Assessment of risk factors for thrombosis in ICU patients with COVID-19

Raushan Rakhimzhanova 1, Zhanar Kozhakhmetova 1, Agilan Ozyerman 1 *
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1 Radiology Department named after academic Zh.Kh. Khamzabayev, Astana Medical University, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 2, pp. 52-59. https://doi.org/10.23950/jcmk/13144
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ABSTRACT

Introduction: High incidence of thrombotic events has been reported in hospitalized patients with COVID-19. Less than 50% of pulmonary embolisms (PE) are associated with signs of deep vein thrombosis (DVT) of the lower extremities.
Objective: To assess the risk factors of deep vein thrombosis (DVT) in intensive care patients with COVID-19 by comparing the clinical features of patients in groups with thrombosis, venous stasis and without deep vein thrombosis.
Material and methods: A prospective cross-sectional study was conducted that included all consecutive adult patients with laboratory-confirmed COVID-19 admitted to the intensive care unit. We investigated chronic comorbid conditions in patients, including arterial hypertension, diabetes mellitus, obesity, chronic kidney failure (CRF), chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and cancer which may be a risk factor for thrombosis.
Results: A total of 465 patients were included in the study. Comorbidities were present in 435 of 465 patients (93.55%). Doppler ultrasound (DUS) confirmed deep vein thrombosis in 60 patients (13.8%), which was associated with older age (71.12±13.98 vs. (79.57%), chronic heart failure - 196 (42.15%), obesity - 161 (34.62%), diabetes mellitus - 144 (30.97%), chronic renal failure (CRF) -58 (12.47%) and oncological diseases - 25 (5.38%). Hypertension (p=0.02), diabetes mellitus (p=0.041) and obesity (p=0.01) were significant risk factors for DVT. D-dimer was a statistically significant predictor of DVT formation (p<0.001), an increase in D-dimer per unit increased the risk of DVT by 14%.
Conclusion: The study identified risk factors for deep vein thrombosis in intensive care patients with COVID-19. These include: age, high levels of D-dimer, and comorbidities such as hypertension, obesity, and diabetes mellitus.
Keywords: COVID-19, deep vein thrombosis (DVT), thromboembolism, ultrasound diagnostics

CITATION

Rakhimzhanova R, Kozhakhmetova Z, Ozyerman A. Assessment of risk factors for thrombosis in ICU patients with COVID-19. J CLIN MED KAZ. 2023;20(2):52-9. https://doi.org/10.23950/jcmk/13144

