Dataset Information

The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19.

ABSTRACT:

Background

Hospitalized patients with COVID-19 have increased risks of venous (VTE) and arterial thromboembolism (ATE). Active cancer diagnosis and treatment are well-known risk factors; however, a risk assessment model (RAM) for VTE in patients with both cancer and COVID-19 is lacking.

Objectives

To assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID-19.

Methods

Among patients with cancer in the COVID-19 and Cancer Consortium registry (CCC19) cohort study, we assessed the incidence of VTE and ATE within 90 days of COVID-19-associated hospitalization. A multivariable logistic regression model specifically for VTE was built using a priori determined clinical risk factors. A simplified RAM was derived and internally validated using bootstrap.

Results

From March 17, 2020 to November 30, 2020, 2804 hospitalized patients were analyzed. The incidence of VTE and ATE was 7.6% and 3.9%, respectively. The incidence of VTE, but not ATE, was higher in patients receiving recent anti-cancer therapy. A simplified RAM for VTE was derived and named CoVID-TE (Cancer subtype high to very-high risk by original Khorana score +1, VTE history +2, ICU admission +2, D-dimer elevation +1, recent systemic anti-cancer Therapy +1, and non-Hispanic Ethnicity +1). The RAM stratified patients into two cohorts (low-risk, 0-2 points, n = 1423 vs. high-risk, 3+ points, n = 1034) where VTE occurred in 4.1% low-risk and 11.3% high-risk patients (c statistic 0.67, 95% confidence interval 0.63-0.71). The RAM performed similarly well in subgroups of patients not on anticoagulant prior to admission and moderately ill patients not requiring direct ICU admission.

Conclusions

Hospitalized patients with cancer and COVID-19 have elevated thrombotic risks. The CoVID-TE RAM for VTE prediction may help real-time data-driven decisions in this vulnerable population.

SUBMITTER: Li A

PROVIDER: S-EPMC8420489 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19.

Li Ang A Kuderer Nicole M NM Hsu Chih-Yuan CY Shyr Yu Y Warner Jeremy L JL Shah Dimpy P DP Kumar Vaibhav V Shah Surbhi S Kulkarni Amit A AA Fu Julie J Gulati Shuchi S Zon Rebecca L RL Li Monica M Desai Aakash A Egan Pamela C PC Bakouny Ziad Z Kc Devendra D Hwang Clara C Akpan Imo J IJ McKay Rana R RR Girard Jennifer J Schmidt Andrew L AL Halmos Balazs B Thompson Michael A MA Patel Jaymin M JM Pennell Nathan A NA Peters Solange S Elshoury Amro A de Lima Lopes Gilbero G Stover Daniel G DG Grivas Petros P Rini Brian I BI Painter Corrie A CA Mishra Sanjay S Connors Jean M JM Lyman Gary H GH Rosovsky Rachel P RP

Journal of thrombosis and haemostasis : JTH 20210813 10

<h4>Background</h4>Hospitalized patients with COVID-19 have increased risks of venous (VTE) and arterial thromboembolism (ATE). Active cancer diagnosis and treatment are well-known risk factors; however, a risk assessment model (RAM) for VTE in patients with both cancer and COVID-19 is lacking.<h4>Objectives</h4>To assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID-19.<h4>Methods</h4>Among patients with cancer in the COVID-19 and Cancer Consort ...[more]

PMID: 34260813

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Project description:ImportancePatients hospitalized with COVID-19 have higher rates of venous thromboembolism (VTE), but the risk and predictors of VTE among individuals with less severe COVID-19 managed in outpatient settings are less well understood.ObjectivesTo assess the risk of VTE among outpatients with COVID-19 and identify independent predictors of VTE.Design, setting, and participantsA retrospective cohort study was conducted at 2 integrated health care delivery systems in Northern and Southern California. Data for this study were obtained from the Kaiser Permanente Virtual Data Warehouse and electronic health records. Participants included nonhospitalized adults aged 18 years or older with COVID-19 diagnosed between January 1, 2020, and January 31, 2021, with follow-up through February 28, 2021.ExposuresPatient demographic and clinical characteristics identified from integrated electronic health records.Main outcomes and measuresThe primary outcome was the rate per 100 person-years of diagnosed VTE, which was identified using an algorithm based on encounter diagnosis codes and natural language processing. Multivariable regression using a Fine-Gray subdistribution hazard model was used to identify variables independently associated with VTE risk. Multiple imputation was used to address missing data.ResultsA total of 398 530 outpatients with COVID-19 were identified. The mean (SD) age was 43.8 (15.8) years, 53.7% were women, and 54.3% were of self-reported Hispanic ethnicity. There were 292 (0.1%) VTE events identified over the follow-up period, for an overall rate of 0.26 (95% CI, 0.24-0.30) per 100 person-years. The sharpest increase in VTE risk was observed during the first 30 days after COVID-19 diagnosis (unadjusted rate, 0.58; 95% CI, 0.51-0.67 per 100 person-years vs 0.09; 95% CI, 0.08-0.11 per 100 person-years after 30 days). In multivariable models, the following variables were associated with a higher risk for VTE in the setting of nonhospitalized COVID-19: age 55 to 64 years (HR 1.85 [95% CI, 1.26-2.72]), 65 to 74 years (3.43 [95% CI, 2.18-5.39]), 75 to 84 years (5.46 [95% CI, 3.20-9.34]), greater than or equal to 85 years (6.51 [95% CI, 3.05-13.86]), male gender (1.49 [95% CI, 1.15-1.96]), prior VTE (7.49 [95% CI, 4.29-13.07]), thrombophilia (2.52 [95% CI, 1.04-6.14]), inflammatory bowel disease (2.43 [95% CI, 1.02-5.80]), body mass index 30.0-39.9 (1.57 [95% CI, 1.06-2.34]), and body mass index greater than or equal to 40.0 (3.07 [1.95-4.83]).Conclusions and relevanceIn this cohort study of outpatients with COVID-19, the absolute risk of VTE was low. Several patient-level factors were associated with higher VTE risk; these findings may help identify subsets of patients with COVID-19 who may benefit from more intensive surveillance or VTE preventive strategies.

Dataset Information

The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19.

Background

Objectives

Methods

Results

Conclusions

Publications

The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19.

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