DVT incidence and risk factors in critically ill patients with COVID-19
DVT incidence and risk factors in critically ill patients with COVID-19
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COVID-19危重患者的 DVT 发生率和危险因素
DOI：
10.1007/s11239-020-02181-w
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发表时间：
2020-06-30
影响因子：
4
通讯作者：
Jiang, Jinjun
中科院分区：
文献类型：
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作者：
Chen, Shujing;Zhang, Dingyu;Jiang, Jinjun
关于预防血栓形成的重症COVID-19患者深静脉血栓形成（DVT）发生率的数据很少。本研究回顾性纳入了中国武汉金银潭医院重症监护室的88名重症COVID-19患者。所有患者均接受加压超声检查以识别DVT。使用Firth logistic回归分析DVT与性别、年龄、低白蛋白血症、D-二聚体和SOFA评分的关系。88例患者的中位（四分位距[IQR]）年龄和SOFA评分分别为63（55-71）岁和5（4-6）岁。尽管所有患者均接受指南推荐的低分子量肝素（LMWH）血栓预防，DVT的发生率为46%（95% CI 35-56%）。在9%（95% CI 3-15%）的患者中识别出近端DVT，而46%（95% CI 35-56%）的患者患有远端DVT。所有近端DVT均合并远端DVT。所有远端DVT患者均存在DVT扩展的危险因素。Padua评分≥ 4分或IMPROVE评分≥ 2分的患者发生DVT的比例分别为53%和46%。急性DVT患者的死亡率（30%）高于非DVT患者（17%），但未达到统计学显著性。血白（比值比[OR]，0.17; 95%CI 0.06- 0.05，P = 0.001），SOFA评分越高（根据IQR的OR，2.07; 95%CI 1.38- 3.39，P = 0.001），D-二聚体升高多因素分析显示，DVT的危险因素有显著性差异（OR = 1.04，95%CI 1.03- 1.84，P = 0.029）。尽管使用了指南推荐的药物血栓预防，但在重症COVID-19患者中发现DVT的发生率很高。低白蛋白血症、SOFA评分增高和D-二聚体升高是DVT的独立危险因素。可能需要制定更有效的VTE预防和管理战略。
Few data are available on the incidence of deep vein thrombosis (DVT) in critically ill COVID-19 with thrombosis prophylaxis. This study retrospectively included 88 patients in the ICU with critically ill COVID-19 at Jinyintan Hospital in Wuhan, China. All patients underwent compression ultrasonography for identifying DVT. Firth logistic regression was used to examine the association of DVT with sex, age, hypoalbuminemia, D-dimer, and SOFA score. The median (interquartile range [IQR]) age and SOFA score of 88 patients were 63 (55–71) years old and 5 (4–6), respectively. Despite all patients receiving guideline-recommended low-molecular-weight heparin (LMWH) thromboprophylaxis, the incidence of DVT was 46% (95% CI 35–56%). Proximal DVT was recognized in 9% (95% CI 3–15%) of the patients, while 46% (95% CI 35–56%) of patients had distal DVT. All of the proximal DVT combined with distal DVT. Risk factors of DVT extension occurred in all distal DVT patients. As Padua score ≥ 4 or IMPROVE score ≥ 2, 53% and 46% of patients had DVT, respectively. Mortality was higher in patients with acute DVT (30%) compared with non-DVT (17%), but did not reach statistical significance. Hypoalbuminemia (odds ratio [OR], 0.17; 95% CI 0.06–0.05,P= 0.001), higher SOFA score (OR per IQR, 2.07; 95% CI 1.38–3.39,P= 0.001), and elevated D-dimer (OR per IQR, 1.04; 95% CI 1.03–1.84,P= 0.029) were significant DVT risk factors in multivariable analyses. High incidence of DVT was identified in patients with critically ill COVID-19, despite the use of guideline-recommended pharmacologic thromboprophylaxis. The presence of hypoalbuminemia, higher SOFA score, and elevated D-dimer were significantly independent risk factors of DVT. More effective VTE prevention and management strategies may need to be addressed.