Abstract Number: PB0261
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: It is widely reported that patients infected with severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) are at increased risk of developing venous thromboembolic disease (VTD) requiring prophylactic heparin.
Aims: To describe predictive biomarkers at the time of emergency room (ER) admission that could predict the development of VTD in these patients.
Methods: From March 2020 to April 2020, 105 patients with COVID-19 were included in this retrospective study. Demographic characteristics, clinical history and blood test data at time of ER admission were collected. Data were compared using Mann–Whitney U test for continuous variables and Chi-squared test for categorical variables. Univariate and multivariate logistic regression analysis were performed to identify independent impact on VTD risk.
Results: Forty-seven patients (44%) presented thromboembolic event (group 1). Thirty-four (32%) of them developed VTD during hospitalization while 13 patients (12%) presented it at the time of ER admission. Blood test results at the time of ER admission are shown in Table 1.
| Group 1 (N: 47) | Group 2 (N: 58) | p-value | |
| D-dimer (ng/dl) | 3613 (96-32967) | 2448 (95-50354) | 0.007 |
| Platelet count (cell/µL) | 214000 (46000-554000) | 216000 (21000-519000) | 0.97 |
| Lymphocyte count (cell/µL) | 859 (200-1800) | 998 (200-3100) | 0.47 |
| International Normalized Ratio | 1.1 (0.3-1.62) | 1.27 (0.95-5.57) | 0.38 |
| Fibrinogen (mg/dl) | 716 (440-949) | 741 (232-1000) | 0.44 |
| Creatinine (mg/dl) | 1.03 (0.52-2.07) | 0.92 (0.49-1.48) | 0.072 |
| Oxygen saturation level (%) | 86% (55-98) | 92% (76-99) | 0.002 |
| Length of stay (days) | 32 (5-119) | 16 (2-71) | 0.001 |
| Exitus (%) | 19.1 | 19 | 0.98 |
Baseline characteristics of the patients. Group 1: patients with VTD. Group 2: patients without VTD.
Statistical differences between both groups were not significant in terms of personal background data collected: age, gender, cardiovascular risk factors, VTD risk factors (obesity, smoking, active cancer, previous immobilization, recent surgical intervention, former VTD or hormone therapy) and previous anticoagulant treatment. In group 1, 17 patients (36%) required ICU admission vs 11 patients (19%) in group 2 (p = 0.047).
Representative univariate and multivariate regression analysis are shown in Table 2. High D-dimer levels and low oxygen saturation levels were discovered to be independent predictors of VTD. In ROC curve analysis, D-dimer levels above 500 ng/dl detects VTD development with a sensitivity of 71.9% and a specificity of 58.6% (AUC: 0.672).
| Univariate | Multivariate | |||
| OR | p-value | OR | p-value | |
| D-dimer > 500ng/dl | 3.620 | 0.007 | 6.734 | 0.013 |
| D-dimer > 1000ng/dl | 5.444 | 0.001 | ||
| Oxygen saturation level < 95% | 6.289 | 0.002 | 11.650 | 0.002 |
| Oxygen saturation level < 90% | 2,262 | 0.078 | ||
| ICU admission | 2.41 | 0.052 | 3.710 | 0.27 |
| High flow oxygen therapy | 3.258 | 0.005 | 2.831 | 0.137 |
Univariate and multivariate regression analysis. ICU: intensive care unit. OR: odds ratio
Conclusions: In our study, higher D-dimer values and lower oxygen saturation levels at the time of ER admission seems to be predictors of development of VTD during hospitalization in patients with Sars-Cov2 infection.
To cite this abstract in AMA style:
Silva de Tena P, Gómez de Antonio R, Martín Rojas RM, Perez Rus G, Díez-Martín JL, Pascual Izquierdo C. Venous Thromboembolic Disease in Patients Wwith SARS-CoV2 Infection: In Search of a Predictive Biomarker [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/venous-thromboembolic-disease-in-patients-wwith-sars-cov2-infection-in-search-of-a-predictive-biomarker/. Accessed December 10, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/venous-thromboembolic-disease-in-patients-wwith-sars-cov2-infection-in-search-of-a-predictive-biomarker/