ABSTRACT
BackgroundDeep venous thrombosis (DVT) is a severe complication of the coronavirus disease 2019 (COVID-19). It may interfere with COVID-19 treatment and delay the recovery, but there is less data about the anticoagulant therapy and sex difference of VTE in patients with COVID-19. The purpose of this study is to study the prevalence, risk factors, anticoagulant therapy and sex difference of deep venous thrombosis (DVT) in patients with COVID-19.MethodsThe enrolled 121 patients were confirmed positive for COVID-19. All suspected patients with a high Caprini index (≥4) or PADUA index (≥4) received color Doppler Ultrasound (US) to screen DVT in both lower extremities. Clinical characteristics of DVT-COVID-19 patients were analyzed. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. The distribution of DVT locations, anticoagulation therapy with sex difference, and the outcomes were also analyzed.ResultsDVT was found in 48% asymptomatic COVID-19 patients with increased PAUDA index or Caprini index by US scanning. Multivariate logistic regression determined that age, CRP and baseline D-dimer were risk factors among COVDI-19 patients. Although the most common DVT location was infrapopliteal (Class I and Class II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in the CRP, neutrophil count and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia condition in DVT patients, men DVT-COVID-19 patients showed higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio but lower lymphocyte count compared to women DVT-COVID-19 patients. ConclusionsDVT is common in COVID-19 patients with high risk factors, especially for older age, higher CRP and baseline D-dimer populations. It is important to consider sex differences in the anticoagulant therapy among DVT-COVID-19 patients.
Subject(s)
Venous Thromboembolism , COVID-19 , Lymphopenia , Venous ThrombosisABSTRACT
Background: The novel coronavirus disease (COVID-19) is leading to high morbidity and mortality. This study aimed to test whether blood urea nitrogen-to-creatinine ratios (BCR) is a predictor of poor prognosis in patients with COVID-19. Method: From 9,165 generally healthy subjects, we calculated ranges of “normal” BCR values. 416 COVID-19 patients were randomly assigned to training cohort and validation cohort contained 337, 79 patients, respectively. The prognostic ability of abnormal BCR range was assessed using a Logistic regression. Development a nomogram for predicting in-hospital mortality incorporated age, sex and BCR. The model discrimination was assessed using the calibration curves and concordance index in training and validation cohort. The predictive accuracy and clinical values of the nomogram was measured by decision curve analysis (DCA) and clinical impact curve analysis (CICA). Results: Among 337 COVID-19 patients, 13.4% and 11.3% were classified into higher and lower than normal range group, respectively. The BCR was identified as an independent risks factor for death in COVID-19 patients (P<0.0001), with area under the curve (AUC) 0.768; 95%CI: 0.717-0.819). Kaplan-Meier curves for all-cause mortality outcomes showed that patients with above normal range of BCR had worse prognosis (p<0.0001). Logistic regression analysis revealed that BCR above the normal range was independently associated with death in COVID-19 patients (Odds ratio 7.54; 95%CI: 1.55-36.66; P=0.012). ROC curves showed that the nomogram had good discrimination in the training cohort (AUC 0.838; 95%CI 0.795–0.880) and the validation cohort (AUC 0.929; 95%CI 0.869-0.989). Using maximum Youden index, the cutoff values of 59.8 points, the sensitivity and specificity were 75.4% and 81%. The calibration curves showed good agreement between nomogram prediction and actual observation. DCA and CICA indicated the clinical usefulness of the prediction nomogram. Conclusion: BCR was a useful prognostic factor for COVID-19 patients. Development of an individualized prediction nomogram BCR-based, which can effectively predict the risk of mortality, and then, help clinicians to improve individual treatment, make clinical decisions timely and early.