Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Department of Clinical Internal, I Clinica Medica, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Thromb Haemost. 2022 Feb;122(2):257-266. doi: 10.1055/a-1692-9939. Epub 2021 Dec 29.
It is still unclear if patients with community-acquired pneumonia (CAP) and coronavirus disease 2019 (COVID-19) have different rate, typology, and impact of thrombosis on survival.
In this multicenter observational cohort study, 1,138 patients, hospitalized for CAP ( = 559) or COVID-19 ( = 579) from seven clinical centers in Italy, were included in the study. Consecutive adult patients (age ≥ 18 years) with confirmed COVID-19-related pneumonia, with or without mechanical ventilation, hospitalized from March 1, 2020 to April 30, 2020, were enrolled. COVID-19 was diagnosed based on the World Health Organization interim guidance. Patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events including ischemic/embolic events.
During the in-hospital stay, 11.4% of CAP and 15.5% of COVID-19 patients experienced thrombotic events ( = 0.046). In CAP patients all the events were arterial thromboses, while in COVID-19 patients 8.3% were venous and 7.2% arterial thromboses.During the in-hospital follow-up, 3% of CAP patients and 17% of COVID-19 patients died ( < 0.001). The highest mortality rate was found among COVID-19 patients with thrombotic events (47.6 vs. 13.4% in thrombotic-event-free patients; < 0.001). In CAP, 13.8% of patients experiencing thrombotic events died versus 1.8% of thrombotic event-free ones ( < 0.001). A multivariable Cox-regression analysis confirmed a higher risk of death in COVID-19 patients with thrombotic events (hazard ratio: 2.1; 95% confidence interval: 1.4-3.3; < 0.001).
Compared with CAP, COVID-19 is characterized by a higher burden of thrombotic events, different thrombosis typology and higher risk of thrombosis-related in-hospital mortality.
目前尚不清楚社区获得性肺炎（CAP）和 2019 年冠状病毒病（COVID-19）患者的血栓形成发生率、类型和对生存的影响是否不同。
在这项多中心观察性队列研究中，纳入了来自意大利 7 个临床中心的 1138 名因 CAP（ = 559 例）或 COVID-19（ = 579 例）住院的患者。连续纳入 2020 年 3 月 1 日至 4 月 30 日期间因 COVID-19 相关肺炎、有或无机械通气而住院的年龄≥18 岁的成年患者。COVID-19 的诊断基于世界卫生组织的临时指南。对患者进行随访直至出院或院内死亡，登记血栓形成事件（包括缺血/栓塞事件）的发生情况。
住院期间，11.4%的 CAP 患者和 15.5%的 COVID-19 患者发生血栓形成事件（ = 0.046）。在 CAP 患者中，所有事件均为动脉血栓形成，而在 COVID-19 患者中，8.3%为静脉血栓形成，7.2%为动脉血栓形成。住院期间，3%的 CAP 患者和 17%的 COVID-19 患者死亡（ < 0.001）。血栓形成事件患者的死亡率最高（47.6% vs. 无血栓形成事件患者的 13.4%； < 0.001）。在 CAP 患者中，发生血栓形成事件的患者中有 13.8%死亡，而无血栓形成事件的患者中有 1.8%死亡（ < 0.001）。多变量 Cox 回归分析证实，COVID-19 患者发生血栓形成事件的死亡风险更高（风险比：2.1；95%置信区间：1.4-3.3； < 0.001）。
与 CAP 相比，COVID-19 具有更高的血栓形成负担、不同的血栓形成类型和更高的血栓形成相关院内死亡率。
