Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia

Songping Cui, Shuo Chen, Xiunan Li, Shi Liu, Feng Wang, Songping Cui, Shuo Chen, Xiunan Li, Shi Liu, Feng Wang

Abstract

Background: Three months ago, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, and spread rapidly around the world. Severe novel coronavirus pneumonia (NCP) patients have abnormal blood coagulation function, but their venous thromboembolism (VTE) prevalence is still rarely mentioned.

Objectives: To determine the incidence of VTE in patients with severe NCP.

Methods: In this study, 81 severe NCP patients in the intensive care unit (ICU) of Union Hospital (Wuhan, China) were enrolled. The results of conventional coagulation parameters and lower limb vein ultrasonography of these patients were retrospectively collected and analyzed.

Results: The incidence of VTE in these patients was 25% (20/81), of which 8 patients with VTE events died. The VTE group was different from the non-VTE group in age, lymphocyte counts, activated partial thromboplastin time (APTT), D-dimer, etc. If 1.5 µg/mL was used as the D-dimer cut-off value to predicting VTE, the sensitivity was 85.0%, the specificity was 88.5%, and the negative predictive value (NPV) was 94.7%.

Conclusions: The incidence of VTE in patients with severe NCP is 25% (20/81), which may be related to poor prognosis. The significant increase of D-dimer in severe NCP patients is a good index for identifying high-risk groups of VTE.

Keywords: D-dimer; blood coagulation; coagulation parameter; novel coronavirus pneumonia; venous thromboembolism.

© 2020 International Society on Thrombosis and Haemostasis.

References

    1. Chen N., Zhou M., Dong X., et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–513.
    1. Huang C., Wang Y., Li X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China. Lancet. 2020;395:497–506.
    1. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18:844–847.
    1. Han H., Yang L., Liu R., et al. Prominent changes in blood coagulation of patients with SARS‐CoV‐2 infection. Clin Chem Lab Med. 2020 doi: 10.1515/cclm-2020-0188.
    1. WHO. Laboratory testing for 2019 novel coronavirus (2019‐nCoV) in suspected human cases. Interim guidance. 2020. .
    1. The fifth revised trial version of the novel coronavirus pneumonia diagnosis and treatment guidance.
    1. Wang D., Hu B., Hu C., et al. Novel coronavirus‐infected pneumonia in Wuhan, China. JAMA. 2019;2020
    1. Qin C., Zhou L., Hu Z., et al. Dysregulation of immune response in patients with COVID‐19 in Wuhan. China. Clin Infect Dis. 2020:ciaa248.
    1. Duan Q., Gong Z., Song H., et al. Symptomatic venous thromboembolism is a disease related to infection and immune dysfunction. Int J Med Sci. 2012;9:453–461.
    1. Wong C.K., Lam C.W., Wu A.K., et al. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome. Clin Exp Immunol. 2004;136:95–103.
    1. Mahallawi W.H., Khabour O.F., Zhang Q., Makhdoum H.M., Suliman B.A. MERS‐CoV infection in humans is associated with a pro‐inflammatory Th1 and Th17 cytokine profile. Cytokine. 2018;104:8–13.
    1. Opal S.M. Interactions between coagulation and inflammation. Scand J Infect Dis. 2003;35:545–554.
    1. Levi M., van der Poll T., Buller H.R. Bidirectional relation between inflammation and coagulation. Circulation. 2004;109:2698–2704.
    1. van der Poll T., Levi M. Crosstalk between inflammation and coagulation: the lessons of sepsis. Curr Vasc Pharmacol. 2012;10:632–638.
    1. Iba T., Thachil J. Present and future of anticoagulant therapy using antithrombin and thrombomodulin for sepsis‐associated disseminated intravascular coagulation: a perspective from Japan. Int J Hematol. 2016;103:253–261.
    1. Koch V., Biener M., Muller‐Hennessen M., et al. Diagnostic performance of D‐dimer in predicting venous thromboembolism and acute aortic dissection. Eur Heart J Acute Cardiovasc Care. 2020

Source: PubMed

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