Dataset Information

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

ABSTRACT: 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.

SUBMITTER: da Silveira WC

PROVIDER: S-EPMC9156830 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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

da Silveira Warley Cezar WC Ramos Lucas Emanuel Ferreira LEF Silva Rafael Tavares RT de Paiva Bruno Barbosa Miranda BBM Pereira Polianna Delfino PD Schwarzbold Alexandre Vargas AV Garbini Andresa Fontoura AF Barreira Bruna Schettino Morato BSM de Castro Bruno Mateus BM Ramos Carolina Marques CM Gomes Caroline Danubia CD Cimini Christiane Corrêa Rodrigues CCR Pereira Elayne Crestani EC Roesch Eliane Würdig EW Kroger Emanuele Marianne Souza EMS Aranha Felipe Ferraz Martins Graça FFMG Anschau Fernando F Botoni Fernando Antonio FA Aranha Fernando Graça FG Crestani Gabriela Petry GP Vietta Giovanna Grunewald GG Bastos Gisele Alsina Nader GAN Costa Jamille Hemétrio Salles Martins JHSM da Fonseca Jéssica Rayane Corrêa Silva JRCS Ruschel Karen Brasil KB de Oliveira Leonardo Seixas LS Pinheiro Lílian Santos LS Pacheco Liliane Souto LS Segala Luciana Borges LB Couto Luciana Siuves Ferreira LSF Kopittke Luciane L Floriani Maiara Anschau MA Silva Majlla Magalhães MM Carneiro Marcelo M Ferreira Maria Angélica Pires MAP Martins Maria Auxiliadora Parreiras MAP de Faria Marina Neves Zerbini MNZ Nogueira Matheus Carvalho Alves MCA Guimarães Júnior Milton Henriques MH Sampaio Natália da Cunha Severino NDCS de Oliveira Neimy Ramos NR Pertile Nicole de Moraes NM Andrade Pedro Guido Soares PGS Assaf Pedro Ledic PL Valacio Reginaldo Aparecido RA Menezes Rochele Mosmann RM Francisco Saionara Cristina SC Guimarães Silvana Mangeon Meirelles SMM Araújo Silvia Ferreira SF Rezende Suely Meireles SM Pereira Susany Anastácia SA Kurtz Tatiana T Fereguetti Tatiani Oliveira TO Polanczyk Carísi Anne CA Pires Magda Carvalho MC Gonçalves Marcos André MA Marcolino Milena Soriano MS

Internal and emergency medicine 20220601 7

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 ...[more]

PMID: 35648280

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Project description:ImportanceVenous thromboembolism (VTE) is a common complication of COVID-19. It is not well understood how hospitals have managed VTE prevention and the effect of prevention strategies on mortality.ObjectiveTo characterize frequency, variation across hospitals, and change over time in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality.Design, setting, and participantsThis cohort study of adults hospitalized with COVID-19 used a pseudorandom sample from 30 US hospitals in the state of Michigan participating in a collaborative quality initiative. Data analyzed were from patients hospitalized between March 7, 2020, and June 17, 2020. Data were analyzed through March 2021.ExposuresNonadherence to VTE prophylaxis (defined as missing ≥2 days of VTE prophylaxis) and receipt of treatment-dose or prophylactic-dose anticoagulants vs no anticoagulation during hospitalization.Main outcomes and measuresThe effect of nonadherence and anticoagulation strategies on in-hospital and 60-day mortality was assessed using multinomial logit models with inverse probability of treatment weighting.ResultsOf a total 1351 patients with COVID-19 included (median [IQR] age, 64 [52-75] years; 47.7% women, 48.9% Black patients), only 18 (1.3%) had a confirmed VTE, and 219 (16.2%) received treatment-dose anticoagulation. Use of treatment-dose anticoagulation without imaging ranged from 0% to 29% across hospitals and increased over time (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.61 per week). Of 1127 patients who ever received anticoagulation, 392 (34.8%) missed 2 or more days of prophylaxis. Missed prophylaxis varied from 11% to 61% across hospitals and decreased markedly over time (aOR, 0.89; 95% CI, 0.82-0.97 per week). VTE nonadherence was associated with higher 60-day (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.03-1.67) but not in-hospital mortality (aHR, 0.97; 95% CI, 0.91-1.03). Receiving any dose of anticoagulation (vs no anticoagulation) was associated with lower in-hospital mortality (only prophylactic dose: aHR, 0.36; 95% CI, 0.26-0.52; any treatment dose: aHR, 0.38; 95% CI, 0.25-0.58). However, only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose: aHR, 0.71; 95% CI, 0.51-0.90; treatment dose: aHR, 0.92; 95% CI, 0.63-1.35).Conclusions and relevanceThis large, multicenter cohort of patients hospitalized with COVID-19, found evidence of rapid dissemination and implementation of anticoagulation strategies, including use of treatment-dose anticoagulation. As only prophylactic-dose anticoagulation was associated with lower 60-day mortality, prophylactic dosing strategies may be optimal for patients hospitalized with COVID-19.

Dataset Information

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

Publications

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

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