Brandão Antonio Adolfo Guerra Soares, de Oliveira Cleyton Zanardo, Rojas Salomon Ordinola, Ordinola Amanda Ayako Minemura, Queiroz Victoria Masi, de Farias Danielle Leão Cordeiro, Scheinberg Phillip, Veiga Viviane Cordeiro
BP- A Beneficência Portuguesa de São Paulo, São Paulo, Brazil; Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
BP- A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
Int J Infect Dis. 2021 Dec;113:236-242. doi: 10.1016/j.ijid.2021.10.020. Epub 2021 Oct 17.
To describe the incidence of thromboembolic events in adult patients with severe COVID-19 and identify clinical and laboratory factors associated with these events.
Observational retrospective cohort study of 243 adult patients with severe COVID-19 admitted to an intensive care unit (ICU) at a Brazilian tertiary hospital.
The incidence of all thromboembolic events was 14.8%, in which 3.8% developed deep vein thrombosis, 7.8% pulmonary embolism, 2.5% acute myocardial infarction, 1.2% stroke, and 1.2% peripheral artery occlusion. Risk factors identified were D-dimer at admission >3000 ng/mL (P=<0.0013) and major bleeding (P=0.001). The cumulative risk of developing thromboembolic events at day 28 after ICU admission was 16.0%. The rate of major bleeding was 4.1%. After receiver operating characteristic curve analysis, the D-dimer cut-off at admission correlating with thromboembolic events was 1140.5 ng/mL.
The rate of thromboembolic events in our study was lower than previously described. High D-dimer level at admission was the leading risk factor; the optimal cut-off was 1140.5 ng/mL. The occurrence of thromboembolic events did not have an impact on the median overall survival rate. The optimal anticoagulant strategy in this context still needs to be established.
描述重症新型冠状病毒肺炎（COVID-19）成年患者血栓栓塞事件的发生率，并确定与这些事件相关的临床和实验室因素。
对巴西一家三级医院重症监护病房（ICU）收治的243例重症COVID-19成年患者进行观察性回顾性队列研究。
所有血栓栓塞事件的发生率为14.8%，其中3.8%发生深静脉血栓形成，7.8%发生肺栓塞，2.5%发生急性心肌梗死，1.2%发生中风，1.2%发生外周动脉闭塞。确定的危险因素为入院时D-二聚体>3000 ng/mL（P<0.0013）和大出血（P=0.001）。ICU入院后第28天发生血栓栓塞事件的累积风险为16.0%。大出血发生率为4.1%。经过受试者工作特征曲线分析，与血栓栓塞事件相关的入院时D-二聚体临界值为1140.5 ng/mL。
我们研究中的血栓栓塞事件发生率低于先前描述的发生率。入院时D-二聚体水平高是主要危险因素；最佳临界值为1140.5 ng/mL。血栓栓塞事件的发生对总体中位生存率没有影响。在这种情况下，最佳抗凝策略仍有待确定。