REFERENCES

  • Chang MC, Park D: How should rehabilitative departments of hospitals prepare for coronavirus disease 2019? Am J Phys Med Rehabil. 2020. https://doi.org/10.1097/PHM.0000000000001428
  • Kucharski AJ, Russell TW, Diamond C, Liu Y, Edmunds J, Funk S, Eggo RM, Centre for Mathematical Modelling of infectious diseases C-wg: early dynamics of transmission and control of COVID-19: a mathematical modelling study. Lancet Infect Dis. 2020. https://doi.org/10.1101/2020.01.31.20019901
  • Chang MC, Seo WS, Park D, Hur J. Analysis of SARS-CoV-2 Screening Clinic (Including Drive-Through System) Data at a Single University Hospital in South Korea from 27 January 2020 to 31 March 2020 during the COVID-19 Outbreak. Healthcare (Basel). 2020. https://doi.org/10.3390/healthcare8020145
  • Baccellieri D, Apruzzi L, Ardita V, et al. The "venous perspective" in Lombardia (Italy) during the first weeks of the COVID-19 epidemic. Phlebology. 2020; 35:295-296. https://doi.org/10.1177/0268355520925727
  • Marone EM and Rinaldi LF. Upsurge of deep venous thrombosis in patients affected by COVID-19: preliminary data and possible explanations. J Vasc Surg. Venous Lymphat Disord. 2020; 8: 694-695.https://doi.org/10.1016/j.jvsv.2020.04.004
  • Ren B, Yan F, Deng Z, et al. Extremely high incidence of lower extremity deep venous thrombosis in 48 patients with severe COVID-19 in Wuhan. Circulation. 2020; 142:181-183. https://doi.org/10.1161/CIRCULATIONAHA.120.047407
  • Zhang L, Feng X, Zhang D, et al. Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation. 2020; 142: 114-128. https://doi.org/10.1161/CIRCULATIONAHA.120.046702
  • Cattaneo M, Bertinato EM, Birocchi S, et al. Pulmonary embolism or pulmonary thrombosis in COVID-19? Is the recommendation to use high-dose heparin for thromboprophylaxis justified? Thromb Haemost. 2020. https://doi.org/10.1055/s-0040-1712097
  • Wichmann D, Sperhake JP, Lu¨tgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med. 2020; 173: 268-277.
  • Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020; 191: 9-14.
  • Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020. https://doi.org/10.1016/j.thromres.2020.04.013
  • Cui S, Chen S, Li X, et al. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020; 18: 1421-1424. https://doi.org/10.1111/jth.14830
  • Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020; 18: 1995-2002. https://doi.org/10.1111/jth.14888
  • Chen J, Wang X, Zhang S, et al. Findings of acute pulmonary embolism in COVID-19 patients. SSRN Electron J. 2020. https://doi.org/10.2139/ssrn.3548771
  • Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020; 46: 1089-1098.
  • Wang T, Chen R, Liu C, et al. Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19. Lancet Haematol. 2020; 7:e362-e363. https://doi.org/10.1016/S2352-3026(20)30109-5
  • Thomas W, Varley J, Johnston A, et al. Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom. Thromb Res. 2020; 191:76-77. https://doi.org/10.1016/j.thromres.2020.04.028
  • Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et.al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020; 383(2):120-8. https://doi.org/10.1056/NEJMoa2015432
  • Gupta N, Zhao YY, Evans CE. The stimulation of thrombosis by hypoxia. Thromb Res. 2019; 181:77- 83. https://doi.org/10.1016/j.thromres.2019.07.013
  • Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061-9.https://doi.org/10.1001/jama.2020.1585
  • Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020. https://doi.org/10.1001/jama.2020.4683
  • Zhou, F.; Yu, T.; Du, R.; Fan, G.; Liu, Y.; Liu, Z.; Xiang, J.; Wang, Y.; Song, B.; Gu, X.; et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020. 395:1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
  • Wu, J.T.; Leung, K.; Bushman, M.; Kishore, N.; Niehus, R.; De Salazar, P.M.; Cowling, B.J.; Lipsitch, M.; Leung, G.M. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nat. Med. 2020; 26:506-510. https://doi.org/10.1038/s41591-020-0822-7
