Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland).
Department of Vascular Interventional Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland).
Med Sci Monit. 2021 Apr 11;27:e929708. doi: 10.12659/MSM.929708.
BACKGROUND Since the outbreak of COVID-19 in December 2019, there have been 96 623 laboratory-confirmed cases and 4784 deaths by December 29 in China. We aimed to analyze the risk factors and the incidence of thrombosis from patients with confirmed COVID-19 pneumonia. MATERIAL AND METHODS Eighty-eight inpatients with confirmed COVID-19 pneumonia were reported (31 critical cases, 33 severe cases, and 24 common cases). The thrombosis risk factor assessment, laboratory results, ultrasonographic findings, and prognoses of these patients were analyzed, and compared among groups with different severity. RESULTS Nineteen of the 88 cases developed DVT (12 critical cases, 7 severe cases, and no common cases). In addition, among the 18 patients who died, 5 were diagnosed with DVT. Positive correlations were observed between the increase in D-dimer level (≥5 µg/mL) and the severity of COVID-19 pneumonia (r=0.679, P<0.01), and between the high Padua score (≥4) and the severity (r=0.799, P<0.01). In addition, the CRP and LDH levels on admission had positive correlations with the severity of illness (CRP: r=0.522, P<0.01; LDH: r=0.600, P<0.01). A negative correlation was observed between the lymphocyte count on admission and the severity of illness (r=-0.523, P<0.01). There was also a negative correlation between the lymphocyte count on admission and mortality in critical patients (r=-0.499, P<0.01). Univariable logistic regression analysis showed that the occurrence of DVT was positively correlated with disease severity (crude odds ratio: 3.643, 95% CI: 1.218-10.896, P<0.05). CONCLUSIONS Our report illustrates that critically or severely ill patients have an associated high D-dimer value and high Padua score, and illustrates that a low threshold to screen for DVT may help improve detection of thromboembolism in these groups of patients, especially in asymptomatic patients. Our results suggest that early administration of prophylactic anticoagulant would benefit the prognosis of critical patients with COVID-19 pneumonia and would likely reduce thromboembolic rates.
自 2019 年 12 月 COVID-19 爆发以来，截至 12 月 29 日，中国已有 96623 例实验室确诊病例和 4784 例死亡。我们旨在分析确诊 COVID-19 肺炎患者的血栓形成的危险因素和发生率。
报告了 88 例确诊 COVID-19 肺炎住院患者（31 例重症病例，33 例重症病例和 24 例普通病例）。分析了这些患者的血栓形成危险因素评估、实验室结果、超声表现和预后，并比较了不同严重程度组之间的差异。
88 例中有 19 例（12 例重症，7 例重症，无普通病例）发生 DVT。此外，在 18 例死亡患者中，有 5 例被诊断为 DVT。D-二聚体水平升高（≥5μg/ml）与 COVID-19 肺炎严重程度呈正相关（r=0.679，P<0.01），Padua 评分升高（≥4）与严重程度呈正相关（r=0.799，P<0.01）。此外，入院时 CRP 和 LDH 水平与疾病严重程度呈正相关（CRP：r=0.522，P<0.01；LDH：r=0.600，P<0.01）。入院时淋巴细胞计数与疾病严重程度呈负相关（r=-0.523，P<0.01）。重症患者入院时淋巴细胞计数与死亡率也呈负相关（r=-0.499，P<0.01）。单变量 logistic 回归分析显示，DVT 的发生与疾病严重程度呈正相关（粗比值比：3.643，95%可信区间：1.218-10.896，P<0.05）。
本报告表明，重症或危重症患者 D-二聚体值和 Padua 评分较高，提示对 DVT 进行低阈值筛查有助于提高对这些患者群体血栓形成的检出率，尤其是无症状患者。我们的结果表明，早期给予预防性抗凝治疗可能有益于 COVID-19 肺炎重症患者的预后，并可能降低血栓栓塞发生率。
