Incidence, risk factors, clinical characteristics and outcomes of deep venous thrombosis in patients with COVID-19 attending the Emergency Department: results of the UMC-19-S-8
Por:
Jimenez, S, Miro, O, Llorens, P, Martin-Sanchez, FJ, Burillo-Putze, G, Pinera, P, Martin, A, Alquezar, A, Garcia-Lamberechts, EJ, Jacob, J, Grima, MLL, Millan, J, Molina, F, Albero, PB, Cardozo, C, Modol, JM, Aguirre, A, Gaya, R, Adroher, M, Llauger, L, Diaz, JJL, Gonzalez, NC, Aragues, PL, Gomez, AP, del Castillo, JG, Behalf Spanish Investigators Emerg
Publicada:
1 jun 2021
Resumen:
Background and importance
A higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19.
Objective
We investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization.
Methods
We retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls.
Results
We identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50 parts per thousand; 95% confidence interval (CI), 1.23-1.80 parts per thousand]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52 parts per thousand; 95% CI, 1.45-1.69 parts per thousand; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03-2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77-2.45).
Conclusions
DVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis.
Filiaciones:
Jimenez, S:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona, Catalonia, Spain
Miro, O:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona, Catalonia, Spain
Llorens, P:
Univ Miguel Hernandez, Hosp Gen Alicante, Emergency Dept, Alicante, Spain
Martin-Sanchez, FJ:
Univ Complutense, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid, Spain
Burillo-Putze, G:
Hosp Univ Canaries, Emergency Dept, Tenerife, Spain
Pinera, P:
Hosp Gen Univ Reina Sofia, Emergency Dept, Murcia, Spain
Martin, A:
Hosp Univ Mostoles, Serv Urgencies, Madrid, Spain
Alquezar, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Garcia-Lamberechts, EJ:
Univ Complutense, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Catalonia, Spain
Grima, MLL:
Hosp Univ Doctor Peset Aleixandre, Emergency Dept, Valencia, Spain
Millan, J:
Hosp Univ & Politecn La Fe, Emergency Dept, Valencia, Spain
Molina, F:
Hosp Univ Gen Alicante, Emergency Dept, Alicante, Spain
Albero, PB:
Hosp Virgen de los Lirios Alcoy, Emergency Dept, Alicante, Spain
Cardozo, C:
Univ Barcelona, Hosp Clin, Emergency Dept, IDIBAPS, Barcelona, Catalonia, Spain
Hosp Austral, Emergency Dept, Buenos Aires, DF, Argentina
Modol, JM:
Hosp Badalona Germans Trias & Pujol, Emergency Dept, Badalona, Spain
Aguirre, A:
Hosp Mar, Emergency Dept, Barcelona, Spain
Gaya, R:
Hosp Univ Joan XXIII, Emergency Dept, Tarragona, Spain
Adroher, M:
Hosp Univ Girona Dr Josep Trueta, Emergency Dept, Girona, Spain
Llauger, L:
Hosp Univ Vic, Emergency Dept, Barcelona, Catalonia, Spain
Diaz, JJL:
Hosp Univ Lucus Augusti, Emergency Dept, Lugo, Spain
Gonzalez, NC:
Hosp Univ Gran Canaria Dr Negrin, Emergency Dept, Las Palmas Gran Canaria, Spain
Aragues, PL:
Hosp Gen Univ Reina Sofia, Emergency Dept, Murcia, Spain
Gomez, AP:
Hosp Lliria, Emergency Dept, Valencia, Spain
del Castillo, JG:
Univ Complutense, Hosp Clin San Carlos, Emergency Dept, IDISSC, Madrid, Spain
Green Published
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