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Predictors of Venous Thromboembolism in COVID-19 Patients: Results of the COVID-19 Brazilian Registry
Background: 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.
Methods: This substudy of a large Brazilian COVID-19 Registry included 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.
Findings: 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.
Interpretation: By using ML and LR analyse, we showed that D-dimer, axillary temperature, neutrophil count, CRP and lactate levels are risk factors for VTE in COVID-19 patients.
Funding Information: Brazilian research centers (FAPEMIG and CNPq).
Declaration of Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethics Approval Statement: The study was approved by the Brazilian National Commission for Research Ethics (CAAE 30350820.5.1001.0008). Individual informed consent was waived due to the severity of the situation and the use of unidentified data, based on medical chart review only.
da Silveira, Warley Cezar and Ramos, Lucas E. F. and Silva, Rafael T. and Paiva, Bruno Barbosa Miranda de and Pereira, Polianna Delfino and Schwarzbold, Alexandre Vargas and Garbini, Andresa Fontoura and Barreira, Bruna Schettino Morato and Castro, Bruno Mateus de and Ramos, Carolina Marques and Gomes, Caroline Danubia and Cimini, Christiane Corrêa Rodrigues and Pereira, Elayne Crestani and Roesch, Eliane Würdig and Kroger, Emanuele Marianne Souza and Aranha, Felipe Ferraz Martins Graça and Anschau, Fernando and Botoni, Fernando Antonio and Aranha, Fernando Graça and Crestani, Gabriela Petry and Vietta, Giovanna Grunewald and Nader Bastos, Gisele Alsina and Salles Martins Costa, Jamille Hemétrio and Rayane Corrêa Silva da Fonseca, Jéssica and Ruschel, Karen Brasil and de Oliveira, Leonardo Seixas and Pinheiro, Lílian Santos and Pacheco, Liliane Souto and Segala, Luciana Borges and Couto, Luciana Siuves Ferreira and Kopittke, Luciane and Floriani, Maiara Anschau and Silva, Majlla Magalhães and Carneiro, Marcelo and Ferreira, Maria Angélica Pires and Nogueira, Matheus Carvalho Alves and Martins, Maria Auxiliadora Parreiras and de Faria, Marina Neves Zerbini and Guimarães Júnior, Milton Henriques and Sampaio, Natália da Cunha Severino and Ramos de Oliveira, Neimy and Pertile, Nicole de Moraes and Andrade, Pedro Guido Soares and Assaf, Pedro Ledic and Valacio, Reginaldo Aparecido and Menezes, Rochele Mosmann and Francisco, Saionara Cristina and Guimarães, Silvana Mangeon Mereilles and Araújo, Silvia Ferreira and Rezende, Suely Meireles and Pereira, Susany Anastácia and Kurtz, Tatiana and Fereguetti, Tatiani Oliveira and Polanczyk, Carísi Anne and Pires, Magda Carvalho and Gonçalves, Marcos André and Soriano Marcolino, Milena, Predictors of Venous Thromboembolism in COVID-19 Patients: Results of the COVID-19 Brazilian Registry. Available at SSRN: https://ssrn.com/abstract=3970713 or http://dx.doi.org/10.2139/ssrn.3970713
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