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Zhu H, Li Y, Su H, Yan C, Xin W, Ying K. What Is the Impact of Baseline Inflammatory and Hemostatic Indicators with the Risk of Mortality in Severe Inpatients with COVID-19: A Retrospective Study. Clin Appl Thromb Hemost 2024; 30:10760296241255959. [PMID: 38831596 DOI: 10.1177/10760296241255959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
The purpose of the study was to investigate baseline inflammatory, hemostatic indicators and new-onset deep vein thrombosis (DVT) with the risk of mortality in COVID-19 inpatients. In this single-center study, a total of 401 COVID-19 patients hospitalized in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were enrolled from December 1, 2022 to January 31, 2023. The basic information, first laboratory examination results, imaging examination, and outcome-related indicators were compared between patients in the moderate and severe subgroups. We found that baseline D-dimer and baseline absolute neutrophil count (ANC) levels were associated with new-onset DVT and death in severe hospitalized patients with COVID-19. The odds ratio (OR) of baseline D-dimer and baseline ANC with mortality was 1.18 (95% confidence interval [CI], 1.08-1.28; P < .001) and 1.13 (95% CI, 1.06-1.21; P < .001). Baseline ANC was associated with the risk of death in severe hospitalized COVID-19 patients, irrespective of the DVT status. In addition, a significantly higher serum neutrophil activity was observed in severe COVID-19 inpatients with DVT or those deceased during hospital stay. New-onset DVT partially mediated the association between baseline D-dimer (indirect effect: 0.011, estimated mediating proportion: 67.0%), baseline ANC (indirect effect: 0.006, estimated mediating proportion: 48.7%), and mortality in severe hospitalized patients with COVID-19. In summary, baseline D-dimer and baseline absolute neutrophil count (ANC) levels were associated with the mortality in severe hospitalized patients with COVID-19, especially DVT inpatients. New-onset DVT partially mediated the association between baseline D-dimer, baseline ANC, and mortality in severe hospitalized patients with COVID-19.
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Affiliation(s)
- Huiqi Zhu
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Yeping Li
- Department of Respiratory and Critical Medicine, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Hua Su
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Chao Yan
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Wanghao Xin
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
| | - Kejing Ying
- Department of Respiratory and Critical Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
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Franco-Moreno A, Brown-Lavalle D, Rodríguez-Ramírez N, Muñoz-Roldán C, Rubio-Aguilera AI, Campos-Arenas M, Muñoz-Rivas N, Moya-Mateo E, Ruiz-Giardín JM, Pardo-Guimerá V, Ulla-Anes M, Pedrero-Tomé R, Torres-Macho J, Bustamante-Fermosel A. Clinical prediction model for pulmonary thrombosis diagnosis in hospitalized patients with SARS-CoV-2 infection. J Clin Transl Res 2023; 9:59-68. [PMID: 37034002 PMCID: PMC10075091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Aim We aimed to develop a clinical prediction model for pulmonary thrombosis (PT) diagnosis in hospitalized COVID-19 patients. Methods Non-intensive care unit hospitalized COVID-19 patients who underwent a computed tomography pulmonary angiogram (CTPA) for suspected PT were included in the study. Demographic, clinical, analytical, and radiological variables as potential factors associated with the presence of PT were selected. Multivariable Cox regression analysis to develop a score for estimating the pre-test probability of PT was performed. The score was internally validated by bootstrap analysis. Results Among the 271 patients who underwent a CTPA, 132 patients (48.7%) had PT. Heart rate >100 bpm (OR = 4.63 [95% CI: 2.30-9.34]; P < 0.001), respiratory rate >22 bpm (OR = 5.21 [95% CI: 2.00-13.54]; P < 0.001), RALE score ≥4 (OR = 3.24 [95% CI: 1.66-6.32]; P < 0.001), C-reactive protein (CRP) >100 mg/L (OR = 2.10 [95% CI: 0.95-4.63]; P = 0.067), and D-dimer >3.000 ng/mL (OR = 6.86 [95% CI: 3.54-13.28]; P < 0.001) at the time of suspected PT were independent predictors of thrombosis. Using these variables, we constructed a nomogram (CRP, Heart rate, D-dimer, RALE score, and respiratory rate [CHEDDAR score]) for estimating the pre-test probability of PT. The score showed a high predictive accuracy (area under the receiver-operating characteristics curve = 0.877; 95% CI: 0.83-0.92). A score lower than 182 points on the nomogram confers a low probability for PT with a negative predictive value of 92%. Conclusions CHEDDAR score can be used to estimate the pre-test probability of PT in hospitalized COVID-19 patients outside the intensive care unit. Relevance for Patients Developing a new clinical prediction model for PT diagnosis in COVID-19 may help in the triage of patients, and limit unnecessary exposure to radiation and the risk of nephrotoxicity due to iodinated contrast.
