The coronavirus disease 2019 (COVID-19) continues to pose an
unprecedented challenge for the entire world and the healthcare system. The
role of D-dimer and troponin-I as markers of thrombosis or procoagulant state
in COVID-19 infection has been under investigation since the inception of this
disease. Different theories have been proposed elucidating the
pathophysiological mechanisms attributing to high mortality and morbidity in
COVID-19 infection. Out of them, thrombosis and procoagulant state have managed
to earn the maximum limelight. The main objective of our study was to assess
the risk and occurrence of thrombotic events (both venous and arterial) among
hospitalized patients including the intensive care unit (ICU) and non-ICU
admissions with confirmed COVID-19 infection. An observational study was
conducted based on data from randomly selected 349 hospitalized patients with
COVID-19 infection in a community-based hospital in New York City during the
first wave of the COVID-19 viral surge in March 2020. Diagnoses were made
during the inpatient clinical care, as screening for thrombotic events is not a
standard method. The statistical analysis involved non-normally distributed
continuous variables that were described as the median and interquartile range
(IQR) while mean and standard deviation were used to describe normally
distributed continuous variables. The primary outcome in our study was defined
as the thrombotic events that included myocardial infarction (MI), deep venous
thrombosis (DVT), cerebrovascular accidents (CVA), and pulmonary embolism (PE).
The study correlated the association of thrombotic events with the level of
biomarkers of interest: D-dimer >1000 ng/ml, troponin-I >1 ng/ml, or
both. The association of D-dimers and troponin-I with thrombotic events was measured
using both univariate and multivariate Cox proportional hazard (PH) regression
analysis. Out of a total of 349 patients, 78 patients (22.35%) were found to
have elevated biomarkers (D-dimer >1000 ng/ml and/or troponin-I >1 ng/ml)
and were categorized as a high-risk group. Eighty-nine patients developed
thrombotic complications (evidence of more than one thrombotic event was found
in several patients). Two-hundred seventy-one (77.65%) patients had no
documentation of thrombosis. The in-patient mortality rate among patients in
our study group, with a high risk of thrombotic events was 44.87% (35/78) as
compared to 38.80% (104/271) in patients without any thrombotic events. The
incidence of thrombotic events included myocardial infarction (MI; N=45;
12.8%), cerebrovascular accidents (CVA; N=16; 4.5%), deep venous thrombosis
(DVT; N=16; 4.5%), and pulmonary embolism (PE; N=9; 2.57%). The lack of prior
immunity to COVID-19 has resulted in large numbers of infected patients across
the globe and uncertainty regarding the management of the complications that
arise in the course of this viral illness. Although D-dimer, sepsis, and
microvascular thrombosis are associated with mortality, current data are
inconclusive for the use of therapeutic doses of anticoagulation for these
findings. With the resurgence of the COVID-19 wave, it is imperative to focus
on optimal diagnostic and prophylactic strategies to prevent thromboembolic
events and potentially improve survival in COVID-19 patients.
Author
(s) Details
Ruchi
Yadav
Hematology/Oncology, Brookdale University Hospital and Medical
Center, Brooklyn, USA.
Beka
Aroshidze
Hematology/Oncology, Brookdale University Hospital and Medical
Center, Brooklyn, USA.
Vivek
Yadav
Pulmonary and Critical Care, State University of New York
Downstate Health Sciences University, New
York, USA.
Umar
Zahid
Nephrology, Brookdale University Hospital and Medical Center,
Brooklyn, USA.
Apoorva
Jayarangaiah
Internal Medicine, New York City (NYC) Health and Hospitals/Jacobi
Medical Center, Bronx, USA.
Anjula
Gandhi
Internal Medicine, Brookdale University Hospital and Medical
Center, Brooklyn, USA.
Vladimir
Gotlieb
Hematology/Oncology, Brookdale University Hospital and Medical
Center, Brooklyn, USA.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v5/1997
No comments:
Post a Comment