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Predictors of Venous Thromboembolism in COVID-19 Patients: Results of the COVID-19 Brazilian Registry

41 Pages Posted: 24 Nov 2021

See all articles by Warley Cezar da Silveira

Warley Cezar da Silveira

Federal University of Minas Gerais (UFMG)

Lucas E. F. Ramos

Federal University of Minas Gerais (UFMG)

Rafael T. Silva

Federal University of Minas Gerais (UFMG)

Bruno Barbosa Miranda de Paiva

Federal University of Minas Gerais (UFMG)

Polianna Delfino Pereira

Federal University of Minas Gerais (UFMG)

Alexandre Vargas Schwarzbold

Hospital Universitário de Santa Maria

Andresa Fontoura Garbini

Hospital Nossa Senhora da Conceição

Bruna Schettino Morato Barreira

Pontifícia Universidade Católica de Minas Gerais

Bruno Mateus de Castro

Hospital de Clínicas de Porto Alegre (HCPA)

Carolina Marques Ramos

Hospital Júlia Kubitschek

Caroline Danubia Gomes

Hospital Mãe de Deus

Christiane Corrêa Rodrigues Cimini

Federal University of the Valleys of Jequitinhonha and Mucuri - Mucuri Medical School

Elayne Crestani Pereira

Hospital SOS Cárdio

Eliane Würdig Roesch

Hospital de Clínicas de Porto Alegre (HCPA)

Emanuele Marianne Souza Kroger

Hospital Júlia Kubitschek

Felipe Ferraz Martins Graça Aranha

University of South of Santa Catarina

Fernando Anschau

Hospital Nossa Senhora da Conceição

Fernando Antonio Botoni

Hospital Júlia Kubitschek

Fernando Graça Aranha

Hospital SOS Cárdio

Gabriela Petry Crestani

Hospital Mãe de Deus

Giovanna Grunewald Vietta

Hospital SOS Cárdio

Gisele Alsina Nader Bastos

Hospital Moinhos de Vento

Jamille Hemétrio Salles Martins Costa

Hospital Márcio Cunha

Jéssica Rayane Corrêa Silva da Fonseca

Hospital Semper

Karen Brasil Ruschel

Hospital Universitário de Santa Maria

Leonardo Seixas de Oliveira

Hospital Santa Rosalia

Lílian Santos Pinheiro

Hospital Santa Rosalia

Liliane Souto Pacheco

Hospital Universitário de Santa Maria

Luciana Borges Segala

Hospital Universitário de Santa Maria

Luciana Siuves Ferreira Couto

Federal University of Ouro Preto

Luciane Kopittke

Hospital Nossa Senhora da Conceição

Maiara Anschau Floriani

Hospital Moinhos de Vento

Majlla Magalhães Silva

Hospital Moinhos de Vento

Marcelo Carneiro

Caja Petrolera de Salud - Hospital Santa Cruz

Maria Angélica Pires Ferreira

Hospital de Clínicas de Porto Alegre (HCPA)

Matheus Carvalho Alves Nogueira

Federal University of Minas Gerais (UFMG)

Maria Auxiliadora Parreiras Martins

Federal University of Minas Gerais (UFMG)

Marina Neves Zerbini de Faria

Hospital Júlia Kubitschek

Milton Henriques Guimarães Júnior

Hospital Márcio Cunha

Natália da Cunha Severino Sampaio

Fundação Hospitalar do Estado de Minas Gerais (FHEMIG) - Hospital Eduardo de Menezes (HEM)

Neimy Ramos de Oliveira

Fundação Hospitalar do Estado de Minas Gerais (FHEMIG) - Hospital Eduardo de Menezes (HEM)

