levels (P < 0.0001), in addition to higher rates of vasopressor requirements (P = 0.038), intubation (P = 0.003), and death (P = 0.023). Age (OR 1.042), obstructive sleep apnea (OR 5.107), and need for intubation (OR 3.796) were associated with significantly increased odds of VTE. Peak D-dimer level was a good predictor of VTE (AUC 0.806, P < 0.0001) and a D-dimer cutoff of >6640 ng/mL had high (>70%) sensitivity and specificity for VTE.
Conclusion: Peak D-dimer level may be the most reliable clinical marker in COVID-19 patients for predicting VTE and future prospective studies should attempt to further validate this.
(© 2021 John Wiley & Sons Ltd.)