Deep vein thrombosis and pulmonary embolism among hospitalized coronavirus disease 2019-positive patients predicted for higher mortality and prolonged intensive care unit and hospital stays in a multisite healthcare system.
Deep vein thrombosis and pulmonary embolism among hospitalized coronavirus disease 2019-positive patients predicted for higher mortality and prolonged intensive care unit and hospital stays in a multisite healthcare system.
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DOI：
10.1016/j.jvsv.2021.03.009
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Meschia JF
中科院分区：
文献类型：
--
作者：
Erben Y;Franco-Mesa C;Gloviczki P;Stone W;Quinones-Hinojoas A;Meltzer AJ;Lin M;Greenway MRF;Hamid O;Devcic Z;Toskich B;Ritchie C;Lamb CJ;De Martino RR;Siegel J;Farres H;Hakaim AG;Sanghavi DK;Li Y;Rivera C;Moreno-Franco P;O'Keefe NL;Gopal N;Marquez CP;Huang JF;Kalra M;Shields R;Prudencio M;Gendron T;McBane R;Park M;Hoyne JB;Petrucelli L;O'Horo JC;Meschia JF
我们评估了2019年冠状病毒病住院患者(新冠肺炎)与具有相似心血管危险因素的匹配队列患者的深静脉血栓(DVT)和肺栓塞(PE)的发生率，以及DVT和PE对住院病程的影响。我们对2020年3月11日至2020年9月4日期间住院的新冠肺炎患者的前瞻性收集数据进行了回顾。这些患者按年龄、性别、入院医院、吸烟史、糖尿病和冠状动脉疾病与一组没有新冠肺炎的患者按1：1的比例随机匹配。使用条件Logistic回归模型，主要终点是DVT/PE的发生率和发生DVT/PE的几率。次要终点是有或无DVT/PE的新冠肺炎患者的住院结果，包括死亡率、重症监护病房(ICU)入院时间、ICU住院时间和住院时间(LOH)。多变量回归分析确定与死亡率、ICU入院、出院处理、ICU持续时间和杂合性丢失相关的变量。共有13,310名患者的新冠肺炎检测呈阳性，其中915人(6.9%)曾在我们的多站点医疗保健系统中住院。住院患者平均年龄60.8±17.0岁，女性396例(43.3%)。在915例患者中，82例(9.0%)经四肢超声检查和/或胸部CT血管造影确诊为DVT/PE。有新冠肺炎感染的患者合并DVT/PE的风险高于无新冠肺炎感染的患者(0.6%[5/915]vs9.0%[82/915]；优势比[OR]为18；95%可信区间[CI]为8.0~51.2；P<0.01)。合并和不合并DVT/PE的新冠肺炎患者的血管危险因素无差异。DVT/PE组的死亡率(P=0.02)、ICU住院需求(P<0.01)、ICU住院时间(P<0.01)和杂合性丢失(P<0.01)均高于无DVT/PE组。多因素Logistic回归分析显示，血红蛋白(OR，0.71；95%CI，0.46~0.95；P=0.04)和D-二聚体(OR，1.0；95%CI，0.33~1.56；P=0.03)水平与较高的死亡率相关。较高的活化部分凝血活酶时间(OR，1.1；95%CI，1.00~1.12；P<0.05)和较高的白介素6(IL-6)水平(OR，1.0；95%CI，1.01~1.07；P<0.05)与ICU入院的风险相关。IL-6(OR，1.0；95%CI，1.00-1.02；P=0.05)与出院后康复安置的风险较大。在多变量伽玛回归分析中，血红蛋白(系数，−3.0；95%CI，0.0 3-0.0 8；P=0.0 5)、活化部分凝血活酶时间(系数2.0；95%CI，0.003-0.006；P=0.05)、国际标准化比率(系数，−3.2；95%CI，0.0 6-0.19；P=.0 0 2)和IL-6(系数2.4；95%CI，0.0011-0.0027；P=0.02)与LOH延长有关。与心血管危险因素匹配的非新冠肺炎队列患者相比，住院的新冠肺炎阳性患者的深静脉血栓/肺栓塞发生率显著更高。与新冠肺炎阳性但无DVT/PE的患者相比，受DVT/PE影响的患者更有可能经历更高的死亡率，需要入院ICU，并经历更长的ICU停留和杂合性丢失。新冠肺炎感染住院患者需要加强深静脉血栓形成/肺栓塞的预防。
We assessed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients with coronavirus disease 2019 (COVID-19) compared with that in a matched cohort with similar cardiovascular risk factors and the effects of DVT and PE on the hospital course. We performed a retrospective review of prospectively collected data from COVID-19 patients who had been hospitalized from March 11, 2020 to September 4, 2020. The patients were randomly matched in a 1:1 ratio by age, sex, hospital of admission, smoking history, diabetes mellitus, and coronary artery disease with a cohort of patients without COVID-19. The primary end point was the incidence of DVT/PE and the odds of developing DVT/PE using a conditional logistic regression model. The secondary end point was the hospitalization outcomes for COVID-19 patients with and without DVT/PE, including