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Minerva Medica 2021 Jun 11

DOI: 10.23736/S0026-4806.21.07331-6


language: English

A novel evidence-based algorithm to predict thromboembolism in patients with COVID-19: preliminary data from a single-centre cohort

Giuseppe A. RAMIREZ 1, 2, Stefania L. CALVISI 3 , Rebecca DE LORENZO 2, 4, Valentina DA PRAT 3, Giorgia BORIO 2, 3, Gabriele GALLINA 2, 3, Federica FAROLFI 2, 3, Ludovica CAVALLO 2, 3, Maria PASCALI 2, 3, Jacopo CASTELLANI 2, 3, Domenico BACCELLIERI 5, Francesca GUZZO 6, Martina BAIARDO REDAELLI 6, Maria Luisa AZZOLINI 6, Ada C. ALBA 6, Alberto ZANGRILLO 2, 6, Enrica P. BOZZOLO 3, Raffaella SCOTTI 3, Giuseppe DI LUCCA 3, Lorenzo PIEMONTI 2, 7, Patrizia ROVERE QUERINI 2, 4, Armando D’ANGELO 2, 8, Moreno TRESOLDI 3, COVID-BioB group 

1 Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; 2 Università Vita-Salute San Raffaele, Milan, Italy; 3 Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy; 4 Unit of Internal Medicine and Endocrinology, IRCCS Ospedale San Raffaele, Milan, Italy; 5 Unit of Vascular Surgery, IRCCS Ospedale San Raffaele, Milan, Italy; 6 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; 7 Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; 8 Coagulation Service and Thrombosis Research Unit, IRCCS Ospedale San Raffaele, Milan, Italy

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-related disease (COVID-19) is an infectious disease characterised by systemic inflammation, which might enhance baseline thrombotic risk, especially in hospitalised patients. Little is, however, known about predictors of thrombotic complications in patients with COVID-19.
METHODS: We prospectively followed up 180 hospitalised COVID-19 patients. Demographics, clinical and laboratory features at presentation and past medical history were tested as predictors of the first thrombotic complication through multivariate Cox regression analysis and a categorical score generated based on the results.
RESULTS: Sixty-four thromboses were recorded in 54 patients, of whom seven with thrombosis on admission and 47 with thrombosis during hospitalisation. Patients with thrombosis were mainly Caucasian and diabetic, had marked baseline signs of inflammation and organ damage, lower PaO2/FiO2 ratio, higher D-dimer levels and history of major haemorrhages. The latter three variables were independently associated to thrombotic complications and concurred to a 0-5 score, which accounted for 80% of the total sample variability. Patients with three or more points of the newly generated score were at higher risk for thrombotic complications (HR=4.9, p<0.001). Patients with thrombotic complications were more likely to be admitted to intensive care and/or to die (HR=1.9, p=0.036). Five of 180 patients were diagnosed with disseminated intravascular coagulation and three of them died. Eleven minor and no major bleeding events were observed.
CONCLUSIONS: Patients with COVID-19 are at increased risk for thrombosis and might be stratified on admission based lower Pao2/FiO2 ratio, higher D-dimer levels and history of major haemorrhages.

KEY WORDS: COVID-19; Thrombosis; D-dimer; Coagulopathy; Predictors

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