Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Department of Gastroenterology, Saddleback Medical Group, Laguna Hills, CA.
Crit Care Med. 2020 Sep;48(9):e783-e790. doi: 10.1097/CCM.0000000000004466.
The aim of this study was to determine the frequency of venous thromboembolism in critically ill coronavirus disease 2019 patients and associate a degree of inflammatory marker elevation to venous thromboembolism development.
An observational study that identified patients with severe coronavirus disease 2019 between March 12, 2020, and March 31, 2020. Data reported are those available through May 6, 2020.
A multicenter study including three Indianapolis area academic hospitals.
Two-hundred forty consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection were admitted to one of three hospitals. One-hundred nine critically ill coronavirus disease 2019 patients admitted to the ICU were included in the analysis.
All patients received routine subcutaneous chemical venous thromboembolism prophylaxis.
The primary outcome of this study was to determine the frequency of venous thromboembolism and the degree of inflammatory and coagulation marker elevation associated with venous thromboembolism development. Descriptive statistics outlined the frequency of venous thromboembolism at any time during severe coronavirus disease 2019. Clinical course and laboratory metrics were compared between patients that developed venous thromboembolism and patients that did not develop venous thromboembolism. Hypercoagulable thromboelastography was defined as two or more hypercoagulable parameters.
One-hundred nine patients developed severe coronavirus disease 2019 requiring ICU care. The mean (± SD) age was 61 ± 16 years and 57% were male. Seventy-five patients (69%) were discharged home, 7 patients (6%) remain in the hospital, and 27 patients (25%) died. Venous thromboembolism was diagnosed in 31 patients (28%) 8 ± 7 days after hospital admission, including two patients diagnosed with venous thromboembolism at presentation to the hospital. Elevated admission D-dimer and peak D-dimer were associated with venous thromboembolism development (p < 0.05). D-dimer greater than 2,600 ng/mL predicted venous thromboembolism with an area under the receiver operating characteristic curve of 0.760 (95% CI, 0.661-0.858; p < 0.0001), sensitivity of 89.7%, and specificity of 59.5%. Twelve patients (11%) had thromboelastography performed and 58% of these patients had a hypercoagulable study. The calculated coagulation index was hypercoagulable in 50% of patients with thromboelastography.
These data show that coronavirus disease 2019 results in a hypercoagulable state. Routine chemical venous thromboembolism prophylaxis may be inadequate in preventing venous thromboembolism in severe coronavirus disease 2019.
本研究旨在确定危重症 2019 年冠状病毒病（COVID-19）患者发生静脉血栓栓塞症（venous thromboembolism，VTE）的频率，并评估炎症标志物升高的程度与 VTE 发生的相关性。
一项观察性研究，纳入 2020 年 3 月 12 日至 3 月 31 日期间确诊的严重 COVID-19 患者。报告的数据截至 2020 年 5 月 6 日。
印第安纳波利斯地区的三家多中心研究机构。
共有 240 例确诊为严重急性呼吸综合征冠状病毒 2 感染的患者入住其中一家医院。109 例入住 ICU 的危重症 COVID-19 患者纳入分析。
所有患者均接受常规皮下化学性 VTE 预防。
本研究的主要结局是确定 VTE 的发生频率以及与 VTE 发生相关的炎症和凝血标志物升高的程度。描述性统计方法概述了在严重 COVID-19 期间任何时间点 VTE 的发生频率。比较了发生 VTE 与未发生 VTE 的患者的临床病程和实验室指标。高凝性血栓弹力图定义为存在两个或更多高凝性参数。
109 例患者发展为需要 ICU 治疗的严重 COVID-19。平均（±标准差）年龄为 61±16 岁，57%为男性。75 例（69%）患者出院回家，7 例（6%）仍在住院，27 例（25%）患者死亡。入院后 8±7 天诊断出 31 例（28%）VTE，包括 2 例在入院时即诊断为 VTE。入院时 D-二聚体升高和峰值 D-二聚体与 VTE 发生相关（p<0.05）。D-二聚体>2600ng/mL 预测 VTE 的曲线下面积为 0.760（95%CI，0.661-0.858；p<0.0001），敏感度为 89.7%，特异度为 59.5%。12 例（11%）患者行血栓弹力图检查，其中 58%的患者检查结果为高凝性。在接受血栓弹力图检查的患者中，50%的患者计算出的凝血指数呈高凝状态。
这些数据表明 COVID-19 可导致高凝状态。在严重 COVID-19 患者中，常规的化学性 VTE 预防可能不足以预防 VTE。
