Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis

Investigating the prevalence of and predictive and risk factors for pulmonary embolism in patients with COVID-19 in Nemazee Teaching Hospital

Background

Pulmonary thromboembolism (PTE) is a significant contributing factor to vascular diseases. This study aimed to determine the prevalence of pulmonary thromboembolism and its predisposing factors in patients with COVID-19.

Methods

This cross-sectional study included 284 patients with COVID-19 who were admitted to Nemazee Teaching Hospital (Shiraz, Iran) between June and August 2021. All patients were diagnosed with COVID-19 by a physician based on clinical symptoms or positive polymerase chain reaction (PCR) test results. The collected data included demographic data and laboratory findings. Data were analyzed using the SPSS software. P≤0.05 was considered statistically significant.

Results

There was a significant difference in the mean age between the PTE group and non-PTE group (P=0.037). Moreover, the PTE group had a significantly higher prevalence of hypertension (36.7% vs. 21.8%, P=0.019), myocardial infarction (4.5% vs. 0%, P=0.006), and stroke (23.9% vs. 4.9%, P=0.0001). Direct bilirubin (P=0.03) and albumin (P=0.04) levels significantly differed between the PTE and non-PTE groups. Notably, there was a significant difference in the partial thromboplastin time (P=0.04) between the PTE and non-PTE groups. A regression analysis indicated that age (OR, 1.02; 95% CI, 1.00‒1.004; P=0.005), blood pressure (OR, 2.07; 95% CI, 1.12‒3.85; P=0.02), heart attack (OR, 1.02; 95% CI, 1.28‒6.06; P=0.009), and albumin level (OR, 0.39; 95% CI, 0.16‒0.97; P=0.04) were all independent predictors of PTE development.

Conclusion

Regression analysis revealed that age, blood pressure, heart attack, and albumin levels were independent predictors of PTE.

Portal vein thrombosis in patients with COVID-19: A systematic review

Several studies have proven that COVID-19 is linked to a higher incidence of different thrombotic events. Thrombosis of the portal vein can result in portal hypertension and can extend to the mesenteric vein resulting in intestinal ischemia. A search of PubMed, Web of Science, and Scopus for relevant studies revealed an association between PVT and COVID-19. This review is structured according to PRISMA guidelines. Thirty-three studies met the inclusion criteria. Twenty-nine case studies/series and four cohort/cross-sectional studies were included. Age at diagnosis was lower when compared to PVT due to cirrhosis. In cohort/cross-sectional studies, males comprised 54.83% of subjects, whereas in case reports/series, males comprised 62.1%. Obesity, asthma, hypertension, and diabetes were the most common comorbidities identified. The majority of the thrombotic events occurred within two weeks. The treatment aimed to prevent thrombus progression and improve recanalization. According to the evidence, early intervention prevents the poor prognosis of intestinal ischemia and its propagation.

Predictors of venous thromboembolism in COVID-19 patients: results of the COVID-19 Brazilian Registry

Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. This cohort study of a large Brazilian COVID-19 Registry included 4120 COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting, and bagging were used to investigate the association of variables upon hospital presentation with VTE. Among 4,120 patients (55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95% CI 1.11-2.02); being an ex-smoker (OR 1.44, 95% CI 1.03-2.01); surgery ≤ 90 days (OR 2.20, 95% CI 1.14-4.23); axillary temperature (OR 1.41, 95% CI 1.22-1.63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2.16, 95% CI 1.26-3.67), lactate (OR 1.10, 95% CI 1.02-1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01-1.18); and neutrophil count (OR 1.04, 95% CI 1.005-1.075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. By using ML and LR analyses, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.

Epidemiological characteristics, clinical relevance, and risk factors of thromboembolic complications among patients with COVID-19 pneumonia at A teaching hospital: Retrospective observational study

Background

Thromboembolism is the third most common cardiovascular disorders and substantial worldwide health burden, with 1-2 instances per 1000 persons each year. This study aimed to describe the epidemiological characteristics, clinical relevance, risk factor and outcome of thromboembolic complications among COVID-19 infected patients.

