Service de Médecine Interne, Hôpital Estaing, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
Université Clermont Auvergne, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, UMR 6602, 63000 Clermont-Ferrand, France.
Int J Environ Res Public Health. 2021 Dec 8;18(24):12944. doi: 10.3390/ijerph182412944.
Venous thromboembolism (VTE) in patients with COVID-19 in intensive care units (ICU) is frequent, but risk factors (RF) remain unidentified. In this meta-analysis (CRD42020188764) we searched for observational studies from ICUs reporting the association between VTE and RF in Medline/Embase up to 15 April 2021. Reviewers independently extracted data in duplicate and assessed the certainty of the evidence using the GRADE approach. Analyses were conducted using the random-effects model and produced a non-adjusted odds ratio (OR). We analysed 83 RF from 21 studies (5296 patients). We found moderate-certainty evidence for an association between VTE and the D-dimer peak (OR 5.83, 95%CI 3.18-10.70), and length of hospitalization (OR 7.09, 95%CI 3.41-14.73) and intubation (OR 2.61, 95%CI 1.94-3.51). We identified low-certainty evidence for an association between VTE and CRP (OR 1.83, 95% CI 1.32-2.53), D-dimer (OR 4.58, 95% CI 2.52-8.50), troponin T (OR 8.64, 95% CI 3.25-22.97), and the requirement for inotropic drugs (OR 1.67, 95% CI 1.15-2.43). Traditional VTE RF (i.e., history of cancer, previous VTE events, obesity) were not found to be associated to VTE in COVID-19. Anticoagulation was not associated with a decreased VTE risk. VTE RF in severe COVID-19 correspond to individual illness severity, and inflammatory and coagulation parameters.
COVID-19 患者在重症监护病房（ICU）中发生静脉血栓栓塞症（VTE）较为常见，但危险因素（RF）仍未明确。在这项荟萃分析（CRD42020188764）中，我们在 Medline/Embase 中检索了截至 2021 年 4 月 15 日报告 ICU 中 VTE 与 RF 之间相关性的观察性研究。审查员独立重复提取数据，并使用 GRADE 方法评估证据的确定性。分析采用随机效应模型，并生成未经调整的比值比（OR）。我们分析了 21 项研究中的 83 个 RF（5296 例患者）。我们发现 VTE 与 D-二聚体峰值（OR 5.83，95%CI 3.18-10.70）、住院时间（OR 7.09，95%CI 3.41-14.73）和插管（OR 2.61，95%CI 1.94-3.51）之间存在中度确定性关联。我们发现 VTE 与 CRP（OR 1.83，95%CI 1.32-2.53）、D-二聚体（OR 4.58，95%CI 2.52-8.50）、肌钙蛋白 T（OR 8.64，95%CI 3.25-22.97）和需要正性肌力药物（OR 1.67，95%CI 1.15-2.43）之间存在低度确定性关联。COVID-19 中，传统的 VTE RF（即癌症史、先前的 VTE 事件、肥胖）与 VTE 无关。抗凝与降低 VTE 风险无关。严重 COVID-19 中的 VTE RF 与个体疾病严重程度、炎症和凝血参数相关。
