Clinical and laboratory characteristics of patients with novel coronavirus disease-2019 infection and deep venous thrombosis.
J Vasc Surg Venous Lymphat Disord
; 9(3): 605-614.e2, 2021 05.
Статья
в английский
| MEDLINE | ID: covidwho-1510080
ABSTRACT
OBJECTIVE:
Early reports suggest that patients with novel coronavirus disease-2019 (COVID-19) infection carry a significant risk of altered coagulation with an increased risk for venous thromboembolic events. This report investigates the relationship of significant COVID-19 infection and deep venous thrombosis (DVT) as reflected in the patient clinical and laboratory characteristics.METHODS:
We reviewed the demographics, clinical presentation, laboratory and radiologic evaluations, results of venous duplex imaging and mortality of COVID-19-positive patients (18-89 years) admitted to the Indiana University Academic Health Center. Using oxygen saturation, radiologic findings, and need for advanced respiratory therapies, patients were classified into mild, moderate, or severe categories of COVID-19 infection. A descriptive analysis was performed using univariate and bivariate Fisher's exact and Wilcoxon rank-sum tests to examine the distribution of patient characteristics and compare the DVT outcomes. A multivariable logistic regression model was used to estimate the adjusted odds ratio of experiencing DVT and a receiver operating curve analysis to identify the optimal cutoff for d-dimer to predict DVT in this COVID-19 cohort. Time to the diagnosis of DVT from admission was analyzed using log-rank test and Kaplan-Meier plots.RESULTS:
Our study included 71 unique COVID-19-positive patients (mean age, 61 years) categorized as having 3% mild, 14% moderate, and 83% severe infection and evaluated with 107 venous duplex studies. DVT was identified in 47.8% of patients (37% of examinations) at an average of 5.9 days after admission. Patients with DVT were predominantly male (67%; P = .032) with proximal venous involvement (29% upper and 39% in the lower extremities with 55% of the latter demonstrating bilateral involvement). Patients with DVT had a significantly higher mean d-dimer of 5447 ± 7032 ng/mL (P = .0101), and alkaline phosphatase of 110 IU/L (P = .0095) than those without DVT. On multivariable analysis, elevated d-dimer (P = .038) and alkaline phosphatase (P = .021) were associated with risk for DVT, whereas age, sex, elevated C-reactive protein, and ferritin levels were not. A receiver operating curve analysis suggests an optimal d-dimer value of 2450 ng/mL cutoff with 70% sensitivity, 59.5% specificity, and 61% positive predictive value, and 68.8% negative predictive value.CONCLUSIONS:
This study suggests that males with severe COVID-19 infection requiring hospitalization are at highest risk for developing DVT. Elevated d-dimers and alkaline phosphatase along with our multivariable model can alert the clinician to the increased risk of DVT requiring early evaluation and aggressive treatment.ключевые слова
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Коллекция:
Международные базы данных
база данных:
MEDLINE
Основная тема:
Fibrin Fibrinogen Degradation Products
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Ultrasonography, Doppler, Duplex
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Risk Assessment
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Venous Thrombosis
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Alkaline Phosphatase
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Extremities
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COVID-19
Тип исследования:
Когортное исследование
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Диагностическое исследование
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Экспериментальные исследования
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Наблюдательное исследование
/
Прогностическое исследование
Темы:
Длинный Ковид
Пределы темы:
Женщины
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Люди
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Мужчины
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Middle aged
Страна как тема:
Северная Америка
Язык:
английский
Журнал:
J Vasc Surg Venous Lymphat Disord
Год:
2021
Тип:
Статья
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