Association between Risk of Venous Thromboembolism and Mortality in Patients with COVID-19 (preprint)

ABSTRACT

Background: Hospitalized patients with COVID-19 appeared high risk of venous thromboembolism (VTE) defined by some risk assessment models (RAMs), which exhibited the predictor of mortality in patients with non-COVID-19. We aimed to investigate the association between risk of VTE with 30-day mortality in COVID-19 patients.Methods: In this retrospective cohort study, 1030 consecutive hospitalized patients, between January 26, 2020 and March 29, 2020, aged 14–98 years with a confirmed diagnosis of COVID-19-related pneumonia were recruited from Jinyintan Hospital and Union Hosptial, Wuhan, China. We collected baseline data on demographics, SOFA parameters, and VTE RAMs including Padua Prediction Score (PPS), IMPROVE RAM and Caprini RAM. The primary outcome of the study was 30-day mortality. The secondary outcome was the length of stay in hospital. Findings: Thirty-day mortality increased progressively from 2% in patients at low risk of VTE to 63% in those at high risk of VTE defined by PPS ≥ 4. Similar findings were also observed for risk of VTE defined by IMPROVE score ³ 2 and Caprini score ³ 5. Progressive increases in VTE risk also were associated with higher SOFA score. Our findings showed that the presence of high risk of VTE was independently associated with 30-day mortality regardless of adjusted gender, smoking status and some comorbidities with hazard ratios of 29.19 (95% CI 15.76 - 54.05), 37.37 (95% CI 18.43 - 75.78), 20.60 (95% CI 11.41 - 37.19) for PPS, IMPROVE RAM and Caprini RAM, respectively (P < 0.001 for all comparisons). Predictive accuracy of PPS (AUC, 0.900; 95% CI 0.881 - 0.919), IMPROVE RAM (AUC, 0.917; 95% CI 0.898 - 0.936) or Caprini RAM (AUC, 0.861; 95% CI 0.840 - 0.882) as the risk of 30-day mortality was markedly well.Interpretation: The presence of high risk of VTE identifies a group of patients with COVID-19 at higher risk for 30-day mortality. Furthermore, there is higher accuracy of VTE RAMs to predict 30-day mortality in COVID-19 hospitalized patients.Funding Statement This study is funded by the National Nature Science Foundation of China (81870062 to Jinjun Jiang, 81900038 to Shujing Chen).Declaration of Interests The authors have no conflict of interest to disclose.Ethics Approval Statement The study was approved by Jinyintan Hospital Ethics Committee (KY2020-06.01) and Union Hospital Ethics Committee (2020-0039). Written informed consent was waived by the Ethics Commission.