Your browser doesn't support javascript.
Clinical and laboratory characteristics of patients with novel coronavirus disease-2019 infection and deep venous thrombosis.
Motaganahalli, Raghu L; Kapoor, Rajat; Timsina, Lava R; Gutwein, Ashley R; Ingram, Michael D; Raman, Subha; Roberts, Scott D; Rahman, Omar; Rollins, David; Dalsing, Michael C.
  • Motaganahalli RL; Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind. Electronic address: rmotagan@iupui.edu.
  • Kapoor R; Division of Pulmonary & Critical Care, Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind.
  • Timsina LR; Department of Surgery, Center for Outcomes Research in Surgery, Indianapolis, Ind.
  • Gutwein AR; Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind.
  • Ingram MD; Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind.
  • Raman S; Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind.
  • Roberts SD; Division of Pulmonary & Critical Care, Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind.
  • Rahman O; Division of Pulmonary & Critical Care, Department of Medicine, Indiana University School of Medicine, Indianapolis, Ind.
  • Rollins D; Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind.
  • Dalsing MC; Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind.
J Vasc Surg Venous Lymphat Disord ; 9(3): 605-614.e2, 2021 05.
Article in English | 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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Fibrin Fibrinogen Degradation Products / Ultrasonography, Doppler, Duplex / Risk Assessment / Venous Thrombosis / Alkaline Phosphatase / Extremities / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Vasc Surg Venous Lymphat Disord Year: 2021 Document Type: Article

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Fibrin Fibrinogen Degradation Products / Ultrasonography, Doppler, Duplex / Risk Assessment / Venous Thrombosis / Alkaline Phosphatase / Extremities / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: J Vasc Surg Venous Lymphat Disord Year: 2021 Document Type: Article