  • Guan, W.-J.; Ni, Z.-Y.; Hu, Y.; Liang, W.-H.; Ou, C.-Q.; He, J.-X.; Liu, L.; Shan, H.; Lei, C.-L.; Hui, D.S.; et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N. Engl. J. Med. 2020; 382:1708-1720. https://doi.org/10.1056/NEJMoa2002032
  • Huang, C.; Wang, Y.; Li, X.; Ren, L.; Zhao, J.; Hu, Y.; Zhang, L.; Fan, G.; Xu, J.; Gu, X.; et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395:497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
  • Wang, D.; Hu, B.; Hu, C.; Zhu, F.; Liu, X.; Zhang, J.;Wang, B.; Xiang, H.; Cheng, Z.; Xiong, Y.; et al. Clinical Characteristics of 138 Hospitalized PatientsWith 2019 Novel Coronavirus-Infected Pneumonia inWuhan, China. JAMA. 2020; 323:1061. https://doi.org/10.1001/jama.2020.1585
  • Gentile, S.; Strollo, F.; Ceriello, A. COVID-19 Infection in italian people with diabetes: Lessons learned for our future (an experience to be used). Diabetes Res. Clin. Pract. 2020; 108137. https://doi.org/10.1016/j.diabres.2020.108137
  • Ma, R.C.W.; Holt, R.I.G. COVID-19 and diabetes. Diabet. Med. 2020; 37:723-725. https://doi.org/10.1111/dme.14300
  • Muniyappa, R.; Gubbi, S. COVID-19 Pandemic, Corona Viruses, and Diabetes Mellitus. Am. J. Physiol. Endocrinol. Metab. 2020. https://doi.org/10.1152/ajpendo.00124.2020
  • Fadini, G.P.; Morieri, M.L.; Longato, E.; Avogaro, A. Prevalence and impact of diabetes among people infected with SARS-CoV-2. J. Endocrinol. Investig. 2020. https://doi.org/10.1007/s40618-020-01236-2
  • Rey, Juan R et al. "Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications." European journal of heart failure. 2020; 22(12):2205-2215. https://doi.org/10.1002/ejhf.1990
  • Li, B.; Yang, J.; Zhao, F.; Zhi, L.;Wang, X.; Liu, L.; Bi, Z.; Zhao, Y. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin. Res. Cardiol. 2020; 109:531. https://doi.org/10.1007/s00392-020-01626-9
  • Ho, Jamie SY, et al. "Obesity in COVID-19: a systematic review and meta-analysis." Ann Acad Med Singap. 2020; 49(12):996-1008. https://doi.org/10.47102/annals-acadmedsg.2020299
  • Klok F.A., Kruip M.J.H.A., van der Meer N.J.M., Arbous M.S., Gommers D.A.M.P.J., Kant K.M., Kaptein F.H.J., Paassen J. van, Stals M.A.M., Huisman M.V., Endemane H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020; 191:145-147. https://doi.org/10.1016/j.thromres.2020.04.013
  • Brogan M, Ross M, J: The Impact of Chronic Kidney Disease on Outcomes of Patients with COVID-19 Admitted to the Intensive Care Unit. Nephron. 2022;146:67-71. https://doi.org/10.1159/000519530
  • Spiezia, L, Boscolo, A, Poletto. COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thromb Haemost. 2020; 120(6):998-1000. https://doi.org/10.1055/s-0040-1710018
  • Suh, Y. J., Hong, H., Ohana, M., Bompard, F., Revel, M. P., Valle, C., Gervaise, A., Poissy, J., Susen, S., Hékimian, G., Artifoni, M., Periard, D., Contou, D., Delaloye, J., Sanchez, B., Fang, C., Garzillo, G., Robbie, H., & Yoon, S. H. (2021). Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 298(2):E70-E80. https://doi.org/10.1148/radiol.2020203557
  • Kerbikov, O., Orekhov, P., Borskaya, E., & Nosenko, N. High incidence of venous thrombosis in patients with moderate-to-severe COVID-19. International journal of hematology. 2021; 113(3):344-347. https://doi.org/10.1007/s12185-020-03061-y
  • Connor-Schuler, R., Daniels, L., Coleman, C., Harris, D., Herbst, N., & Fiza, B. (2021). Presence of Spontaneous Echo Contrast on Point-of-Care Vascular Ultrasound and the Development of Major Clotting Events in Coronavirus Disease 2019 Patients. Critical care explorations. 3(1):e0320. https://doi.org/10.1097/CCE.0000000000000320
  • Jean-François Llitjos, Maxime Leclerc, Camille Chochois, Jean-Michel Monsallier, Michel Ramakers, Malika Auvray, Karim Merouani. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J. Thromb Haemost. 2020; 18 (7):1743-1746. https://doi.org/10.1111/jth.14869
  • Li J, Yan S, Zhang X, et al. Circulating D-Dimers Increase the Risk of Mortality and Venous Thromboembolism in Patients With Lung Cancer: A Systematic Analysis Combined With External Validation. Front Med (Lausanne). 2022; 9:853941. https://doi.org/10.3389/fmed.2022.853941