Deep Venous Thrombosis and Pulmonary Embolism Among Hospitalized Coronavirus Disease 2019 (COVID-19) Positive Patients Predict Higher Mortality, Prolonged Intensive Care Unit and Hospital Stays: A Multi-Site Healthcare System Experience
Erben Y1, Franco-Mesa C1, Gloviczki P3, Stone W4, Quinones-Hinojosa A5, Meltzer AJ4, Lin M2, Greenway MRF,2 Hamid O1, Devcic Z6, Toskich B6, Ritchie C6, Lamb CJ2, De Martino RR3, Siegel J2,5,7, Farres H1, Hakaim AG1, Sanghavi DK7, Li Y8, Rivera C9, Moreno-Franco P7, O'Keefe NL10, Gopal N2, Marquez CP11, Huang JF2, KaIra M3, Shields RC12, Prudencio M13, Gendron T13, McBane RD12, Park MS14, Hoyne JB11, PetruceIli L13, O'Horo JC15, Meschia JF2
1Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, 2Department of Neurology, Mayo Clinic, Jacksonville, FL, 3Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, 4Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, AZ, 5Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, 6Division of Vascular and Interventional Radiology, Mayo Clinic, Jacksonville, FL, 7Department of Critical Care, Mayo Clinic, Jacksonville, FL, 8Department of Political Science and Economics, Rowan University, Glassboro, NJ, 9Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL, 10Quality Management Services, Mayo Clinic, Jacksonville, FL, 11Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, 12Division of Vascular Medicine of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, 13Department of Neuroscience and Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Jacksonville, FL, 14Division of Trauma and Critical Care and General Surgery, Mayo Clinic, Rochester, MN, 15Division of Infectious Diseases, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Objective: To assess the incidence of deep venous thrombosis (DVT) andpulmonary emboli (PE) of Coronavirus Disease 2019 (COVID-19) positivepatients in comparison with a cohort of hospitalized patients evaluated pre-pandemic and how this diagnosis affects their outcomes.Methods: Retrospective review of prospectively collected data on COVID-19positive patients, who were hospitalized across a multi-site health care systemfrom 03/11/2020 after the World Health Organization’s (WHO) declaration ofthe pandemic to 07/27/2020. The primary end point is the incidence of DVT andPE in hospitalized COVID-19 positive patients compared with the rate of DVTand PE in hospitalized patients across the health care system during 01/01/2019-12/31/2019. The secondary end point was to assess this patient population’soutcomes while hospitalized including mortality, intensive care unit (ICU) stay,ICU days and length of hospitalization (LOH). Multivariable regression analysiswas performed to determine predictors of ICU days and LOH.Results: There were 8,675 patients with COVID-19 infection and 424 (4.9%)were hospitalized across our multi-site health care system. Mean age was59.5±17.2 years and 184 (43.4%) were female. There were 46 (10.8%) withDVT/PE diagnosis confirmed with the appropriate imaging studies includingvenous ultrasound of the extremities and/or computed tomography angiographyof the chest. In contrast, the DVT/PE incidence of hospitalized patients in theyear 2019 was 0.03% (p<0.0001). Baseline patient risk factors were no differentamong patients with and without DVT/PE. Hemoglobin (Hb) was lower(p=0.007), white blood cell (WBC) (p=0.011) and platelet counts were higher(p=0.040) and the proportion of patients with two or more systemic inflammatoryresponse syndrome (SIRS) criteria was also higher (p=0.012) in the DVT/PEcohort. Partial thromboplastin time (p=0.001), international normalized ratio(INR) (p=0.008), D-dimer (p<0.001), pro-brain natriuretic peptide (p=0.021),interleukin-6 (IL-6) (p=0.002) and pro-calcitonin (p=0.005) were higher in theDVT/PE cohort. Mortality was equivalent among groups. However, need for ICUcare (p<0.001), ICU days (p=0.001) and LOH (p<0.001) were higher in theDVT/PE cohort. On multivariable regression, WBC is a predictor of ICU stay(OR -2.2, 95% CI 0.27-0.86, p<0.031), Hb is a predictor of prolonged ICU stay(Coef: -2.9, 95% CI 0.03-0.09, p<0.01) and INR (Coef: -2.9, 95% CI 0.06-0.1,p=0.007) and IL-6 (Coef: 2.2, 95% CI 0.001-0.002, p=0.04) are predictors ofprolonged LOH.Conclusion: There is a significant higher incidence of DVT/PE in COVID-19positive hospitalized patients compared with those patients hospitalized pre-pandemic. Patients affected by DVT/PE are also are at a higher risk for requiringICU care and prolonged ICU days and hospitalizations. Our inpatient
anticoagulation protocols have been adjusting to attend to the higher incidencefor DVT/PE. However, the number of patients affected with DVT/PE continuesto remain high. Further studies analyzing each patient’s inflammatory and pro-coagulant factors may be necessary to assess the best management protocol forthis high risk pa
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