Predicting Venous Thromboembolic Events in Patients with Coronavirus Disease 2019 Requiring Hospitalization: an Observational Retrospective Study by the COVIDIC Initiative in a Swiss University Hospital

Abstract

Background. Coronavirus disease 2019 (COVID-19) can result in profound changes in blood coagulation. The aim of the study was to determine the incidence and predictors of venous thromboembolic events (VTE) among patients with COVID-19 requiring hospital admission. Subjects and Methods. We performed a retrospective study at the Lausanne University Hospital with patients admitted because of COVID-19 from February 28 to April 30, 2020. Results. Among 443 patients with COVID-19, VTE was diagnosed in 41 patients (9.3%; 27 pulmonary embolisms, 12 deep vein thrombosis, one pulmonary embolism and deep vein thrombosis, one portal vein thrombosis). VTE was diagnosed already upon admission in 14 (34.1%) patients and 27 (65.9%) during hospital stay (18 in ICU and nine in wards outside the ICU). Multivariate analysis revealed D-dimer value > 3,120 ng / ml ( P < 0.001 ; OR 15.8, 95% CI 4.7-52.9) and duration of 8 days or more from COVID-19 symptoms onset to presentation ( P 0.020; OR 4.8, 95% CI 1.3-18.3) to be independently associated with VTE upon admission. D-dimer value ≥ 3,000 ng / l combined with a Wells score for PE ≥ 2 was highly specific (sensitivity 57.1%, specificity 91.6%) in detecting VTE upon admission. Development of VTE during hospitalization was independently associated with D-dimer value > 5,611 ng / ml ( P < 0.001 ; OR 6.3, 95% CI 2.4-16.2) and mechanical ventilation ( P < 0.001 ; OR 5.9, 95% CI 2.3-15.1). Conclusions. VTE seems to be a common COVID-19 complication upon admission and during hospitalization, especially in ICU. The combination of Wells ≥ 2 score and D − dimer ≥ 3,000 ng / l is a good predictor of VTE at admission.

Clinical characteristics and outcomes of venous thromboembolism in patients hospitalized for COVID-19: Systematic review and meta-analysis

“… 3 (6.8) vs 9 (7.6) NA NA NA NA Pellens B(20) Belgium cross-sectional 12 DVT; 8 ( 67 ) 62.4±5.6 vs 65.5±14.7 7 (87.5) vs 2 (50.0) NA 3 (37.5) vs 2 ( 50 ) NA 3 (37.5) vs 1 ( 25 ) 0 (0) vs 2 ( 50 ) NA NA NA NA NA Ren B(21) China cross sectional 48 DVT; 36 ( 75 ) 71.3 ± 13.13 vs 67 ± 12.6 21 (58.3) vs 2 (28.6) NA 13 (36.1) vs 3 (42.9) 10 (27.8) vs 2 (28.6) 8 (22.2) vs 1 (14.3) NA 10 (27.8) vs 2 (28.6) NA NA 22 (61.1) vs 4 (57.1) Fang C(22) London retrospective cohort 93 PE; 41 ( 44 ) 62.35 ± 10 vs 58.8 ± 13.7 28 ( 68 ) vs 32 ( 61 , 5 ) NA 20 ( 49 ) vs 24 ( ...…”

“… UK Retrospective study 84 PE; 32 (38.1) 60.97 ± 11.64 vs 59.00 ± 19.07 17 ( 53 ) vs 25 ( 48 ) NA NA NA NA NA NA NA NA NA NA Maatman T K(39) US Observational 109 VTE; 31 (28.4) 60 ± 17 vs 62 ± 15 20 ( 65 ) vs 42 ( 54 ) 34.7 ± 12.7 vs 34.8 ± 11.5 17 ( 55 ) vs 57 ( 73 ) 10 ( 32 ) vs 33 ( 42 ) NA 3 ( 10 ) vs 14 ( 18 ) 5(16) vs 28 ( 36 ) 8 (25.8) vs 19 (24.4) NA NA NA Artifoni M(40) France Retrospective cohort 71 VTE; 16 (22.5) 60.2 ± 31.05 vs 62.06 ±20.94 11 (68.7) vs 32 (58.2) 27.22±2.93 vs 28±6.17 3 ( 19 ) vs 26 ( 47 ) 0 (0) vs 14 ( 25 ) NA …”

Association of coagulation disturbances with severity of COVID-19: a longitudinal study

“…Although, measuring D-dimer levels lacks internationally certified calibrators, quality controls, and possesses inter-laboratory and inter-individual variability [10]. However, it is confirmed that high levels of D-dimer seem to be a major clinical risk factor for patients diagnosed with venous thromboembolic events (VTE) [11]. In patients with nonsevere COVID-19, fibrinogen alone was abnormally increased, and the change was not significant.…”

Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

“…In the COVICLOT study [15] , a D-dimers level >5 µg/mL was associated with a positive predictive value of 50% for thrombotic complications (unpublished data). In hospitalised patients (ward and critically ill patients), diagnosis of venous thromboembolism during hospitalisation was independently associated with D-dimers level >5611 ng/mL (OR 6.3, 95% CI 2.4–16.2) [25] . Among patients who underwent CT pulmonary angiography, the closest D-dimers levels to imaging request had a positive predictive value for pulmonary embolism of approximately 70% when values approached 5 µg/mL [26] .…”