Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Eur Rev Med Pharmacol Sci. 2021 Feb;25(4):2123-2130. doi: 10.26355/eurrev_202102_25118.
Diffuse thrombosis represents one of the most predominant causes of death by COVID-19 and SARS-CoV-2 infection seems to increase the risk of developing venous thromboembolic diseases (VTE). Aim of this study is to analyze the relationship between validated predictive scores for VTE such as IMPROVE and IMPROVEDD and: (1) Intensification of Care (IoC, admission to Pulmonology Department or Intensive Care Unit) (2) in-hospital mortality rate 3) 30-days mortality rate.
We retrospectively evaluated 51 adult patients with laboratory diagnosis of SARS-CoV-2 infection and calculated IMPROVE and IMPROVEDD scores. All patients underwent venous color-Doppler ultrasound of the lower limbs to assess the presence of superficial vein thrombosis (SVT) and/or deep vein thrombosis (DVT). Patients with normal values of D-dimer did not receive heparin therapy (LMWH); patients with ≥ 4 ULN values of D-dimer or with a diagnosis of DVT were treated with therapeutic LMWH dosage, while the remaining patients were treated with prophylactic LMWH dosages.
We found strong relations between IMPROVE score and the need for IoC and with the in-hospital mortality rate and between the IMPROVEDD score and the need for IoC. We defined that an IMPROVE score greater than 4 points was significantly associated to in-hospital mortality rate (p = 0.05), while an IMPROVEDD score greater than 3 points was associated with the need for IoC (p = 0.04). Multivariate logistic analysis showed how IMPROVE score was significantly associated to in-hospital and 30-days mortality rates.
IMPROVE score can be considered an independent predictor of in-hospital and 30-days mortality.
弥漫性血栓形成是 COVID-19 导致死亡的最主要原因之一，而 SARS-CoV-2 感染似乎增加了发生静脉血栓栓塞疾病（VTE）的风险。本研究旨在分析 IMPROVE 和 IMPROVEDD 等 VTE 预测评分与以下因素之间的关系：（1）强化护理（IoC，收入肺病科或重症监护病房）（2）住院死亡率（3）30 天死亡率。
我们回顾性评估了 51 例实验室诊断为 SARS-CoV-2 感染的成年患者，并计算了 IMPROVE 和 IMPROVEDD 评分。所有患者均接受下肢静脉彩色多普勒超声检查，以评估是否存在浅静脉血栓形成（SVT）和/或深静脉血栓形成（DVT）。D-二聚体正常的患者未接受肝素治疗（LMWH）；D-二聚体≥4ULN 值或诊断为 DVT 的患者接受治疗性 LMWH 剂量治疗，而其余患者则接受预防性 LMWH 剂量治疗。
我们发现 IMPROVE 评分与 IoC 的需求以及住院死亡率之间存在很强的关系，与 IMPROVEDD 评分与 IoC 的需求之间存在很强的关系。我们定义，IMPROVE 评分大于 4 分与住院死亡率显著相关（p = 0.05），而 IMPROVEDD 评分大于 3 分与 IoC 的需求相关（p = 0.04）。多变量逻辑分析显示，IMPROVE 评分与住院和 30 天死亡率显著相关。
IMPROVE 评分可作为住院和 30 天死亡率的独立预测指标。
