Deep vein thrombosis and pulmonary embolism among hospitalized coronavirus disease 2019–positive patients predicted for higher mortality and prolonged intensive care unit and hospital stays in a multisite healthcare system

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) NY), 2021-11, Vol.9 (6), p.1361-1370.e1
• Main Authors: Erben, Young, Franco-Mesa, Camila, Gloviczki, Peter, Stone, William, Quinones-Hinojoas, Alfredo, Meltzer, Andrew J., Lin, Michelle, Greenway, Melanie R.F., Hamid, Osman, Devcic, Zlatko, Toskich, Beau, Ritchie, Charles, Lamb, Christopher J., De Martino, Randall R., Siegel, Jason, Farres, Houssan, Hakaim, Albert G., Sanghavi, Devang K., Li, Yupeng, Rivera, Candido, Moreno-Franco, Pablo, O'Keefe, Nancy L., Gopal, Neethu, Marquez, Christopher P., Huang, Josephine F., Kalra, Manju, Shields, Raymond, Prudencio, Mercedes, Gendron, Tania, McBane, Robert, Park, Myung, Hoyne, Jonathan B., Petrucelli, Leonard, O'Horo, John C., Meschia, James F.
• Format: Article
• Language: English
• Subjects: COVID-19; COVID-19 and venous disease; Deep venous thrombosis; Hospitalized COVID-19 patients; Pulmonary embolism
• ISSN: 2213-333X; 2213-3348
• DOI: 10.1016/j.jvsv.2021.03.009

We assessed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients with coronavirus disease 2019 (COVID-19) compared with that in a matched cohort with similar cardiovascular risk factors and the effects of DVT and PE on the hospital course. We performed a retrospective review of prospectively collected data from COVID-19 patients who had been hospitalized from March 11, 2020 to September 4, 2020. The patients were randomly matched in a 1:1 ratio by age, sex, hospital of admission, smoking history, diabetes mellitus, and coronary artery disease with a cohort of patients without COVID-19. The primary end point was the incidence of DVT/PE and the odds of developing DVT/PE using a conditional logistic regression model. The secondary end point was the hospitalization outcomes for COVID-19 patients with and without DVT/PE, including mortality, intensive care unit (ICU) admission, ICU stay, and length of hospitalization (LOH). Multivariable regression analysis was performed to identify the variables associated with mortality, ICU admission, discharge disposition, ICU duration, and LOH. A total of 13,310 patients had tested positive for COVID-19, 915 of whom (6.9%) had been hospitalized across our multisite health care system. The mean age of the hospitalized patients was 60.8 ± 17.0 years, and 396 (43.3%) were women. Of the 915 patients, 82 (9.0%) had had a diagnosis of DVT/PE confirmed by ultrasound examination of the extremities and/or computed tomography angiography of the chest. The odds of presenting with DVT/PE in the setting of COVID-19 infection was greater than that without COVID-19 infection (0.6% [5 of 915] vs 9.0% [82 of 915]; odds ratio [OR], 18; 95% confidence interval [CI], 8.0-51.2; P < .001). The vascular risk factors were not different between the COVID-19 patients with and without DVT/PE. Mortality (P = .02), the need for ICU stay (P < .001), duration of ICU stay (P < .001), and LOH (P < .001) were greater in the DVT/PE cohort than in the cohort without DVT/PE. On multivariable logistic regression analysis, the hemoglobin (OR, 0.71; 95% CI, 0.46-0.95; P = .04) and D-dimer (OR, 1.0; 95% CI, 0.33-1.56; P = .03) levels were associated with higher mortality. Higher activated partial thromboplastin times (OR, 1.1; 95% CI, 1.00-1.12; P = .03) and higher interleukin-6 (IL-6) levels (OR, 1.0; 95% CI, 1.01-1.07; P = .05) were associated with a greater risk of ICU admission. IL-6 (OR, 1.0; 95% CI, 1.00-1.02; P =