Nicole de Moraes Pertile

Hospital Moinhos de Vento

Pedro Guido Soares Andrade

Hospital Semper

Pedro Ledic Assaf

Hospital Metropolitano Doutor Célio de Castro

Reginaldo Aparecido Valacio

Hospital Metropolitano Odilon Behrens

Rochele Mosmann Menezes

Caja Petrolera de Salud - Hospital Santa Cruz

Saionara Cristina Francisco

Hospital Metropolitano Doutor Célio de Castro

Silvana Mangeon Mereilles Guimarães

Hospital Semper

Silvia Ferreira Araújo

Hospital Semper

Suely Meireles Rezende

Federal University of Minas Gerais (UFMG)

Susany Anastácia Pereira

Federal University of Minas Gerais (UFMG)

Tatiana Kurtz

Caja Petrolera de Salud - Hospital Santa Cruz

Tatiani Oliveira Fereguetti

Fundação Hospitalar do Estado de Minas Gerais (FHEMIG) - Hospital Eduardo de Menezes (HEM)

Carísi Anne Polanczyk

Institute for Health Technology Assessment (IATS), Porto Alegre

Magda Carvalho Pires

Federal University of Minas Gerais (UFMG)

Marcos André Gonçalves

Federal University of Minas Gerais (UFMG)

Milena Soriano Marcolino

Federal University of Minas Gerais (UFMG)

More...

Abstract

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.

Suggested Citation

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

Warley Cezar Da Silveira (Contact Author)

Federal University of Minas Gerais (UFMG) ( email )

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Lucas E. F. Ramos

Federal University of Minas Gerais (UFMG) ( email )

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Rafael T. Silva

Federal University of Minas Gerais (UFMG) ( email )

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Bruno Barbosa Miranda de Paiva

Federal University of Minas Gerais (UFMG) ( email )

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Polianna Delfino Pereira

Federal University of Minas Gerais (UFMG) ( email )

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Alexandre Vargas Schwarzbold

Hospital Universitário de Santa Maria ( email )

Santa Maria
Brazil

Andresa Fontoura Garbini

Hospital Nossa Senhora da Conceição ( email )

Porto Alegre
Brazil

Bruna Schettino Morato Barreira

Pontifícia Universidade Católica de Minas Gerais ( email )

Praça da Liberdade
Brazil

Bruno Mateus de Castro

Hospital de Clínicas de Porto Alegre (HCPA) ( email )

Porto Alegre
Brazil

Carolina Marques Ramos

Hospital Júlia Kubitschek ( email )

Belo Horizonte
Brazil

Caroline Danubia Gomes

Hospital Mãe de Deus ( email )

Porto Alegre
Brazil

Christiane Corrêa Rodrigues Cimini

Federal University of the Valleys of Jequitinhonha and Mucuri - Mucuri Medical School ( email )

Teófilo Otoni
Brazil

Elayne Crestani Pereira

Hospital SOS Cárdio ( email )

Florianópolis
Brazil

Eliane Würdig Roesch

Hospital de Clínicas de Porto Alegre (HCPA) ( email )

Porto Alegre
Brazil

Emanuele Marianne Souza Kroger

Hospital Júlia Kubitschek ( email )

Belo Horizonte
Brazil

Felipe Ferraz Martins Graça Aranha

University of South of Santa Catarina ( email )

887904-900 - Tubarao - SC
Brazil

Fernando Anschau

Hospital Nossa Senhora da Conceição ( email )

Porto Alegre
Brazil

Fernando Antonio Botoni

Hospital Júlia Kubitschek ( email )

Belo Horizonte
Brazil

Fernando Graça Aranha

Hospital SOS Cárdio ( email )

Florianópolis
Brazil

Gabriela Petry Crestani

Hospital Mãe de Deus ( email )

Porto Alegre
Brazil

Giovanna Grunewald Vietta

Hospital SOS Cárdio ( email )

Florianópolis
Brazil

Gisele Alsina Nader Bastos

Hospital Moinhos de Vento ( email )

Porto Alegre
Brazil

Jamille Hemétrio Salles Martins Costa

Hospital Márcio Cunha ( email )