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Affiliation(s)
- Anabel Franco-Moreno
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
- Corresponding author: Anabel Franco-Moreno Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre. Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | - David Brown-Lavalle
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
- Corresponding author: Anabel Franco-Moreno Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre. Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | | | - Candela Muñoz-Roldán
- Department of Radiology, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Ana Ignes Rubio-Aguilera
- Department of Radiology, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Maria Campos-Arenas
- Department of Radiology, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Nuria Muñoz-Rivas
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Eva Moya-Mateo
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | | | - Virginia Pardo-Guimerá
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Mariano Ulla-Anes
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
| | - Roberto Pedrero-Tomé
- EPINUT-UCM (Ref. 920325) Investigation Group, Universidad Complutense de Madrid, Madrid, Spain
- Fundación para la Investigación e Innovación Biomédica de los Hospitales Universitarios Infanta Leonor y del Sureste, Madrid, Spain
| | - Juan Torres-Macho
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
- Corresponding author: Anabel Franco-Moreno Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre. Gran Via del Este Avenue, 80, 28031, Madrid, Spain.
| | - Ana Bustamante-Fermosel
- Department of Internal Medicine, Hospital Universitario Infanta Leonor–Virgen de la Torre, Madrid, Spain
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Franco-Moreno A, Brown-Lavalle D, Bustamante-Fermosel A. Prediction of pulmonary embolism in patients with SARS-CoV-2 infection. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:137-138. [PMID: 36628354 PMCID: PMC9816076 DOI: 10.1016/j.medcle.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Indexed: 01/09/2023]
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Franco-Moreno A, Brown-Lavalle D, Bustamante-Fermosel A. [Prediction of pulmonary embolism in patients with SARS-CoV-2 infection]. Med Clin (Barc) 2023; 160:137-138. [PMID: 36379734 PMCID: PMC9595364 DOI: 10.1016/j.medcli.2022.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Anabel Franco-Moreno
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, España.
| | - David Brown-Lavalle
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, España
| | - Ana Bustamante-Fermosel
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, España
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Franco-Moreno A, Bustamante-Fermosel A, Ruiz-Giardin J, Muñoz-Rivas N, Torres-Macho J, Brown-Lavalle D. Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review. Rev Clin Esp 2023; 223:40-49. [PMID: 36241500 PMCID: PMC9492501 DOI: 10.1016/j.rceng.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. METHODS A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. RESULTS Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level <3000ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. CONCLUSIONS Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed.
