Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
J Thromb Thrombolysis. 2021 Jan;51(1):33-39. doi: 10.1007/s11239-020-02181-w.
Few data are available on the incidence of deep vein thrombosis (DVT) in critically ill COVID-19 with thrombosis prophylaxis. This study retrospectively included 88 patients in the ICU with critically ill COVID-19 at Jinyintan Hospital in Wuhan, China. All patients underwent compression ultrasonography for identifying DVT. Firth logistic regression was used to examine the association of DVT with sex, age, hypoalbuminemia, D-dimer, and SOFA score. The median (interquartile range [IQR]) age and SOFA score of 88 patients were 63 (55-71) years old and 5 (4-6), respectively. Despite all patients receiving guideline-recommended low-molecular-weight heparin (LMWH) thromboprophylaxis, the incidence of DVT was 46% (95% CI 35-56%). Proximal DVT was recognized in 9% (95% CI 3-15%) of the patients, while 46% (95% CI 35-56%) of patients had distal DVT. All of the proximal DVT combined with distal DVT. Risk factors of DVT extension occurred in all distal DVT patients. As Padua score ≥ 4 or IMPROVE score ≥ 2, 53% and 46% of patients had DVT, respectively. Mortality was higher in patients with acute DVT (30%) compared with non-DVT (17%), but did not reach statistical significance. Hypoalbuminemia (odds ratio [OR], 0.17; 95% CI 0.06-0.05, P = 0.001), higher SOFA score (OR per IQR, 2.07; 95% CI 1.38-3.39, P = 0.001), and elevated D-dimer (OR per IQR, 1.04; 95% CI 1.03-1.84, P = 0.029) were significant DVT risk factors in multivariable analyses. High incidence of DVT was identified in patients with critically ill COVID-19, despite the use of guideline-recommended pharmacologic thromboprophylaxis. The presence of hypoalbuminemia, higher SOFA score, and elevated D-dimer were significantly independent risk factors of DVT. More effective VTE prevention and management strategies may need to be addressed.
在中国武汉金银潭医院的 ICU 中，有 88 例 COVID-19 危重症患者接受了血栓预防。所有患者均接受了压缩超声检查以确定 DVT。使用 Firth 逻辑回归检查 DVT 与性别、年龄、低蛋白血症、D-二聚体和 SOFA 评分的关联。88 例患者的中位（四分位距[IQR]）年龄和 SOFA 评分为 63（55-71）岁和 5（4-6）。尽管所有患者均接受了指南推荐的低分子肝素（LMWH）血栓预防，但 DVT 的发生率为 46%（95%CI 35-56%）。近端 DVT 见于 9%（95%CI 3-15%）的患者，而 46%（95%CI 35-56%）的患者存在远端 DVT。所有近端 DVT 均与远端 DVT 合并。所有远端 DVT 患者均发生 DVT 扩展的危险因素。Padua 评分≥4 或 IMPROVE 评分≥2 的患者分别有 53%和 46%发生 DVT。与非 DVT 患者（17%）相比，急性 DVT 患者的死亡率更高（30%），但无统计学意义。低蛋白血症（比值比[OR]，0.17；95%CI 0.06-0.05，P=0.001）、更高的 SOFA 评分（IQR 每分，2.07；95%CI 1.38-3.39，P=0.001）和升高的 D-二聚体（IQR 每分，1.04；95%CI 1.03-1.84，P=0.029）是多变量分析中 DVT 的显著危险因素。尽管使用了指南推荐的药物性血栓预防，但 COVID-19 危重症患者中仍存在较高的 DVT 发生率。低蛋白血症、更高的 SOFA 评分和升高的 D-二聚体是 DVT 的显著独立危险因素。可能需要制定更有效的 VTE 预防和管理策略。
