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Deep vein thrombosis in COVID-19 patients in general wards: prevalence and association with clinical and laboratory
Anna Maria Ierardi1, Nicola Gaibazzi2, Domenico Tuttolomondo2
1Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy. amierardi@yahoo.it.
Insights
Deep vein thrombosis (DVT) affects 25.5% of hospitalized COVID-19 patients. Inflammation, indicated by C-reactive protein, is linked to DVT, suggesting screening for this complication.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Cardiology
Background:
- Preliminary reports indicated a hypercoagulable state in COVID-19 patients.
- Deep vein thrombosis (DVT) is suspected as a common complication in hospitalized COVID-19 patients, but prevalence data were lacking.
Purpose of the Study:
- To determine the prevalence of DVT in general ward COVID-19 patients using lower extremities duplex ultrasound (LEDUS).
- To investigate associations between DVT and clinical, laboratory, and inflammatory markers.
- To report on in-hospital mortality as a secondary endpoint.
Main Methods:
- A total of 263 COVID-19 patients were screened with LEDUS between March 1, 2020, and April 5, 2020.
- These patients were part of a larger cohort of 1012 admitted COVID-19 patients.
Main Results:
- Deep vein thrombosis (DVT) was detected in 67 screened patients, representing a prevalence of 25.5%.
- In-hospital mortality occurred in 41 patients (15.6%).
- Elevated C-reactive protein levels were independently associated with the presence of DVT (OR 1.009, P < 0.001). Age and C-reactive protein were independently associated with in-hospital mortality.
Conclusions:
- The prevalence of DVT in COVID-19 patients admitted to general wards is 25.5%.
- Screening for DVT in COVID-19 patients is recommended due to its potential severity and treatability.
- Inflammation, as measured by C-reactive protein, is the primary factor associated with DVT in these patients, independent of other clinical or laboratory variables.
Background:
Preliminary reports suggest a hypercoagulable state in COVID-19. Deep vein thrombosis (DVT) is perceived as a frequent finding in hospitalized COVID-19 patients, but data describing the prevalence of DVT are lacking.
Objectives:
We aimed to report the prevalence of DVT in COVID-19 patients in general wards, blinded to symptoms/signs of disease, using lower extremities duplex ultrasound (LEDUS) in random patients. We tested the association of DVT with clinical, laboratory and inflammatory markers and also reported on the secondary endpoint of in-hospital mortality.
Patients/Methods:
n = 263 COVID-19 patients were screened with LEDUS between March 01, 2020 and April 05, 2020 out of the overall n = 1012 admitted with COVID-19.
Results:
DVT was detected in n = 67 screened patients (25.5%), n = 41 patients (15.6%) died during the index hospitalization. Multiple logistic regression demonstrated that only C-reactive protein (odds ratio 1.009, 95% CI 1.004-1.013, p < 0.001) was independently associated with the presence of DVT at LEDUS. Both age (odds ratio 1.101, 95% CI 1.054-1.150, p < 0.001) and C-reactive protein (odds ratio 1.012, 95% CI 1.006-1.018, p < 0.001) were instead significantly independently associated with in-hospital mortality.
Conclusions:
The main study finding is that DVT prevalence in COVID-19 patients admitted to general wards is 25.5%, suggesting it may be reasonable to screen COVID-19 patients for this potentially severe but treatable complication, and that inflammation, measured with serum C-reactive protein, is the main variable associated with the presence of DVT, where all other clinical or laboratory variables, age or D-dimer included, are instead not independently associated with DVT.
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