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Affiliation(s)
- A.I. Franco-Moreno
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, Spain,Corresponding author
| | - A. Bustamante-Fermosel
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, Spain
| | - J.M. Ruiz-Giardin
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - N. Muñoz-Rivas
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, Spain
| | - J. Torres-Macho
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, Spain
| | - D. Brown-Lavalle
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, Spain
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Franco-Moreno A, Bustamante-Fermosel A, Ruiz-Giardin J, Muñoz-Rivas N, Torres-Macho J, Brown-Lavalle D. [Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review]. Rev Clin Esp 2023; 223:40-49. [PMID: 35945950 PMCID: PMC9353599 DOI: 10.1016/j.rce.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 01/06/2023]
Abstract
Background and objective Clinical prediction models determine the pre-test probability of pulmonary embolism (PE) and assess the need for tests for these patients. Coronavirus infection is associated with a greater risk of PE, increasing its severity and conferring a worse prognosis. The pathogenesis of PE appears to be different in patients with and without SARS-CoV-2 infection. This systematic review aims to discover the utility of probability models developed for PE in patients with COVID-19 by reviewing the available literature. Methods A literature search on the PubMed, Scopus, and EMBASE databases was carried out. All studies that reported data on the use of clinical prediction models for PE in patients with COVID-19 were included. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. Results Thirteen studies that evaluated five prediction models (Wells score, Geneva score, YEARS algorithm, and PERC and PEGeD clinical decision rules) were included. The different scales were used in 1,187 patients with COVID-19. Overall, the models showed limited predictive ability. The two-level Wells score with low (or unlikely) clinical probability in combination with a D-dimer level < 3000 ng/mL or a normal bedside lung ultrasound showed an adequate correlation for ruling out PE. Conclusions Our systematic review suggests that the clinical prediction models available for PE that were developed in the general population are not applicable to patients with COVID-19. Therefore, their use is in clinical practice as the only diagnostic screening tool is not recommended. New clinical probability models for PE that are validated in these patients are needed.
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Affiliation(s)
- A.I. Franco-Moreno
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, España,Autor para correspondencia
| | - A. Bustamante-Fermosel
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, España
| | - J.M. Ruiz-Giardin
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - N. Muñoz-Rivas
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, España
| | - J. Torres-Macho
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, España
| | - D. Brown-Lavalle
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor - Hospital Virgen de la Torre, Madrid, España
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Vio R, Giordani AS, Stefil M, Alturki A, Russo V, China P, Gasperetti A, Schiavone M, Čulić V, Biondi-Zoccai G, Themistoclakis S, Lip GY, Proietti R. Therapeutic vs. prophylactic anticoagulation in COVID-19 patients: a systematic review and meta-analysis of real-world studies. Minerva Cardiol Angiol 2022; 70:652-662. [PMID: 36305780 DOI: 10.23736/s2724-5683.22.06230-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Coagulopathy, in the form of either venous or arterial thromboembolism, is one of the most severe sequelae of coronavirus disease (COVID-19) and has been associated with poorer outcomes. However, the role of therapeutic anticoagulation (tAC) or prophylactic anticoagulation (pAC) in COVID-19 patients has not been definitely established. Therefore, the aim of this systematic review and meta-analysis was to gather all the available real-world data in the field and to provide a reliable effect size of the effect on mortality of tAC compared to pAC in COVID-19 patients. EVIDENCE ACQUISITION Real-world studies (RWS) were identified by searching electronic databases from inception to 31st October, 2021. Randomized controlled trials were excluded. Mortality and bleedings were considered as primary and secondary outcomes, respectively. EVIDENCE SYNTHESIS 10 RWS and 5541 patients were included in the analysis. Overall, tAC was associated with lower mortality (HR=0.62, 95% CI: 0.54-0.71). There was asymmetry at the funnel plot suggesting publication bias, that was not confirmed at the Egger test (P=0.07). For the secondary endpoint, there was a non-statistically significant tendency for more bleedings in patients treated with tAC compared to pAC (RR=1.75, 95% CI: 0.81-3.81). CONCLUSIONS Our meta-analysis, based on RWS and adjusted estimates of risk, suggests a survival benefit of tAC over pAC in COVID-19 patients in the real world.
