ABSTRACT
Introduction: Current estimates show that, globally, there are 531 million cases and 6.3 million deaths due to COVID-19. Studies have shown that COVID-19 could lead to deep vein thrombosis (DVT) resulting in increased morbidity and mortality. In this study we sought to estimate the prevalence of DVT among COVID-19 hospitalizations as well as its effects on hospital outcomes using a large administrative database. Hypothesis: The adverse in-hospital outcomes of COVID-19 will be significantly higher among DVT hospitalizations. Method(s): We conducted a retrospective analysis of the 2020 California State Inpatient Database. All hospitalizations with age 18 and above and primary diagnosis of COVID-19 were included for the study. They were classified into those with and without DVT. The main outcomes of the study were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Length of stay >=75th percentile was grouped as prolonged length of stay. Multivariate logistic regressions with covariate adjustments were conducted to compare COVID-19 related outcomes between those with and without DVT. Result(s): We included a total of 94,114 primary COVID-19 hospitalizations for the analysis. Among them 1575 (1.7%) had DVT. The prevalence of mortality (27.5% versus 11.1%, P<0.001), prolonged length of stay (62.2% versus 27.8%, P<0.001), vasopressor use (7.9% versus 2.1%, P<0.001), mechanical ventilation (36.2% versus 9.7%, P<0.001), and ICU admission (35.7% versus 9.3%, P<0.001) were significantly higher among those with DVT. After adjusting for covariates, regression analysis showed that those with DVT had significantly greater odds for mortality (aOR, 2.34, 95% CI: 2.07-2.65), prolonged length of stay (aOR, 3.51, 95% CI: 3.16-3.91), vasopressor use (aOR, 4.23, 95% CI: 3.78-4.74), mechanical ventilation (aOR, 2.90, 95% CI: 2.38-3.53), and ICU admission (aOR, 4.32, 95% CI: 3.85-4.84). Conclusion(s): In our cohort, only few COVID-19 hospitalizations had a diagnosis of DVT. However, among those with DVT, the risk for adverse outcomes were significantly higher. Since DVT among COVID-19 is uncommon but associated with adverse hospital outcomes, healthcare providers should promptly monitor for DVT and manage it.
ABSTRACT
Introduction: According to recent global estimates there are nearly 530 million cases and 6.3 million deaths due to novel coronavirus disease 2019 (COVID-19) pandemic. Studies have shown that COVID-19 disproportionately affects males than females. In this study we looked at differences in in-hospital outcomes of COVID-19 based on sex using a larger administrative database. Hypothesis: The adverse in-hospital outcomes of COVID-19 will be significantly higher among males. Method(s): This was a retrospective analysis of the California State Inpatient Database 2020. All COVID-19 hospitalizations with age 18 years and above were included for the analysis. These hospitalizations were classified into males and females. The main outcomes of the study were inhospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission. Any length of stay >=75th percentile value for the entire cohort was considered as prolonged length of stay. Logistic regression analyses after adjusting for covariates were used to compare COVID-19 related outcomes between males and females. Result(s): A total of 95,180 primary COVID-19 hospitalizations were included for the analysis. Of these 52465 (55.1%) were males and 42715 (44.9%) were females. Among these hospitalizations, mortality (12.4% versus 10.1%, P<0.001), prolonged length of stay (30.6% versus 25.8%, P<0.001), vasopressor use (2.6% versus 1.6%, P<0.001), mechanical ventilation (11.8% versus 8.0%, P<0.001), and ICU admission (11.4% versus 7.8%, P<0.001) were significantly higher among males. Logistics regression analysis showed that males had significantly greater odds for mortality (aOR, 1.38, 95% CI: 1.32-1.44), prolonged length of stay (aOR, 1.35, 95% CI: 1.31-1.39), vasopressor use (aOR, 1.59, 95% CI: 1.51-1.66), mechanical ventilation (aOR, 1.62, 95% CI: 1.47- 1.78), and ICU admission (aOR, 1.58, 95% CI: 1.51-1.66). Conclusion(s): Adverse outcomes such as mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and ICU admission were independently associated with male sex. These findings could be due differences to both biological and social factors between the sexes. Future studies should explore these factors to efficiently control COVID-19.