Clin Respir J. 2021 Apr 17. doi: 10.1111/crj.13377. Online ahead of print.
INTRODUCTION: Venous thromboembolism (VTE) is reported in up to 27% of patients with COVID-19 due to SARS-CoV-2 infection. Dysregulated systemic inflammation and various patient traits are presumed to underlie this anomaly. Optimal VTE prophylaxis in COVID-19 patients has not been established due to a lack of validated models for predicting VTE in this population. Our study aims to address this deficiency by identifying demographic and clinical characteristics of COVID-19 patients associated with increased VTE risk.
METHODS: This study is a retrospective analysis of all adult patients (final sample, n = 355) hospitalized with confirmed COVID-19 at Einstein Medical Center Philadelphia between March 1 and April 24, 2020. Demographic and clinical patient data were collected and factors associated with VTE were identified and analyzed using t-tests, multivariable logistic regression, and receiver operating characteristic (ROC) curves.
RESULTS: Thirty patients (8.5%) developed VTE. Patients with VTE had significantly higher D-dimer levels on admission (p=0.045) and peak D-dimer levels (p<0.0001), in addition to higher rates of vasopressor requirements (p=0.038), intubation (p=0.003), and death (p=0.023). Age (OR 1.042), obstructive sleep apnea (OR 5.107), and need for intubation (OR 3.796) were associated with significantly increased odds of VTE. Peak D-dimer level was a good predictor of VTE (AUC 0.806, p<0.0001) and a D-dimer cutoff of >6640 ng/mL had high (>70%) sensitivity and specificity for VTE.
CONCLUSION: Peak D-dimer level may be the most reliable clinical marker in COVID-19 patients for predicting VTE and future prospective studies should attempt to further validate this.