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

• DOI: 10.1007/s11739-022-03002-z
• Publication Date: 2022-06-01T07:02:46Z
• Authors: Warley Cezar da S...; Lucas Emanuel Fer...; Rafael Tavares Silva; Bruno Barbosa Mir...; Polianna Delfino ...; Alexandre Vargas ...; Andresa Fontoura ...; Bruna Schettino M...; Bruno Mateus de C...; Carolina Marques ...; Caroline Danubia ...; Christiane Corrêa...; Elayne Crestani P...; Eliane Würdig Roesch; Emanuele Marianne...; Felipe Ferraz Mar...; Fernando Anschau; Fernando Antonio ...; Fernando Graça Ar...; Gabriela Petry Cr...; Giovanna Grunewal...; Gisele Alsina Nad...; Jamille Hemétrio ...; Jéssica Rayane Co...; Karen Brasil Ruschel; Leonardo Seixas d...; Lílian Santos Pin...; Liliane Souto Pac...; Luciana Borges Se...; Luciana Siuves Fe...; Luciane Kopittke; Maiara Anschau Fl...; Majlla Magalhães ...; Marcelo Carneiro; Maria Angélica Pi...; Maria Auxiliadora...; Marina Neves Zerb...; Matheus Carvalho ...; Milton Henriques ...; Natália da Cunha ...; Neimy Ramos de Ol...; Nicole de Moraes ...; Pedro Guido Soare...; Pedro Ledic Assaf; Reginaldo Apareci...; Rochele Mosmann M...; Saionara Cristina...; Silvana Mangeon M...; Silvia Ferreira A...; Suely Meireles Re...; Susany Anastácia ...; Tatiana Kurtz; Tatiani Oliveira ...; Carísi Anne Polan...; Magda Carvalho Pires; Marcos André Gonç...; Milena Soriano Ma...
• Keywords: Adult; Male; Anticoagulants; COVID-19; Venous Thromboembolism; Im - Original; 3. Good health; Cohort Studies; Oxygen; 03 medical and health sciences; C-Reactive Protein; 0302 clinical medicine; Risk Factors; Lactates; Humans; Female; Registries; Brazil

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.