Method

This is a retrospective, single-center, observational study using a hospital information system (HIS). The study included 46-patients with a confirmed diagnosis of pneumonia by SARS-CoV-2 admitted to a tertiary hospital.

Results

The incidence of cardiovascular thromboembolic events among COVID-19 infected patients was 41.3% (n = 19). Cerebrovascular accident was the most common thromboembolic events among COVID-19 infected patients about 15.2%, flowed by pulmonary embolism (13%), acute myocardial infract (8.7%), and deep venous thrombosis (4.4%). In generally, 63% (n = 29) were males, while 37% (n = 17) were females. The majority of those who suffered thromboembolic events were over 65 years old (p < 0.000**).Patients with thromboembolic event were also more likely to have IHD (13.0% vs 0%, p = 0.003), diabetes (24% vs 13.0%, p = 0.025) and CL (10.9% vs 2.2%, p = 0.03) as precipitating factors when compared those without thromboembolic events.According to the outcome, 19 examinees had thrombotic events: 11 (24%) patients had admitted to non ICU inpatient ward, 2 (43%) had admitted to ICU and remaining 6 (13%) patients had dead. There was significant statistical difference in the proportion of examinees with thrombotic and non-thrombotic events in relation to outcome (p = 0.000).

Conclusion

The incidence of thromboembolic complications among COVID19 infected patients were associated with elder (>65years), IHD, diabetes and CLD.

The predictive value of serum level of cystatin C for COVID-19 severity

To investigate the potential prognostic value of Serum cystatin C (sCys C) in patients with COVID-19 and determine the association of sCys C with severe COVID-19 illness. We performed a retrospective review of medical records of 162 (61.7 ± 13.5 years) patients with COVID-19. We assessed the predictive accuracy of sCys C for COVID-19 severity by the receiver operating characteristic (ROC) curve analysis. The participants were divided into two groups based on the sCys C cut-off value. We evaluated the association between high sCys C level and the development of severe COVID-19 disease, using a COX proportional hazards regression model. The area under the ROC curve was 0.708 (95% CI 0.594-0.822), the cut-off value was 1.245 (mg/L), and the sensitivity and specificity was 79.1% and 60.7%, respectively. A multivariable Cox analysis showed that a higher level of sCys C (adjusted HR 2.78 95% CI 1.25-6.18, p = 0.012) was significantly associated with an increased risk of developing a severe COVID-19 illness. Patients with a higher sCys C level have an increased risk of severe COVID-19 disease. Our findings suggest that early assessing sCys C could help to identify potential severe COVID-19 patients.

COVID-19-related deaths among women of reproductive age in Brazil: The burden of postpartum

Objective

To compare risk of death due to COVID‐19 among pregnant, postpartum, and non‐pregnant women of reproductive age in Brazil, using the severe acute respiratory syndrome surveillance system (SARS‐SS).

Methods

A secondary analysis was performed of the Brazilian official SARS‐SS, with data retrieved up to August 17, 2020. Cases were stratified by pregnancy status, risk factors or co‐morbidities, and outcome (death or recovery). Multiple logistic regression was employed to examine associations between independent variables and risk of death.

Results

A total of 24 805 cases were included, with 3129 deaths (12.6%), including 271 maternal deaths. Postpartum was associated with increased risk of death, admission to the intensive care unit (ICU), and mechanical ventilation. Co‐morbidities with higher impact on case fatality rate among non‐obstetric cases were cancer and neurological and kidney diseases. Among pregnant women, cancer, diabetes mellitus, obesity, and rheumatology diseases were associated with risk of death. In the postpartum subgroup, age over 35 years and diabetes mellitus were independently associated with higher chance of death.

Conclusion

Postpartum was associated with worse outcomes among the obstetric population, despite lower risk of dying without accessing ICU care. Non‐pregnant women with cancer, neurological diseases, and kidney diseases have a higher risk of death due to COVID‐19.

Postpartum increased the risk of death, admission to the ICU, and mechanical ventilation among reproductive‐age women admitted to hospital due to COVID‐19 severe acute respiratory syndrome.