Woller Scott C, de Wit Kerstin, Robert-Ebadi Helia, Masias Camila, Klok Frederikus A, den Exter Paul L, Morange Pierre-Emmanuel, Castelli David, Hansen John-Bjarne
Department of Medicine Intermountain Medical Center, Intermountain Healthcare Murray Utah USA.
Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA.
Res Pract Thromb Haemost. 2022 Aug 26;6(6):e12786. doi: 10.1002/rth2.12786. eCollection 2022 Aug.
Thrombosis is reported to occur more often among patients with COVID-19 than otherwise expected in the setting of viral pneumonia and sepsis. Systemic inflammatory biomarkers may be associated with venous thromboembolism (VTE) risk. The ISTH subcommittee on Predictive and Diagnostic Variables in Thrombotic Disease aimed to report the evidence on prognostic biomarkers for VTE in hospitalized patients with COVID-19.
Using a standardized Preferred Reporting Items for Systematic Reviews and Meta-analysis methodology, we conducted a systematic literature review to identify studies reporting prognostic biomarkers for VTE among hospitalized patients with COVID-19. Eligible studies included adults hospitalized with COVID-19 and reported the prognostic associations between any biomarker measured on admission, and the subsequent diagnosis of deep vein thrombosis or pulmonary embolism. Two authors reviewed titles and abstracts, and three authors extracted study data and performed review of bias. Results were displayed descriptively. Meta-analysis was not possible.
From the initial 196 identified studies, full-text review was performed for 72 studies. Admission D-dimer levels were associated with VTE during hospitalization in five studies, and elevated platelet count was associated with VTE during hospitalization in one study. The risk of bias ranged from low to high for included studies. Overall, there was a paucity of high-quality prognostic studies. Studies on other biomarkers did not meet the systematic review inclusion criteria.
Admission D-dimer was associated with VTE diagnosis during hospitalization for COVID-19; however, prospective validation of this finding is needed to identify optimal D-dimer thresholds to guide VTE prophylaxis measures.
据报道，新型冠状病毒肺炎（COVID-19）患者中血栓形成的发生率高于病毒性肺炎和脓毒症患者的预期。全身炎症生物标志物可能与静脉血栓栓塞（VTE）风险相关。国际血栓与止血学会（ISTH）血栓性疾病预测和诊断变量小组委员会旨在报告COVID-19住院患者VTE预后生物标志物的证据。
我们采用标准化的系统评价和Meta分析优先报告项目方法，进行了一项系统文献综述，以确定报告COVID-19住院患者VTE预后生物标志物的研究。符合条件的研究包括因COVID-19住院的成年人，并报告了入院时测量的任何生物标志物与随后深静脉血栓形成或肺栓塞诊断之间的预后关联。两位作者审查标题和摘要，三位作者提取研究数据并进行偏倚审查。结果以描述性方式呈现。无法进行Meta分析。
从最初确定的196项研究中，对72项研究进行了全文审查。五项研究表明，入院时D-二聚体水平与住院期间的VTE相关，一项研究表明，血小板计数升高与住院期间的VTE相关。纳入研究的偏倚风险从低到高不等。总体而言，高质量的预后研究较少。关于其他生物标志物的研究未达到系统评价纳入标准。
入院时D-二聚体与COVID-19住院期间的VTE诊断相关；然而，需要对这一发现进行前瞻性验证，以确定最佳的D-二聚体阈值，以指导VTE预防措施。
