TY - JOUR
T1 - Arterial and venous thrombosis in coronavirus 2019 disease (Covid-19)
T2 - relationship with mortality
AU - Violi, Francesco
AU - Ceccarelli, Giancarlo
AU - Cangemi, Roberto
AU - Cipollone, Francesco
AU - D'Ardes, Damiano
AU - Oliva, Alessandra
AU - Pirro, Matteo
AU - Rocco, Monica
AU - Alessandri, Francesco
AU - D'Ettorre, Gabriella
AU - Lichtner, Miriam
AU - Pignatelli, Pasquale
AU - Ferro, Domenico
AU - Ruberto, Franco
AU - Lip, Gregory Y H
AU - Pugliese, Francesco
AU - Mastroianni, Claudio Maria
AU - Intensive Care, Infectious Diseases COVID-19 Study Group of Sapienza University
N1 - © 2021. The Author(s).
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - Aged
KW - Aged, 80 and over
KW - C-Reactive Protein/analysis
KW - COVID-19/complications
KW - Coronary Artery Disease/epidemiology
KW - Female
KW - Fibrin Fibrinogen Degradation Products/analysis
KW - Humans
KW - Intensive Care Units/organization & administration
KW - Kaplan-Meier Estimate
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Mortality/trends
KW - Odds Ratio
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Thromboembolism/epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85109668508&partnerID=8YFLogxK
U2 - 10.1007/s11739-020-02621-8
DO - 10.1007/s11739-020-02621-8
M3 - Journal article
C2 - 34218413
SN - 1828-0447
VL - 16
SP - 1231
EP - 1237
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
IS - 5
ER -