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COVID-19 and Risk of VTE in Ethnically Diverse Populations.
Chest. 2021 Jul 19 [Online ahead of print]Chest

Abstract

BACKGROUND

Limited existing data suggest that the novel COVID-19 may increase risk of VTE, but information from large, ethnically diverse populations with appropriate control participants is lacking.

RESEARCH QUESTION

Does the rate of VTE among adults hospitalized with COVID-19 differ from matched hospitalized control participants without COVID-19?

STUDY DESIGN AND METHODS

We conducted a retrospective study among hospitalized adults with laboratory-confirmed COVID-19 and hospitalized adults without evidence of COVID-19 matched for age, sex, race or ethnicity, acute illness severity, and month of hospitalization between February 2020 and August 2020 from two integrated health-care delivery systems with 36 hospitals. Outcomes included VTE (DVT or pulmonary embolism ascertained using diagnosis codes combined with validated natural language processing algorithms applied to electronic health records) and death resulting from any cause at 30 days. Fine and Gray hazards regression was performed to evaluate the association of COVID-19 with VTE after accounting for competing risk of death and residual differences between groups, as well as to identify predictors of VTE in patients with COVID-19.

RESULTS

We identified 6,319 adults with COVID-19 and 6,319 matched adults without COVID-19, with mean ± SD age of 60.0 ± 17.2 years, 46% women, 53.1% Hispanic, 14.6% Asian/Pacific Islander, and 10.3% Black. During 30-day follow-up, 313 validated cases of VTE (160 COVID-19, 153 control participants) and 1,172 deaths (817 in patients with COVID-19, 355 in control participants) occurred. Adults with COVID-19 showed a more than threefold adjusted risk of VTE (adjusted hazard ratio, 3.48; 95% CI, 2.03-5.98) compared with matched control participants. Predictors of VTE in patients with COVID-19 included age ≥ 55 years, Black race, prior VTE, diagnosed sepsis, prior moderate or severe liver disease, BMI ≥ 40 kg/m2, and platelet count > 217 k/μL.

INTERPRETATION

Among ethnically diverse hospitalized adults, COVID-19 infection increased the risk of VTE, and selected patient characteristics were associated with higher thromboembolic risk in the setting of COVID-19.

Authors+Show Affiliations

Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Departments of Medicine and of Health Research and Policy, Stanford University, Palo Alto, CA. Electronic address: Alan.S.Go@kp.org.Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.Division of Research, Kaiser Permanente Northern California, Oakland, CA.Department of Medicine, University of California, San Francisco, San Francisco, CA.Division of Research, Kaiser Permanente Northern California, Oakland, CA.Division of Research, Kaiser Permanente Northern California, Oakland, CA.Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.Division of Research, Kaiser Permanente Northern California, Oakland, CA.Department of Hematology/Oncology, Kaiser Permanente Oakland Medical Center, Oakland, CA.Department of Medicine, University of California, San Francisco, San Francisco, CA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34293316

Citation

Go, Alan S., et al. "COVID-19 and Risk of VTE in Ethnically Diverse Populations." Chest, 2021.
Go AS, Reynolds K, Tabada GH, et al. COVID-19 and Risk of VTE in Ethnically Diverse Populations. Chest. 2021.
Go, A. S., Reynolds, K., Tabada, G. H., Prasad, P. A., Sung, S. H., Garcia, E., Portugal, C., Fan, D., Pai, A. P., & Fang, M. C. (2021). COVID-19 and Risk of VTE in Ethnically Diverse Populations. Chest. https://doi.org/10.1016/j.chest.2021.07.025
Go AS, et al. COVID-19 and Risk of VTE in Ethnically Diverse Populations. Chest. 2021 Jul 19; PubMed PMID: 34293316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 and Risk of VTE in Ethnically Diverse Populations. AU - Go,Alan S, AU - Reynolds,Kristi, AU - Tabada,Grace H, AU - Prasad,Priya A, AU - Sung,Sue Hee, AU - Garcia,Elisha, AU - Portugal,Cecilia, AU - Fan,Dongjie, AU - Pai,Ashok P, AU - Fang,Margaret C, Y1 - 2021/07/19/ PY - 2021/03/08/received PY - 2021/07/09/revised PY - 2021/07/10/accepted PY - 2021/7/23/pubmed PY - 2021/7/23/medline PY - 2021/7/22/entrez KW - VTE KW - covid-19 KW - epidemiology KW - risk factor JF - Chest JO - Chest N2 - BACKGROUND: Limited existing data suggest that the novel COVID-19 may increase risk of VTE, but information from large, ethnically diverse populations with appropriate control participants is lacking. RESEARCH QUESTION: Does the rate of VTE among adults hospitalized with COVID-19 differ from matched hospitalized control participants without COVID-19? STUDY DESIGN AND METHODS: We conducted a retrospective study among hospitalized adults with laboratory-confirmed COVID-19 and hospitalized adults without evidence of COVID-19 matched for age, sex, race or ethnicity, acute illness severity, and month of hospitalization between February 2020 and August 2020 from two integrated health-care delivery systems with 36 hospitals. Outcomes included VTE (DVT or pulmonary embolism ascertained using diagnosis codes combined with validated natural language processing algorithms applied to electronic health records) and death resulting from any cause at 30 days. Fine and Gray hazards regression was performed to evaluate the association of COVID-19 with VTE after accounting for competing risk of death and residual differences between groups, as well as to identify predictors of VTE in patients with COVID-19. RESULTS: We identified 6,319 adults with COVID-19 and 6,319 matched adults without COVID-19, with mean ± SD age of 60.0 ± 17.2 years, 46% women, 53.1% Hispanic, 14.6% Asian/Pacific Islander, and 10.3% Black. During 30-day follow-up, 313 validated cases of VTE (160 COVID-19, 153 control participants) and 1,172 deaths (817 in patients with COVID-19, 355 in control participants) occurred. Adults with COVID-19 showed a more than threefold adjusted risk of VTE (adjusted hazard ratio, 3.48; 95% CI, 2.03-5.98) compared with matched control participants. Predictors of VTE in patients with COVID-19 included age ≥ 55 years, Black race, prior VTE, diagnosed sepsis, prior moderate or severe liver disease, BMI ≥ 40 kg/m2, and platelet count > 217 k/μL. INTERPRETATION: Among ethnically diverse hospitalized adults, COVID-19 infection increased the risk of VTE, and selected patient characteristics were associated with higher thromboembolic risk in the setting of COVID-19. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/34293316/Covid-19_and_Risk_of_Venous_Thromboembolism_in_Ethnically_Diverse_Populations. L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(21)01353-2 DB - PRIME DP - Unbound Medicine ER -
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