Incidence of thrombotic complications and overall survival in hospitalized patients with COVID-19 in the second and first wave.
Incidence of thrombotic complications and overall survival in hospitalized patients with COVID-19 in the second and first wave.
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DOI：
10.1016/j.thromres.2020.12.019
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发表时间：
2021-03
影响因子：
7.5
通讯作者：
Huisman MV
中科院分区：
文献类型：
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作者：
Dutch COVID & Thrombosis Coalition;Kaptein FHJ;Stals MAM;Grootenboers M;Braken SJE;Burggraaf JLI;van Bussel BCT;Cannegieter SC;Ten Cate H;Endeman H;Gommers DAMPJ;van Guldener C;de Jonge E;Juffermans NP;Kant KM;Kevenaar ME;Koster S;Kroft LJM;Kruip MJHA;Leentjens J;Marechal C;Soei YL;Tjepkema L;Visser C;Klok FA;Huisman MV
在第一波中，血栓性并发症在COVID-19患者中很常见。目前尚不清楚最先进的治疗是否导致第二波血栓并发症较少。我们评估了2020年9月1日至11月30日期间在荷兰8家医院住院的COVID-19患者的血栓并发症发生率和总体死亡率。随访在出院、转至另一家医院、死亡时或2020年11月30日（以先发生者为准）结束。估计累积发生率，并根据竞争性死亡风险进行调整。这些数据与2020年2月24日至4月26日期间第一波入院的579名患者的观察结果进行了比较，通过考克斯回归技术调整了年龄，性别和体重。共有947名COVID-19患者纳入该分析，其中358名患者入住ICU; 144名患者死亡（15%）。10、20和30天后所有血栓性并发症的校正累积发生率分别为12%（95%置信区间（CI）9.8-15%）、16%（13-19%）和21%（17-25%）。第一波和第二波之间的患者特征具有可比性。第二波与第一波总体死亡率的调整后风险比（HR）为0.53（95%CI 0.41-0.70）。第二波与第一波中任何血栓性并发症的校正HR为0.89（95%CI 0.65-1.2）。在第二波中死亡率降低了47%，但血栓性并发症发生率仍然很高，与第一波相当。始终需要仔细注意提供充分的血栓预防措施。
In the first wave, thrombotic complications were common in COVID-19 patients. It is unknown whether state-of-the-art treatment has resulted in less thrombotic complications in the second wave. We assessed the incidence of thrombotic complications and overall mortality in COVID-19 patients admitted to eight Dutch hospitals between September 1st and November 30th 2020. Follow-up ended at discharge, transfer to another hospital, when they died, or on November 30th 2020, whichever came first. Cumulative incidences were estimated, adjusted for competing risk of death. These were compared to those observed in 579 patients admitted in the first wave, between February 24th and April 26th 2020, by means of Cox regression techniques adjusted for age, sex and weight. In total 947 patients with COVID-19 were included in this analysis, of whom 358 patients were admitted to the ICU; 144 patients died (15%). The adjusted cumulative incidence of all thrombotic complications after 10, 20 and 30 days was 12% (95% confidence interval (CI) 9.8–15%), 16% (13–19%) and 21% (17–25%), respectively. Patient characteristics between the first and second wave were comparable. The adjusted hazard ratio (HR) for overall mortality in the second wave versus the first wave was 0.53 (95%CI 0.41–0.70). The adjusted HR for any thrombotic complication in the second versus the first wave was 0.89 (95%CI 0.65–1.2). Mortality was reduced by 47% in the second wave, but the thrombotic complication rate remained high, and comparable to the first wave. Careful attention to provision of adequate thromboprophylaxis is invariably warranted.