Venous thromboembolism is linked to severity of disease in COVID‐19 patients: A systematic literature review and exploratory meta‐analysis

Parveen, Rizwana; Mishra, Pinki; Saha, Nilanjan; Bajpai, Ram; Agarwal, Nidhi

doi:10.1111/ijcp.14910

Cited by 13 publications

(12 citation statements)

References 36 publications

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“…Higher COVID-19 severity and features of stronger inflammation have been recognized as predictors of VTE in several cohorts ( 30 - 32 ) and in the current study, highlighting the interconnected pathways of hyperinflammation and thrombosis. Lower MCHC is a red blood cell index reflecting hemoglobin content and the quality of erythropoiesis.…”

Section: Discussionsupporting

confidence: 57%

Incidence and risk factors for venous and arterial thromboses in hospitalized patients with coronavirus disease 2019: data on 4014 patients from a tertiary center registry

et al. 2022

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Aim To evaluate the burden and predictors of thromboembolic complications in a large real-life cohort of hospitalized patients with established coronavirus disease 2019 (COVID-19). Methods We retrospectively reviewed the records of 4014 consecutive adult patients admitted to a tertiary-level institution because of COVID-19 from March 2020 to March 2021 for the presence of venous and arterial thrombotic events. Results Venous-thromboembolic (VTE) events were present in 5.3% and arterial thrombotic events in 5.8% patients. The majority of arterial thromboses occurred before or on the day of admission, while the majority of VTE events occurred during hospitalization. The majority of both types of events occurred before intensive care unit (ICU) admission, although both types of events were associated with a higher need for ICU use and prolonged immobilization. In multivariate logistic regression, VTE events were independently associated with metastatic malignancy, known thrombophilia, lower mean corpuscular hemoglobin concentration, higher D-dimer, lower lactate dehydrogenase, longer duration of disease on admission, bilateral pneumonia, longer duration of hospitalization, and immobilization for at least one day. Arterial thromboses were independently associated with less severe COVID-19, higher Charlson comorbidity index, coronary artery disease, peripheral artery disease, history of cerebrovascular insult, aspirin use, lower C reactive protein, better functional status on admission, ICU use, immobilization for at least one day, absence of hyperlipoproteinemia, and absence of metastatic malignancy. Conclusion Among hospitalized COVID-19 patients, venous and arterial thromboses differ in timing of presentation, association with COVID-19 severity, and other clinical characteristics.

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Section: Discussionsupporting

confidence: 57%

Incidence and risk factors for venous and arterial thromboses in hospitalized patients with coronavirus disease 2019: data on 4014 patients from a tertiary center registry

et al. 2022

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“…Moreover, D-dimer and NLR-as also reported in literature-correlate with the severity of inflammation, a poor prognosis, and fatal outcome [71,[75][76][77][78][79].…”

Section: Discussionsupporting

confidence: 54%

“…Recent theories on COVID-19 pathophysiology have focused on vasculitis-like anomalies or immune-mediated thrombosis in which viral alveolitis drives inflammation, endotheliopathy, and microvascular injury, leading to vascular tone dysregulation and pulmonary intravascular coagulopathy [5][6][7][8][9][10][11][12]. Postmortem reports and pathological specimens from COVID-19 patients showed DAD together with pulmonary infarction, small pulmonary vessel and capillary thrombosis, and hemorrhage [65,[67][68][69][70][71][72].…”

Section: Discussionmentioning

confidence: 99%

Automated Quantitative Lung CT Improves Prognostication in Non-ICU COVID-19 Patients beyond Conventional Biomarkers of Disease