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Affiliation(s)
- Riccardo Vio
- Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy -
| | - Andrea S Giordani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Maria Stefil
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Ahmed Alturki
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Monaldi Hospital, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Paolo China
- Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - Alessio Gasperetti
- Unit of Cardiology, ASST Fatebenefratelli Sacco-Luigi Sacco University Hospital, Milan, Italy
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marco Schiavone
- Unit of Cardiology, ASST Fatebenefratelli Sacco-Luigi Sacco University Hospital, Milan, Italy
| | - Viktor Čulić
- School of Medicine, University of Split, Split, Croatia
- Department of Cardiology and Angiology, University Hospital Centre Split, Split, Croatia
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Sakis Themistoclakis
- Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy
| | - Gregory Y Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Riccardo Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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Zhou C, Guang Y, Luo Y, Ge H, Wei H, Liu H, Zhang J, Pan P, Zhang J, Peng L, Aili A, Liu Y, Pu J, Zhong X, Wang Y, Yi Q, Zhou H. Superior Predictive Value of D-Dimer to the Padua Prediction Score for Venous Thromboembolism in Inpatients with AECOPD: A Multicenter Cohort Study. Int J Chron Obstruct Pulmon Dis 2022; 17:2711-2722. [PMID: 36304969 PMCID: PMC9595060 DOI: 10.2147/copd.s380418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background The optimal tool for risk prediction of venous thromboembolism (VTE) in inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is still unknown. This study aimed to evaluate whether D-dimer could predict the risk of VTE in inpatients with AECOPD compared to the Padua Prediction Score (PPS). Methods Inpatients with AECOPD were prospectively enrolled from seven medical centers in China between December 2018 and June 2020. On admission, D-dimer was detected, PPS was calculated for each patient, and the incidence of 2-month VTE was investigated. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of D-dimer and PPS on VTE development, and the best cut-off value for both methods was evaluated through the Youden index. Results Among the 4468 eligible patients with AECOPD, 90 patients (2.01%) developed VTE within 2 months after admission. The area under the receiver operating characteristic curves (AUCs) of D-dimer for predicting VTE were significantly higher than those of the PPS both in the overall cohort (0.724, 95% CI 0.672–0.776 vs 0.620, 95% CI 0.562–0.679; P<0.05) and the subgroup of patients without thromboprophylaxis (0.747, 95% CI 0.695–0.799 vs 0.640, 95% CI 0.582–0.698; P<0.05). By calculating the Youden Index, the best cut-off value of D-dimer was determined to be 0.96 mg/L with an AUC of 0.689, which was also significantly better than that of the PPS with the best cut-off value of 2 (AUC 0.581, P=0.007). After the combination of D-dimer with PPS, the AUC (0.621) failed to surpass D-dimer alone (P=0.104). Conclusion D-dimer has a superior predictive value for VTE over PPS in inpatients with AECOPD, which might be a better choice to guide thromboprophylaxis in inpatients with AECOPD due to its effectiveness and convenience. Clinical Trial Registration Chinese Clinical Trail Registry NO. ChiCTR2100044625; URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.
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Affiliation(s)
- Chen Zhou
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yujie Guang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yuanming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Huiqing Ge
- Department of Respiratory and Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Hailong Wei
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Leshan, Leshan, Sichuan Province, People’s Republic of China
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Jianchu Zhang
- Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Pinhua Pan
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Jiarui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Lige Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Adila Aili
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yu Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Jiaqi Pu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Xia Zhong
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yixi Wang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China,Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, Cancer Hospital Affiliate to School of Medicine, UESTC, Chengdu, Sichuan Province, People’s Republic of China
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China,Correspondence: Haixia Zhou, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Guo-Xue-Xiang 37#, Wuhou District, Chengdu, Sichuan Province, 610041, People’s Republic of China, Tel +86-28-85422571, Fax +86-28-85422571, Email
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Narayan M, Leahy N, Alqunaibit D, An A, de Angelis P, Bronstein M, Eachempati S, Gibson C, Kelly A, Minneman JA, Shou J, Smith KE, Villegas C, Winchell RJ, Witenko C, Barie PS. Thrombotic Events and Anticoagulation-Related Bleeding Complications in Critically Ill Patients with Coronavirus Disease 2019. Surg Infect (Larchmt) 2022; 23:705-711. [PMID: 36083247 DOI: 10.1089/sur.2022.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Thrombosis (T) is common in coronavirus disease 2019 (COVID-19) patients, and d-dimer concentrations correlate with outcomes. Controversy exists with regards to anticoagulation (AC) for patients. We implemented a full-heparinization AC protocol from the onset of the pandemic and hypothesized that a safety signal would be undetectable. Patients and Methods: Prospective evaluation of 111 patients with COVID-19 critical illness hospitalized from March to June 2020. All patients received therapeutic heparinoid-based AC from admission. Incidences of T, bleeding (B), or both (BT) were noted. The primary outcome was mortality. Kruskal-Wallis test and logistic regression were performed. Results are expressed as n (%), median (interquartile range) and odds ratios with 95% confidence intervals. Alpha was set at 0.05. Results: Thirty-two patients (28%) had T, 23 (20%) had B, and 14 (12%) had BT; 42 (40%) patients were unaffected. Two logistic regression models (outcome = mortality) evaluated BT as T, or BT as B. For BT as T, neither T, B, nor male gender predicted mortality; similarly, for BT as B, neither T, B, nor male gender predicted mortality. Factors associated with higher odds of death included higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00-1.13; p = 0.0045), higher d-dimer concentration (OR, 1.00; 95% CI, 1.00-1.01; p = 0.043), and higher activated partial thromboplastin time (aPTT; OR, 1.09; 95% CI, 1.02-1.16; p = 0.010). Conclusions: Neither T nor B predicted mortality in this prospective cohort of anticoagulated patients with COVID-19 critical illness. These data support continued full-dose heparinoid prophylaxis.
