Thromboembolic Disease and COVID-19: Experience of a University and Emergency Hospital During the Pandemic.

BACKGROUND

COVID-19 leads to vasculopathy, which is linked to both a prothrombotic state and an impaired immune response. A notable increase in pulmonary embolism (PE) and deep venous thrombosis (DVT) has been documented.

METHODS

We conducted a retrospective analysis of all patients who were admitted with venous thromboembolic disease (VTD) in the largest university and emergency hospital in Romania, between May 1, 2020, and April 30, 2021. Patients were categorized into two groups based on the presence (Group 1) or absence (Group 2) of COVID-19 virus infection at the time of admission. The aim of this study was to assess the characteristics of VTD in COVID-19 patients and to compare the clinical and paraclinical parameters of the Group 1 and Group 2 patients admitted for VTD in an emergency hospital during the first two waves of the pandemic (12 months). We compared clinical, biological, and imaging parameters and applied binary logistic analysis for the predictive models.

RESULTS

A total of 198 patients were diagnosed with VTD (at admission or during the hospitalization); out of 33,373 patients hospitalized, 43 (21.7%) were diagnosed with COVID-19 (12.2% with mild COVID-19, 61.0% moderate, and 26.8% severe). Group 1 showed higher heart rates and leukocytes, more severe pulmonary changes (p<0.05), higher N-terminal-pro-B-type natriuretic peptide (NTproBNP), and high sensitivity troponin I (hs-cTnI) (p>0.05). Not reaching statistical significance, the mortality tended to be higher in Group 1. These patients were admitted to the intensive care units for longer (3.5 vs. 1.5 days, p > 0.05). The minimum value of thrombocytes during hospitalization was inversely correlated with the risk of death. Interestingly, the Pulmonary Embolism Severity Index (PESI) score was not predictive for in-hospital death in Group 1, but only in Group 2 (area under the curve (AUC) = 0.821, CI 0.689-0.952).

CONCLUSION

Individuals with severe manifestations of COVID-19 remain vulnerable to developing VTD and are prone to adverse outcomes. The efficacy of PESI as a predictive tool for in-hospital death is non-significant. Further refinement of specific predictive scores tailored to VTD associated with COVID-19 is needed.