Palumbo

Bruno

et al. 2021

Diagnostics

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(1) Background: COVID-19 continues to represent a worrying pandemic. Despite the high percentage of non-severe illness, a wide clinical variability is often reported in real-world practice. Accurate predictors of disease aggressiveness, however, are still lacking. The purpose of our study was to evaluate the impact of quantitative analysis of lung computed tomography (CT) on non-intensive care unit (ICU) COVID-19 patients’ prognostication; (2) Methods: Our historical prospective study included fifty-five COVID-19 patients consecutively submitted to unenhanced lung CT. Primary outcomes were recorded during hospitalization, including composite ICU admission for the need of mechanical ventilation and/or death occurrence. CT examinations were retrospectively evaluated to automatically calculate differently aerated lung tissues (i.e., overinflated, well-aerated, poorly aerated, and non-aerated tissue). Scores based on the percentage of lung weight and volume were also calculated; (3) Results: Patients who reported disease progression showed lower total lung volume. Inflammatory indices correlated with indices of respiratory failure and high-density areas. Moreover, non-aerated and poorly aerated lung tissue resulted significantly higher in patients with disease progression. Notably, non-aerated lung tissue was independently associated with disease progression (HR: 1.02; p-value: 0.046). When different predictive models including clinical, laboratoristic, and CT findings were analyzed, the best predictive validity was reached by the model that included non-aerated tissue (C-index: 0.97; p-value: 0.0001); (4) Conclusions: Quantitative lung CT offers wide advantages in COVID-19 disease stratification. Non-aerated lung tissue is more likely to occur with severe inflammation status, turning out to be a strong predictor for disease aggressiveness; therefore, it should be included in the predictive model of COVID-19 patients.

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“…CAR was also shown to be predictive of worse functional impairment and higher occurrence of deep venous thrombosis and bacterial sepsis. Considering these associations, CAR could reflect more severe COVID-19 which was shown to be associated with higher occurrence of venous thrombosis [ 25 , 26 ]. Conversely, probably due to a baseline association with a more favorable cardiovascular risk profile, acute arterial thromboses were less frequent in patients with higher CAR.…”

Section: Discussionmentioning

confidence: 99%

Clinical and prognostic significance of C-reactive protein to albumin ratio in hospitalized coronavirus disease 2019 (COVID-19) patients

Lucijanić

Stojić

Atić

et al. 2022

Wien Klin Wochenschr

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C‑reactive protein (CRP) and albumin are inflammation sensitive parameters that are regulated by interleukin‑6 inflammatory pathways. The CRP to albumin ratio (CAR) integrates these two into a potent clinical parameter whose clinical and prognostic association in the context of coronavirus disease 2019 (COVID-19) have not been well defined. We aimed to investigate the clinical and prognostic significance of CAR in the context of COVID-19 infection. We retrospectively analyzed 2309 consecutive COVID-19 patients hospitalized at a tertiary level hospital in the period from March 2020 to March 2021 who had baseline data for a CAR assessment. Findings were validated in an independent cohort of 1155 patients hospitalized from March 2021 to June 2021. The majority of patients (85.8%) had severe or critical COVID-19 on admission. Median CRP, albumin and CAR levels were 91 mg/L, 32 g/L and 2.92, respectively. Higher CAR was associated with a tendency for respiratory deterioration during hospitalization, increased requirement of high-flow oxygen treatment and mechanical ventilation, higher occurrence of bacteriemia, higher occurrence of deep venous thrombosis, lower occurrence of myocardial infarction, higher 30-day mortality and higher postdischarge mortality rates. We defined and validated four CAR prognostic categories (< 1.0, 1.0–2.9, 3.0–5.9 and ≥ 6.0) with distinct 30-day survival. In the series of multivariate Cox regression models we could demonstrate robust prognostic properties of CAR that was associated with inferior 30-day survival independently of COVID-19 severity, age and comorbidities and additionally independently of COVID-19 severity, CURB-65 and VACO index in both development and validation cohorts. The CAR seems to have a good potential to improve prognostication of hospitalized COVID-19 patients. Supplementary Information The online version of this article (10.1007/s00508-021-01999-5) contains supplementary material, which is available to authorized users.

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Venous thromboembolism is linked to severity of disease in COVID‐19 patients: A systematic literature review and exploratory meta‐analysis

Cited by 13 publications

References 36 publications

Incidence and risk factors for venous and arterial thromboses in hospitalized patients with coronavirus disease 2019: data on 4014 patients from a tertiary center registry

Incidence and risk factors for venous and arterial thromboses in hospitalized patients with coronavirus disease 2019: data on 4014 patients from a tertiary center registry

Automated Quantitative Lung CT Improves Prognostication in Non-ICU COVID-19 Patients beyond Conventional Biomarkers of Disease

Clinical and prognostic significance of C-reactive protein to albumin ratio in hospitalized coronavirus disease 2019 (COVID-19) patients

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