Arterial and venous thrombosis in coronavirus 2019 disease (Covid-19): relationship with mortality

Francesco Violi*, Giancarlo Ceccarelli, Roberto Cangemi, Francesco Cipollone, Damiano D'Ardes, Alessandra Oliva, Matteo Pirro, Monica Rocco, Francesco Alessandri, Gabriella D'Ettorre, Miriam Lichtner, Pasquale Pignatelli, Domenico Ferro, Franco Ruberto, Gregory Y H Lip, Francesco Pugliese, Claudio Maria Mastroianni, Intensive Care, Infectious Diseases COVID-19 Study Group of Sapienza University

*Corresponding author for this work

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Abstract

BACKGROUND: Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse.

METHODS: Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered.

RESULTS: Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8-12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4-5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28-0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59-4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014-1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277-0.723; p = 0.001) predicted morality.

CONCLUSIONS: Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.

Original languageEnglish
JournalInternal and Emergency Medicine
Volume16
Issue number5
Pages (from-to)1231-1237
Number of pages7
ISSN1828-0447
DOIs
Publication statusPublished - Aug 2021

Bibliographical note

© 2021. The Author(s).

Keywords

  • Aged
  • Aged, 80 and over
  • C-Reactive Protein/analysis
  • COVID-19/complications
  • Coronary Artery Disease/epidemiology
  • Female
  • Fibrin Fibrinogen Degradation Products/analysis
  • Humans
  • Intensive Care Units/organization & administration
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Mortality/trends
  • Odds Ratio
  • Proportional Hazards Models
  • Prospective Studies
  • Thromboembolism/epidemiology

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