在急诊科就诊的 COVID-19 患者中深静脉血栓形成的发生率、危险因素、临床特征和结局：UMC-19-S8 的结果。
Incidence, risk factors, clinical characteristics and outcomes of deep venous thrombosis in patients with COVID-19 attending the Emergency Department: results of the UMC-19-S8.
机构信息
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia.
Emergency Department, Hospital General de Alicante, University Miguel Hernández, Elche, Alicante.
出版信息
Eur J Emerg Med. 2021 Jun 1;28(3):218-226. doi: 10.1097/MEJ.0000000000000783.
BACKGROUND AND IMPORTANCE
A higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19.
OBJECTIVE
We investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization.
METHODS
We retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls.
RESULTS
We identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50‰; 95% confidence interval (CI), 1.23-1.80‰]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52‰; 95% CI, 1.45-1.69‰; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03-2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77-2.45).
CONCLUSIONS
DVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis.
背景与重要性
已描述患有 2019 年冠状病毒病（COVID-19）的患者中静脉血栓栓塞症（包括肺栓塞和深静脉血栓形成[DVT]）的发生率更高。但是，对于在急诊就诊并被诊断为 COVID-19 的患者中 DVT 的真实发生率知之甚少。
目的
我们研究了在 COVID-19 大流行的头 2 个月期间，在西班牙 62 个急诊就诊的 COVID-19 患者中 DVT 的发生率，发病的危险因素，临床特征和结局。
方法
我们回顾性分析了在 COVID-19 大流行期间在西班牙 62 个急诊就诊中被诊断为 DVT 的所有 COVID 患者（占西班牙急诊就诊的 20％，病例组）。我们比较了 DVT-COVID-19 患者与 COVID-19 无 DVT 患者（对照组）。估计了 COVID 和非 COVID 患者在急诊就诊中的 DVT 相对频率，并分别为两个人群估计了年度标准化发生率。比较了病例组和对照组之间的 63 种患者特征和 4 种结局。
结果
我们在 74814 例 COVID-19 急诊就诊患者中发现了 112 例 DVT [1.50‰；95％置信区间（CI），1.23-1.80‰]。这种相对频率与非 COVID 患者相似[2109/1388879；1.52‰；95％CI，1.45-1.69‰；比值比（OR）=0.98 [0.82-1.19]。COVID 患者的 DVT 标准化发生率更高（98,38 比 42,93/100,000/年；OR，2.20；95％CI，2.03-2.38）。在 COVID 患者中，与发生 DVT 的风险增加相关的临床特征是年龄较大，有静脉血栓栓塞史，近期手术/固定和高血压；到达急诊时胸痛和低氧血症以及某些分析干扰也更为常见，D-二聚体> 5000ng/mL 是最强的。在调整年龄和性别后，与对照组相比，病例组中住院，入住 ICU 和住院时间延长更为常见，而死亡率相似（OR，1.37；95％CI，0.77-2.45）。
结论
在 COVID 患者中，DVT 是 COVID 患者的一种不常见表现形式，但与预后较差有关。
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