Deep vein thrombosis in COVID-19 patients in general wards: prevalence and association with clinical and laboratory variables

Abstract

Background Preliminary reports suggest a hypercoagulable state in COVID-19. Deep vein thrombosis (DVT) is perceived as a frequent finding in hospitalized COVID-19 patients, but data describing the prevalence of DVT are lacking. Objectives We aimed to report the prevalence of DVT in COVID-19 patients in general wards, blinded to symptoms/signs of disease, using lower extremities duplex ultrasound (LEDUS) in random patients. We tested the association of DVT with clinical, laboratory and inflammatory markers and also reported on the secondary endpoint of in-hospital mortality. Patients/Methods n = 263 COVID-19 patients were screened with LEDUS between March 01, 2020 and April 05, 2020 out of the overall n = 1012 admitted with COVID-19. Results DVT was detected in n = 67 screened patients (25.5%), n = 41 patients (15.6%) died during the index hospitalization. Multiple logistic regression demonstrated that only C-reactive protein (odds ratio 1.009, 95% CI 1.004-1.013, p < 0.001) was independently associated with the presence of DVT at LEDUS. Both age (odds ratio 1.101, 95% CI 1.054-1.150, p < 0.001) and C-reactive protein (odds ratio 1.012, 95% CI 1.006-1.018, p < 0.001) were instead significantly independently associated with in-hospital mortality. Conclusions The main study finding is that DVT prevalence in COVID-19 patients admitted to general wards is 25.5%, suggesting it may be reasonable to screen COVID-19 patients for this potentially severe but treatable complication, and that inflammation, measured with serum C-reactive protein, is the main variable associated with the presence of DVT, where all other clinical or laboratory variables, age or D-dimer included, are instead not independently associated with DVT.

Risk Factors and Incidence of Deep Venous Thrombosis in Non-severe Coronavirus Disease-19 Patients

“…Lower extremity thrombosis classification has been suggested by the DVT guidelines and is widely used in clinical practice, and this classification stratifies the DVT patients into four classes [9]. Regarding the class, the majority of the DVT patients were diagnosed as Class I, which was consistent with other published papers [9], [15], [24]. The greatest number of detected DVT cases was in calf veins, but because of later complications such as the post-thrombotic syndrome and the mortality of 27% in these patients, early diagnosis and treatment is obligatory [9].…”

“…Several studies demonstrated a significant increase in D-dimer and fibrinogen levels [23] as well as CRP value [24], which reflected the hypercoagulability state. On the other hand, Motaganahalli et al proved that the value of CRP is not associated with DVT [25].…”

Usefulness of Easy-to-Use Risk Scoring Systems Rated in the Emergency Department to Predict Major Adverse Outcomes in Hospitalized COVID-19 Patients

“…Each biomarker considered in the inflammation-based risk scoring system was independently assessed for thrombosis in patients with COVID-19. Indeed, C-reactive protein was in-dependently associated with the presence of a deep-vein thrombosis demonstrated by duplex ultrasound as well as a pulmonary embolism demonstrated by computed tomography pulmonary angiography [34,35]. Moreover, C-reactive protein levels may predict the occurrence of venous thromboembolism in critically ill COVID-19 patients admitted to the ICU with an AUC of 0.75; for comparison, the AUC of the D-dimer in this study was only 0.64 [36].…”

Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma

“…Ultrasound (US) is an imaging tool is cheap, noninvasive, non-irradiating and, thus, repeatable, suitable for patient disease monitoring [22][23][24][25]. Contrast-Enhanced Ultrasound (CEUS) imaging is an improved ultrasound-based technology, assuming the injection into the blood of a specific contrast agent, consisting of gas filled microbubbles [22].…”