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Affiliation(s)
- Mayur Narayan
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Nicole Leahy
- Trauma Program, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Dalia Alqunaibit
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Anjile An
- Division of Biostatistics, Department of Population Health Sciences, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Paolo de Angelis
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Matthew Bronstein
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Soumitra Eachempati
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Cameron Gibson
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Anton Kelly
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer A Minneman
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jian Shou
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Kira E Smith
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Cassandra Villegas
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Robert J Winchell
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Division of Medical Ethics, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Corey Witenko
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philip S Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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10
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Lippi G, Mullier F, Favaloro EJ. D-dimer: old dogmas, new (COVID-19) tricks. Clin Chem Lab Med 2022; 61:841-850. [PMID: 35849562 DOI: 10.1515/cclm-2022-0633] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 12/22/2022]
Abstract
Abstract
D-dimer is a fibrin degradation product encompassing multiple cross-linked D domains and/or E domains present in the original fibrinogen molecule, whose generation is only theoretically possible when hemostasis and fibrinolysis pathways are concomitantly activated. D-dimer measurement has now become a pillar in the diagnosis/exclusion and prognostication of venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC), when incorporated into validated clinical algorithms and especially using age-adjusted diagnostic thresholds. Although emerging evidence is also supporting its use for predicting the duration of anticoagulant therapy in certain categories of patients, the spectrum of clinical applications is constantly expanding beyond traditional thrombotic pathologies to the diagnosis of acute aortic dissection, acute intestinal ischemia and cerebral venous thrombosis among others, embracing also clinical management of coronavirus disease 2019 (COVID-19). Recent findings attest that D-dimer elevations are commonplace in patients with severe acute respiratory syndrome (SARS-CoV-2) infection (especially in those with thrombosis), its value predicts the clinical severity (up to death) of COVID-19 and remains more frequently increased in COVID-19 patients with post-discharge clinical sequelae. Further, D-dimer-based anticoagulant escalation may be associated with a lower risk of death in patients with severe SARS-CoV-2 infection and, finally, D-dimer elevation post-COVID-19 vaccination mirrors an increased risk of developing vaccine-induced thrombocytopenia and thrombosis (VITT).
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry and School of Medicine , University of Verona , Verona , Italy
| | - François Mullier
- Namur Thrombosis and Hemostasis Center (NTHC) , Université catholique de Louvain, CHU UCL Namur , Hematology Laboratory , Yvoir , Belgium
| | - Emmanuel J. Favaloro
- Department of Haematology , Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital , Westmead , NSW , Australia
- Sydney Centres for Thrombosis and Haemostasis , Westmead , NSW , Australia
- Faculty of Science and Health , Charles Sturt University , Wagga Wagga , NSW , Australia
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11
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Abstract
Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are prone to venous, cerebrovascular, and coronary thrombi, particularly those with severe coronavirus disease 2019 (COVID-19). The pathogenesis is multifactorial and likely involves proinflammatory cascades, development of coagulopathy, and neutrophil extracellular traps, although further investigations are needed. Elevated levels of D-dimers are common in patients with COVID-19 and cannot be used in isolation to predict venous thromboembolism in people with SARS-CoV-2. If given early in hospital admission, therapeutic-dose heparin improves clinical outcomes in patients with moderate COVID-19. To date, antithrombotics have not improved outcomes in patients with severe COVID-19.
