Predictors of venous thromboembolism in patients with COVID-19 in an underserved urban population: A single tertiary center experience

Abstract

Introduction: Venous thromboembolism (VTE) is reported in up to 27% of patients with COVID-19 due to SARS-CoV-2 infection. Dysregulated systemic inflammation and various patient traits are presumed to underlie this anomaly. Optimal VTE prophylaxis in COVID-19 patients has not been established due to a lack of validated models for predicting VTE in this population. Our study aims to address this deficiency by identifying demographic and clinical characteristics of COVID-19 patients associated with increased VTE risk. Methods: This study is a retrospective analysis of all adult patients (final sample, n = 355) hospitalized with confirmed COVID-19 at Einstein Medical Center Philadelphia between March 1 and April 24, 2020. Demographic and clinical patient data were collected and factors associated with VTE were identified and analyzed using t-tests, multivariable logistic regression, and receiver operating characteristic (ROC) curves. Results: Thirty patients (8.5%) developed VTE. Patients with VTE had significantly higher D-dimer levels on admission (P = 0.045) and peak D-dimer levels (P < 0.0001), in addition to higher rates of vasopressor requirements (P = 0.038), intubation (P = 0.003), and death (P = 0.023). Age (OR 1.042), obstructive sleep apnea (OR 5.107), and need for intubation (OR 3.796) were associated with significantly increased odds of VTE. Peak D-dimer level was a good predictor of VTE (AUC 0.806, P < 0.0001) and a D-dimer cutoff of >6640 ng/mL had high (>70%) sensitivity and specificity for VTE. Conclusion: Peak D-dimer level may be the most reliable clinical marker in COVID-19 patients for predicting VTE and future prospective studies should attempt to further validate this.