학술논문
The CoVID‐TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID‐19
Document Type
article
Author
Li, Ang; Kuderer, Nicole M; Hsu, Chih‐Yuan; Shyr, Yu; Warner, Jeremy L; Shah, Dimpy P; Kumar, Vaibhav; Shah, Surbhi; Kulkarni, Amit A; Fu, Julie; Gulati, Shuchi; Zon, Rebecca L; Li, Monica; Desai, Aakash; Egan, Pamela C; Bakouny, Ziad; Devendra, KC; Hwang, Clara; Akpan, Imo J; McKay, Rana R; Girard, Jennifer; Schmidt, Andrew L; Halmos, Balazs; Thompson, Michael A; Patel, Jaymin M; Pennell, Nathan A; Peters, Solange; Elshoury, Amro; de Lima Lopes, Gilbero; Stover, Daniel G; Grivas, Petros; Rini, Brian I; Painter, Corrie A; Mishra, Sanjay; Connors, Jean M; Lyman, Gary H; Rosovsky, Rachel P; consortium, the CCC19
Source
Journal of Thrombosis and Haemostasis. 19(10)
Subject
Language
Abstract
BackgroundHospitalized patients with COVID-19 have increased risks of venous (VTE) and arterial thromboembolism (ATE). Active cancer diagnosis and treatment are well-known risk factors; however, a risk assessment model (RAM) for VTE in patients with both cancer and COVID-19 is lacking.ObjectivesTo assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID-19.MethodsAmong patients with cancer in the COVID-19 and Cancer Consortium registry (CCC19) cohort study, we assessed the incidence of VTE and ATE within 90 days of COVID-19-associated hospitalization. A multivariable logistic regression model specifically for VTE was built using a priori determined clinical risk factors. A simplified RAM was derived and internally validated using bootstrap.ResultsFrom March 17, 2020 to November 30, 2020, 2804 hospitalized patients were analyzed. The incidence of VTE and ATE was 7.6% and 3.9%, respectively. The incidence of VTE, but not ATE, was higher in patients receiving recent anti-cancer therapy. A simplified RAM for VTE was derived and named CoVID-TE (Cancer subtype high to very-high risk by original Khorana score +1, VTE history +2, ICU admission +2, D-dimer elevation +1, recent systemic anti-cancer Therapy +1, and non-Hispanic Ethnicity +1). The RAM stratified patients into two cohorts (low-risk, 0-2 points, n = 1423 vs. high-risk, 3+ points, n = 1034) where VTE occurred in 4.1% low-risk and 11.3% high-risk patients (c statistic 0.67, 95% confidence interval 0.63-0.71). The RAM performed similarly well in subgroups of patients not on anticoagulant prior to admission and moderately ill patients not requiring direct ICU admission.ConclusionsHospitalized patients with cancer and COVID-19 have elevated thrombotic risks. The CoVID-TE RAM for VTE prediction may help real-time data-driven decisions in this vulnerable population.