mortality, intensive care unit (ICU) admission, ICU stay, and length of hospitalization (LOH). Multivariable regression analysis was performed to identify the variables associated with mortality, ICU admission, discharge disposition, ICU duration, and LOH. A total of 13,310 patients had tested positive for COVID-19, 915 of whom (6.9%) had been hospitalized across our multisite health care system. The mean age of the hospitalized patients was 60.8 ± 17.0 years, and 396 (43.3%) were women. Of the 915 patients, 82 (9.0%) had had a diagnosis of DVT/PE confirmed by ultrasound examination of the extremities and/or computed tomography angiography of the chest. The odds of presenting with DVT/PE in the setting of COVID-19 infection was greater than that without COVID-19 infection (0.6% [5 of 915] vs 9.0% [82 of 915]; odds ratio [OR], 18; 95% confidence interval [CI], 8.0-51.2; P < .001). The vascular risk factors were not different between the COVID-19 patients with and without DVT/PE. Mortality (P = .02), the need for ICU stay (P < .001), duration of ICU stay (P < .001), and LOH (P < .001) were greater in the DVT/PE cohort than in the cohort without DVT/PE. On multivariable logistic regression analysis, the hemoglobin (OR, 0.71; 95% CI, 0.46-0.95; P = .04) and D-dimer (OR, 1.0; 95% CI, 0.33-1.56; P = .03) levels were associated with higher mortality. Higher activated partial thromboplastin times (OR, 1.1; 95% CI, 1.00-1.12; P = .03) and higher interleukin-6 (IL-6) levels (OR, 1.0; 95% CI, 1.01-1.07; P = .05) were associated with a greater risk of ICU admission. IL-6 (OR, 1.0; 95% CI, 1.00-1.02; P = .05) was associated with a greater risk of rehabilitation placement after discharge. On multivariable gamma regression analysis, hemoglobin (coefficient, −3.0; 95% CI, 0.03-0.08; P = .005) was associated with a prolonged ICU stay, and the activated partial thromboplastin time (coefficient, 2.0; 95% CI, 0.003-0.006; P = .05), international normalized ratio (coefficient, −3.2; 95% CI, 0.06-0.19; P = .002) and IL-6 (coefficient, 2.4; 95% CI, 0.0011-0.0027; P = .02) were associated with a prolonged LOH. A significantly greater incidence of DVT/PE occurred in hospitalized COVID-19–positive patients compared with a non–COVID-19 cohort matched for cardiovascular risk factors. Patients affected by DVT/PE were more likely to experience greater mortality, to require ICU admission, and experience prolonged ICU stays and LOH compared with COVID-19–positive patients without DVT/PE. Advancements in DVT/PE prevention are needed for patients hospitalized for COVID-19 infection.
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影响因子：
4.6
作者：
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DOI：
10.4103/ijmr.ijmr_2890_20
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期刊：
The Indian journal of medical research
影响因子：
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作者：
Kayina CA;Haritha D;Soni L;Behera S;Nair PR;Gouri M;Girish K;Deeparaj L;Maitra S;Anand RK;Ray BR;Baidya DK;Subramaniam R
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