Plasma D-dimer value corrected by inflammatory markers in patients with SARS-CoV-2 infection: Its prognostic value in the diagnosis of venous thromboembolism

Improving guideline-concordant thromboprophylaxis prescribing for children admitted to hospital with COVID-19

BACKGROUND

The incidence of venous thrombo-embolism (VTE) in hospitalized children has increased by 130%-200% over the last two decades. Given this increase, many centers utilize electronic clinical decision support (CDS) to prognosticate VTE risk and recommend prophylaxis. SARS-CoV-2 infection (COVID-19) is a risk factor for VTE; however, CDS developed before the COVID-19 pandemic may not accurately prognosticate VTE risk in children with COVID-19. This study's objective was to identify areas to improve thromboprophylaxis recommendations for children with COVID-19.

METHODS

Inpatients with a positive COVID-19 test at admission were identified at a quaternary-care pediatric center between March 1, 2020 and January 20, 2022. The results of the institution's automated CDS thromboprophylaxis recommendations were compared to institutional COVID-19 thromboprophylaxis guidelines and to the actual thromboprophylaxis received. CDS optimization was performed to improve adherence to COVID-19 thromboprophylaxis recommendations.

RESULTS

Of the 329 patients included in this study, 106 (28.2%) were prescribed pharmaco-prophylaxis, 167 (50.8%) were identified by the institutional COVID-19 guidelines as requiring pharmaco-prophylaxis, and 45 (13.2%) were identified by the CDS as needing pharmaco-prophylaxis. On univariate analysis, only age 12 years or more was associated with recipient of appropriate prophylaxis (OR 1.78, 95% CI: 1.13-2.82, p = .013). Five patients developed VTEs; three had symptoms at presentation, two were identified as high risk for VTE by both the automated and best practice assessments but were not prescribed pharmaco-prophylaxis.

CONCLUSION

Automated thromboprophylaxis recommendations developed prior to the COVID-19 pandemic may not identify all COVID-19 patients needing pharmaco-prophylaxis. Existing CDS tools need to be updated to reflect COVID-19-specific risk factors for VTEs.

The effect of prescribing vitamin D analogues and serum vitamin D status on both contracting COVID-19 and clinical outcomes in kidney dialysis patients'

Aims

Vitamin D plays a role in innate immune system activation, and deficiency increases susceptibility to respiratory infections and disease severity including COVID‐19. We determined whether vitamin D levels and medications were associated with contracting COVID‐19, and disease severity defined by hospitalisation and dialysis patient mortality.

Methods

We reviewed serum vitamin D levels, and prescription of cholecalciferol and alfacalcidol along with corresponding medical records of adult dialysis patients from a United Kingdom tertiary centre between March 2020 and May 2021. COVID‐19 infection was determined by polymerase chain reaction (PCR) results.

Results

362 (35%) of 1035 dialysis patients tested PCR positive for COVID‐19. COVID‐19 positive patients had lower native median vitamin D (65 (39–95) versus 74 (40.5–101) nmol/L (p = .009) despite greater prescription of cholecalciferol (median 20 000 (20000‐20 000) versus 20 000 (0–20 000) IU/week), p < .001, but lower prescription of alfacalcidol 0 (0–3.0) versus 2.0 (0.–5.0) ug/week, p < .001. On multivariate logistic regression COVID‐19 infection was associated with haemodialysis versus peritoneal dialysis (p < .001), cholecalciferol dose (p < .001) and negatively with alfacalcidol (p < .001). However, serum vitamin D levels and alfacalcidol dosages were not significantly different for those requiring hospitalisation compared to those managed at home, although those who died were prescribed lower alfacalcidol dosages.

Conclusion

Dialysis patients who contracted COVID‐19 had lower levels of native vitamin D prior to COVID‐19 and were prescribed lower dosages of alfacalcidol. However, there was no association between vitamin D status and disease severity. This retrospective observational analysis supports a potential role for vitamin D and susceptibility to COVID‐19 infection in dialysis patients.

Vitamin D plays a key role in activating the innate immune system and deficiency increases susceptibility to respiratory infections. We report on the effect of vitamin D levels and medications in more than 1000 dialysis patients during the first two pandemic waves of COVID‐19.