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Predictors of venous thromboembolism in COVID-19 patients: results of the COVID-19 Brazilian Registry

2022; Springer Science+Business Media; Volume: 17; Issue: 7 Linguagem: Inglês

10.1007/s11739-022-03002-z

1970-9366

Warley Cezar da Silveira, Lucas Emanuel Ferreira Ramos, Rafael Tavares Silva, Bruno Barbosa Miranda de Paiva, Polianna Delfino-Pereira, Alexandre Vargas Schwarzbold, Andresa Fontoura Garbini, Bruna Schettino Morato Barreira, Bruno Mateus de Castro, Carolina Marques Ramos, Caroline Danubia Gomes, Christiane Corrêa Rodrigues Cimini, Elayne Crestani Pereira, Eliane Würdig Roesch, Emanuele Marianne Souza Kroger, Felipe Ferraz Martins Graça Aranha, Fernando Anschau, Fernando Antônio Botoni, Fernando Graça Aranha, Gabriela Petry Crestani, Giovanna Grünewald Vietta, Gisele Alsina Nader Bastos, Jamille Hemétrio Salles Martins Costa, Jéssica Rayane Corrêa Silva da Fonseca, Karen Brasil Ruschel, Leonardo Seixas de Oliveira, Lílian Santos Pinheiro, Liliane Souto Pacheco, Luciana Borges Segala, Luciana Siuves Ferreira Couto, Luciane Kopittke, Maiara Anschau Floriani, Majlla Magalhães Silva, Marcelo Carneiro, Maria Angélica Pires Ferreira, Maria Auxiliadora Parreiras Martins, Marina Neves Zerbini de Faria, Matheus Carvalho Alves Nogueira, Milton Henriques Guimarães Júnior, Natália da Cunha Severino Sampaio, Neimy Ramos de Oliveira, Nicole de Moraes Pertile, Pedro Guido Soares Andrade, Pedro Ledic Assaf, Reginaldo Aparecido Valácio, Rochele Mosmann Menezes, Saionara Cristina Francisco, Silvana Mangeon Meirelles Guimarães, Silvia Ferreira Araújo, Suely Meireles Rezende, Susany Anastácia Pereira, Tatiana Kurtz, Tatiani Oliveira Fereguetti, Carísi Anne Polanczyk, Magda Carvalho Pires, Marcos André Gonçalves, Milena Soriano Marcolino,

COVID-19 and healthcare impacts

Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. This cohort study of a large Brazilian COVID-19 Registry included 4120 COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting, and bagging were used to investigate the association of variables upon hospital presentation with VTE. Among 4,120 patients (55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95% CI 1.11–2.02); being an ex-smoker (OR 1.44, 95% CI 1.03–2.01); surgery ≤ 90 days (OR 2.20, 95% CI 1.14–4.23); axillary temperature (OR 1.41, 95% CI 1.22–1.63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2.16, 95% CI 1.26–3.67), lactate (OR 1.10, 95% CI 1.02–1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01–1.18); and neutrophil count (OR 1.04, 95% CI 1.005–1.075) were independent predictors of VTE. Atrial fibrillation, peripheral oxygen saturation/inspired oxygen fraction (SF) ratio and prophylactic use of anticoagulants were protective. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. By using ML and LR analyses, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.