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Affiliation(s)
- Derek V Gibbs
- Division of General Internal Medicine, Department of Medicine, University of Cincinnati School of Medicine, 231 Albert Sabin Way, MSB 6065, Cincinnati, OH 45267, USA
| | - Satya S Shreenivas
- Division of Cardiology, The Christ Hospital, 2139 Auburn Avenue, Cincinnati, OH 45219, USA
| | - Kristin M Hudock
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Cincinnati School of Medicine, 231 Albert Sabin Way, MSB 6053, Cincinnati, OH 45267, USA; Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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12
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Tamayo-Velasco Á, Bombín-Canal C, Cebeira MJ, Sánchez-De Prada L, Miramontes-González JP, Martín-Fernández M, Peñarrubia-Ponce MJ. Full Characterization of Thrombotic Events in All Hospitalized COVID-19 Patients in a Spanish Tertiary Hospital during the First 18 Months of the Pandemic. J Clin Med 2022; 11:jcm11123443. [PMID: 35743512 PMCID: PMC9225147 DOI: 10.3390/jcm11123443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/29/2022] [Accepted: 06/13/2022] [Indexed: 02/06/2023] Open
Abstract
The presence of a procoagulant state, COVID-19-related coagulopathy, and an increased rate of thrombotic events (TEs) is widely known about. However, descriptive studies are scarce. Here, we conducted a large retrospective study including 2894 hospitalized COVID-19 patients followed up during the first 18 months of the pandemic to completely characterize any TE. Major TEs showed a 3.45% incidence rate. TEs were associated with increased intubation/90-day mortality risk [OR = 1.71, 95% CI (1.12−2.61), p < 0.013]. Venous thrombotic events (VTEs) were more frequent than arterial thrombotic events (ATEs) (72% vs. 28%), associated with enhanced levels of D-dimer (cross-linked fibrin derivatives formed during thrombolysis), which were related to mortality but more useful for early detection of thrombosis. In this regard, D-dimer plasma levels above 2014 µg/mL at hospital admission identify TEs with 91% accuracy (AUC = 0.91, p < 0.001), rising to almost 95% (AUC = 0.94, p < 0.001) with a cut-off value of 2666 µg/mL in VTEs. Moreover, 41% of TEs occurred in patients receiving LMWH thromboprophylactic treatments in hospital or domiciliary therapies. SARS-CoV-2 infection along with a sedentary lifestyle derived from the confinement in 2020 could be more determinant than a procoagulant state in patients with risk factors for TEs. Furthermore, the normal results obtained from the thrombophilia study after the acute process are linked to this independent procoagulant state and to SARS-CoV-2-derived coagulopathy.
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Affiliation(s)
- Álvaro Tamayo-Velasco
- Department of Haematology and Hemotherapy, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (Á.T.-V.); (C.B.-C.); (M.J.C.); (M.J.P.-P.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005 Valladolid, Spain
| | - Carolina Bombín-Canal
- Department of Haematology and Hemotherapy, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (Á.T.-V.); (C.B.-C.); (M.J.C.); (M.J.P.-P.)
| | - María José Cebeira
- Department of Haematology and Hemotherapy, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (Á.T.-V.); (C.B.-C.); (M.J.C.); (M.J.P.-P.)
| | - Laura Sánchez-De Prada
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | - José Pablo Miramontes-González
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad Pontificia de Salamanca, 37002 Salamanca, Spain;
- Department of Internal Medicine, Hospital Universitario Río Hortega, 47012 Valladolid, Spain
| | - Marta Martín-Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47005 Valladolid, Spain
- Department of Medicine, Toxicology and Dermatology, Universidad de Valladolid, 47003 Valladolid, Spain
- Correspondence:
| | - María Jesús Peñarrubia-Ponce
- Department of Haematology and Hemotherapy, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (Á.T.-V.); (C.B.-C.); (M.J.C.); (M.J.P.-P.)
