Venous or arterial thrombosis and deaths among COVID-19 cases: a European network cohort study.
Venous or arterial thrombosis and deaths among COVID-19 cases: a European network cohort study.
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DOI：
10.1016/s1473-3099(22)00223-7
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发表时间：
2022-08
影响因子：
56.3
通讯作者：
Prieto-Alhambra, Daniel
中科院分区：
文献类型：
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作者：
Burn, Edward;Duarte-Salles, Talita;Fernandez-Bertolin, Sergio;Reyes, Carlen;Kostka, Kristin;Delmestri, Antonella;Rijnbeek, Peter;Verhamme, Katia;Prieto-Alhambra, Daniel
关于COVID-19病例中血栓形成发生率的数据很少，大多数研究集中在住院患者身上。我们旨在估计COVID-19病例中静脉血栓栓塞、动脉血栓栓塞和死亡的发生率，并评估这些事件对住院和死亡风险的影响。我们使用荷兰、意大利、西班牙和英国的初级保健记录以及德国的门诊专家记录进行了一项分布式网络队列研究。西班牙数据库与医院入院情况相关联。参与者从确诊COVID-19或SARS-CoV-2 RT-PCR检测阳性（索引日期）起接受90天的随访。主要研究结局为自索引日期起90天内的静脉血栓栓塞事件、动脉血栓栓塞事件和死亡。我们估计了研究结果的累积发生率。使用多状态模型计算静脉血栓栓塞或动脉血栓栓塞发生与住院或COVID-19死亡风险之间相关性的校正风险比（HR）。总体而言，研究了2020年9月1日或之后的909473例COVID-19病例和32 329例COVID-19住院患者。 数据库的最新索引日期为2021年1月30日至2021年7月31日。在COVID-19病例中，静脉血栓栓塞的累积90天发生率范围为0.2%至0.8%，住院患者高达4.5%。对于动脉血栓栓塞，COVID-19病例中的估计值范围为0.1%至0.8%，在住院患者中增加至3.1%。COVID-19患者的病死率范围为1.1%至2.0%，住院患者的病死率上升至14.6%。COVID-19患者发生静脉血栓栓塞与死亡风险增加相关（未住院患者的校正HR为4.42 [3.07 - 6.36]，住院患者的校正HR为1.63 [1.39 - 1.90]），动脉血栓栓塞的发生也是如此（3.16 [2.65 - 3.75]和1.93 [1.57 - 2.37]）。静脉血栓栓塞和动脉血栓栓塞的风险在COVID-19病例中高达1%，并且在男性和住院患者中随着年龄的增长而增加。它们的发生与死亡率过高有关，强调了制定有效治疗策略以降低其发生频率的重要性。欧洲药品管理局。
There are few data on the incidence of thrombosis among COVID-19 cases, with most research concentrated on hospitalised patients. We aimed to estimate the incidence of venous thromboembolism, arterial thromboembolism, and death among COVID-19 cases and to assess the impact of these events on the risks of hospitalisation and death. We conducted a distributed network cohort study using primary care records from the Netherlands, Italy, Spain, and the UK, and outpatient specialist records from Germany. The Spanish database was linked to hospital admissions. Participants were followed up from the date of a diagnosis of COVID-19 or positive RT-PCR test for SARS-CoV-2 (index date) for 90 days. The primary study outcomes were venous thromboembolic events, arterial thromboembolic events, and death, all over the 90 days from the index date. We estimated cumulative incidences for the study outcomes. Multistate models were used to calculate adjusted hazard ratios (HRs) for the association between venous thromboembolism or arterial thromboembolism occurrence and risks of hospitalisation or COVID-19 fatality. Overall, 909 473 COVID-19 cases and 32 329 patients hospitalised with COVID-19 on or after Sept 1, 2020, were studied. The latest index dates across the databases ranged from Jan 30, 2021, to July 31, 2021. Cumulative 90-day incidence of venous thromboembolism ranged from 0·2% to 0·8% among COVID-19 cases, and up to 4·5% for those hospitalised. For arterial thromboembolism, estimates ranged from 0·1% to 0·8% among COVID-19 cases, increasing to 3·1% among those hospitalised. Case fatality ranged from 1·1% to 2·0% among patients with COVID-19, rising to 14·6% for hospitalised patients. The occurrence of venous thromboembolism in patients with COVID-19 was associated with an increased risk of death (adjusted HRs 4·42 [3·07–6·36] for those not hospitalised and 1·63 [1·39–1·90] for those hospitalised), as was the occurrence of arterial thromboembolism (3·16 [2·65–3·75] and 1·93 [1·57–2·37]). Risks of venous thromboembolism and arterial thromboembolism were up to 1% among COVID-19 cases, and increased with age, among males, and in those who were hospitalised. Their occurrence was associated with excess mortality, underlying the importance of developing effective treatment strategies that reduce their frequency. European Medicines Agency.