Yadav Ruchi, Aroshidze Beka, Yadav Vivek, Zahid Umar, Jayarangaiah Apoorva, Gandhi Anjula, Gotlieb Vladimir
Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA.
Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York, USA.
Cureus. 2021 Oct 8;13(10):e18601. doi: 10.7759/cureus.18601. eCollection 2021 Oct.
Coronavirus disease 2019 (COVID-19) continues to pose an unprecedented challenge for the entire world and the healthcare system. Different theories have been proposed elucidating the pathophysiological mechanisms attributing to high mortality and morbidity in COVID-19 infection. Out of them, thrombosis and procoagulant state have managed to earn the maximum limelight. We conducted an observational study based on data from randomly selected 349 hospitalized patients with COVID-19 infection in a community-based hospital in New York City during the first wave of the COVID-19 viral surge in March 2020. The main objective of our study was to assess the risk and occurrence of thrombotic events (both venous and arterial) among the hospitalized patients including the intensive care unit (ICU) and non-ICU admissions with confirmed COVID-19 infection. The primary outcome in our study was defined as the thrombotic events that included myocardial infarction (MI), deep venous thrombosis (DVT), cerebrovascular accidents (CVA), and pulmonary embolism (PE). The study correlated the association of thrombotic events with the level of biomarkers of interest: D-dimer >1000 ng/ml, troponin-I >1 ng/ml, or both. The association of D-dimers and troponin-I with thrombotic events was measured using both univariate and multivariate Cox proportional hazard (PH) regression analysis. Out of a total of 349 patients, 78 patients (22.35%) were found to have elevated biomarkers (D-dimer >1000 ng/ml and/or troponin-I >1 ng/ml) and were categorized as a high-risk group. Eighty-nine patients developed thrombotic complications (evidence of more than one thrombotic event was found in several patients). Two-hundred seventy-one (77.65%) patients had no documentation of thrombosis. The incidence of thrombotic events included myocardial infarction (MI; N=45; 12.8%), cerebrovascular accidents (CVA; N=16; 4.5%), deep venous thrombosis (DVT; N=16; 4.5%), and pulmonary embolism (PE; N=9; 2.57%).
2019冠状病毒病（COVID-19）继续给整个世界和医疗系统带来前所未有的挑战。人们提出了不同的理论来阐释导致COVID-19感染高死亡率和高发病率的病理生理机制。其中，血栓形成和促凝状态最受关注。我们基于2020年3月COVID-19病毒第一波激增期间在纽约市一家社区医院随机选取的349例住院COVID-19感染患者的数据进行了一项观察性研究。我们研究的主要目的是评估确诊COVID-19感染的住院患者（包括重症监护病房（ICU）和非ICU病房患者）发生血栓事件（静脉和动脉）的风险及情况。我们研究中的主要结局定义为血栓事件，包括心肌梗死（MI）、深静脉血栓形成（DVT）、脑血管意外（CVA）和肺栓塞（PE）。该研究将血栓事件与感兴趣的生物标志物水平相关联：D-二聚体>1000 ng/ml、肌钙蛋白I>1 ng/ml或两者皆有。使用单变量和多变量Cox比例风险（PH）回归分析来衡量D-二聚体和肌钙蛋白I与血栓事件的关联。在总共349例患者中，78例患者（22.35%）被发现生物标志物升高（D-二聚体>1000 ng/ml和/或肌钙蛋白I>1 ng/ml），并被归类为高危组。89例患者发生了血栓并发症（在数例患者中发现不止一种血栓事件的证据）。271例（77.65%）患者没有血栓形成的记录。血栓事件的发生率包括心肌梗死（MI；N = 45；12.8%）、脑血管意外（CVA；N = 16；4.5%）、深静脉血栓形成（DVT；N = 16；4.5%）和肺栓塞（PE；N = 9；2.57%）。