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13
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Auron M, Porres-Aguilar M, Cameron SJ. COVID-19 and Elevated D-Dimer: A Tale of Caution. J Gen Intern Med 2022; 37:1304-1305. [PMID: 34989999 PMCID: PMC8734549 DOI: 10.1007/s11606-021-07280-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Moises Auron
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Mateo Porres-Aguilar
- Division of Hospital Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Scott J Cameron
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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14
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Riera-Mestre A, Jara-Palomares L, Lecumberri R, Trujillo-Santos J, Grau E, Blanco-Molina A, Piera Carbonell A, Jiménez S, Frías Vargas M, Fuset MP, Bellmunt-Montoya S, Monreal M, Jiménez D. PICO Questions and DELPHI Methodology for the Management of Venous Thromboembolism Associated with COVID-19. Viruses 2021; 13:2128. [PMID: 34834935 PMCID: PMC8624706 DOI: 10.3390/v13112128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
Patients with coronavirus disease 2019 (COVID-19) have a higher risk of venous thromboembolic disease (VTE) than patients with other infectious or inflammatory diseases, both as macrothrombosis (pulmonar embolism and deep vein thrombosis) or microthrombosis. However, the use of anticoagulation in this scenario remains controversial. This is a project that used DELPHI methodology to answer PICO questions related to anticoagulation in patients with COVID-19. The objective was to reach a consensus among multidisciplinary VTE experts providing answers to those PICO questions. Seven PICO questions regarding patients with COVID-19 responded with a broad consensus: 1. It is recommended to avoid pharmacological thromboprophylaxis in most COVID-19 patients not requiring hospital admission; 2. In most hospitalized patients for COVID-19 who are receiving oral anticoagulants before admission, it is recommended to replace them by low molecular weight heparin (LMWH) at therapeutic doses; 3. Thromboprophylaxis with LMWH at standard doses is suggested for COVID-19 patients admitted to a conventional hospital ward; 4. Standard-doses thromboprophylaxis with LMWH is recommended for COVID-19 patients requiring admission to Intensive Care Unit; 5. It is recommended not to determine D-Dimer levels routinely in COVID-19 hospitalized patients to select those in whom VTE should be suspected, or as a part of the diagnostic algorithm to rule out or confirm a VTE event; 6. It is recommended to discontinue pharmacological thromboprophylaxis at discharge in most patients hospitalized for COVID-19; 7. It is recommended to withdraw anticoagulant treatment after 3 months in most patients with a VTE event associated with COVID-19. The combination of PICO questions and DELPHI methodology provides a consensus on different recommendations for anticoagulation management in patients with COVID-19.
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Affiliation(s)
- Antoni Riera-Mestre
- Internal Medicine Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08907 Barcelona, Spain
| | - Luis Jara-Palomares
- Medical-Surgical Unit for Respiratory Diseases, Virgen del Rocío University Hospital, 28029 Sevilla, Spain;
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | - Ramón Lecumberri
- Hematology Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- Center for Biomedical Research Network on Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Javier Trujillo-Santos
- Internal Medicine Department, Hospital General Universitario Santa Lucía, 30204 Cartagena, Spain;
- Faculty of Health Sciences, Universidad Católica San Antonio de Murcia (UCAM), 30107 Murcia, Spain;
| | - Enric Grau
- Hematology Department, Lluis Alcanyis de Xativa Hospital, 46800 Valencia, Spain;
| | | | | | - Sonia Jiménez
- Emergency Area, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
| | | | - Mari Paz Fuset
- Intensive Medicine Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain;
| | - Sergi Bellmunt-Montoya
- Angiology and Vascular Surgery Department, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
- Surgery Department, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Manuel Monreal
- Faculty of Health Sciences, Universidad Católica San Antonio de Murcia (UCAM), 30107 Murcia, Spain;
- Internal Medicine Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain
| | - David Jiménez
- Center for Biomedical Research in Respiratory Diseases Network (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Pulmonology Department, Ramón y Cajal Hospital (IRYCIS), 28034 Madrid, Spain
- Department of Medicine, Alcala University, 28805 Madrid, Spain
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