Ipatinga
Brazil

Jéssica Rayane Corrêa Silva da Fonseca

Hospital Semper

Belo Horizonte
Brazil

Karen Brasil Ruschel

Hospital Universitário de Santa Maria

Santa Maria
Brazil

Leonardo Seixas De Oliveira

Hospital Santa Rosalia

Teófilo Otoni
Brazil

Lílian Santos Pinheiro

Hospital Santa Rosalia

Teófilo Otoni
Brazil

Liliane Souto Pacheco

Hospital Universitário de Santa Maria

Santa Maria
Brazil

Luciana Borges Segala

Hospital Universitário de Santa Maria

Santa Maria
Brazil

Luciana Siuves Ferreira Couto

Federal University of Ouro Preto

Ouro Preto, Minas Gerais
Brazil

Luciane Kopittke

Hospital Nossa Senhora da Conceição

Porto Alegre
Brazil

Maiara Anschau Floriani

Hospital Moinhos de Vento

Porto Alegre
Brazil

Majlla Magalhães Silva

Hospital Moinhos de Vento

Porto Alegre
Brazil

Marcelo Carneiro

Caja Petrolera de Salud - Hospital Santa Cruz ( email )

Santa Cruz de la Sierra
Bolivia

Maria Angélica Pires Ferreira

Hospital de Clínicas de Porto Alegre (HCPA)

Porto Alegre
Brazil

Matheus Carvalho Alves Nogueira

Federal University of Minas Gerais (UFMG)

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Maria Auxiliadora Parreiras Martins

Federal University of Minas Gerais (UFMG)

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Marina Neves Zerbini De Faria

Hospital Júlia Kubitschek

Belo Horizonte
Brazil

Milton Henriques Guimarães Júnior

Hospital Márcio Cunha

Ipatinga
Brazil

Natália da Cunha Severino Sampaio

Fundação Hospitalar do Estado de Minas Gerais (FHEMIG) - Hospital Eduardo de Menezes (HEM)

Belo Horizonte
Brazil

Neimy Ramos de Oliveira

Fundação Hospitalar do Estado de Minas Gerais (FHEMIG) - Hospital Eduardo de Menezes (HEM) ( email )

Belo Horizonte
Brazil

Nicole de Moraes Pertile

Hospital Moinhos de Vento

Porto Alegre
Brazil

Pedro Guido Soares Andrade

Hospital Semper

Belo Horizonte
Brazil

Pedro Ledic Assaf

Hospital Metropolitano Doutor Célio de Castro

Belo Horizonte
Brazil

Reginaldo Aparecido Valacio

Hospital Metropolitano Odilon Behrens

Belo Horizonte
Brazil

Rochele Mosmann Menezes

Caja Petrolera de Salud - Hospital Santa Cruz

Santa Cruz de la Sierra
Bolivia

Saionara Cristina Francisco

Hospital Metropolitano Doutor Célio de Castro

Belo Horizonte
Brazil

Silvana Mangeon Mereilles Guimarães

Hospital Semper

Belo Horizonte
Brazil

Silvia Ferreira Araújo

Hospital Semper

Belo Horizonte
Brazil

Suely Meireles Rezende

Federal University of Minas Gerais (UFMG)

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Susany Anastácia Pereira

Federal University of Minas Gerais (UFMG)

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Tatiana Kurtz

Caja Petrolera de Salud - Hospital Santa Cruz

Santa Cruz de la Sierra
Bolivia

Tatiani Oliveira Fereguetti

Fundação Hospitalar do Estado de Minas Gerais (FHEMIG) - Hospital Eduardo de Menezes (HEM)

Belo Horizonte
Brazil

Carísi Anne Polanczyk

Institute for Health Technology Assessment (IATS), Porto Alegre

Brazil

Magda Carvalho Pires

Federal University of Minas Gerais (UFMG)

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Marcos André Gonçalves

Federal University of Minas Gerais (UFMG)

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Milena Soriano Marcolino

Federal University of Minas Gerais (UFMG)

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil