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Erschienen in: Critical Care 1/2020

Open Access 01.12.2020 | Research Letter

Pooled prevalence of deep vein thrombosis among coronavirus disease 2019 patients

verfasst von: Ying Wang, Li Shi, Haiyan Yang, Guangcai Duan, Yadong Wang

Erschienen in: Critical Care | Ausgabe 1/2020

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Ying Wang and Li Shi contributed equally to this work.

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To the editor,
The article by Ren et al. reported that there was an extremely high incidence (85.4%) of lower extremity deep venous thrombosis (DVT) among 48 patients with severe coronavirus disease 2019 (COVID-19) in Wuhan, China [1]. As the global pandemic of COVID-19, there have been several studies on the incidence, risk factors, and preventive strategies of DVT [14]. However, the incidence of DVT has been reported diversely among different clinical centers. Thus, we performed a meta-analysis to estimate the pooled prevalence of DVT in confirmed COVID-19 patients.
We searched PubMed, EMBASE, Web of Science, and medRxiv databases until June 22, 2020, for relevant studies, using the keywords (“coronavirus” or “COVID-19” or “SARS-CoV-2” or “2019-nCoV”) and (“thrombosis” or “thrombi” or “thrombus”). In addition, we screened out the relevant potential articles in the references of selected studies. Articles reporting the prevalence of DVT in confirmed COVID-19 patients were included.
The pooled prevalence and its 95% confidence interval (CI) were used to estimate the combined effects. We calculated the prevalence estimates with the variance stabilizing double arcsine transformation [5, 6]. The heterogeneity among studies was assessed with the I2 statistic and Cochran’s Q test. The meta-regression and subgroup analysis were used to investigate the potential heterogeneity sources (such as sample size, prevalence of prophylaxis in COVID-19 patients, location, design of studies, screening methods of DVT, and COVID-19 patients in intensive care unit (ICU)). We chose Egger’s test and Begg’s test to assess publication bias. All analyses were performed using the Stata 11.2 (StataCorp, College Station, TX), and a two-tailed P value < 0.05 was considered to be statistically significant.
A total of 1202 records were initially identified by our searches. We finally included 28 articles in our meta-analysis. The basic characteristics of included studies are shown in Table 1. There were 397 DVT cases in a total of 4138 COVID-19 patients. The pooled estimate of the prevalence for DVT was 16% by using a random-effects model (95% CI 10–23%, P < 0.01, I2 = 96.81, Q = 846.41, P < 0.01) (Fig. 1a). According to patients’ geographic location, the much higher pooled prevalence of DVT was found in COVID-19 patients from China (30%, 95% CI 2–72%, P = 0.02, I2 = 98.73%, Q = 313.90, P < 0.01) compared with those from western countries (13%, 95% CI 8–19%, P < 0.01, I2 = 95.62%, Q = 502.07, P < 0.01) (Fig. 1b). Twenty articles clearly reported the prevalence of DVT in COVID-19 patients treated in ICU or non-ICU. The pooled prevalence of DVT in COVID-19 patients treated in ICU was 23% (95% CI 11–38%, P < 0.01, I2 = 96.44%, Q = 421.29, P < 0.01), which was significantly higher than in COVID-19 patients treated in non-ICU (5%, 95% CI 1–11%, P < 0.01, I2 = 92.17%, Q = 89.42, P < 0.01) (Fig. 1c, d). We found significant publication bias by Egger’s test (P < 0.001) and Begg’s test (P < 0.001). The subgroup analysis showed that none of these factors could explain the significant heterogeneity. However, the meta-regression analysis of multiple covariates indicated that the geographic location of patients could partially explain heterogeneity (P = 0.036).
Table 1
Characteristics of the included studies
Authors
Sample
Age
Male (%)
Location
Design of studies
Screening of DVT
ICU/non-ICU*
Prophylaxis (%)
DVT (%)
Zhang et al. (PMID: 32421381)
143
63 (mean)
74 (51.7)
China
Cross-sectional study
Ultrasound
N/R
53 (37.1)
66 (46.2)
Ren et al. (PMID: 32412320)
48
70 (median)
26 (54.2)
China
Cross-sectional study
Ultrasound
ICU
47 (97.9)
41 (85.4)
Demelo-Rodríguez et al. (PMID: 32405101)
156
68.1 (mean)
102 (65.4)
Spain
Prospective study
Ultrasound
Non-ICU
153 (98.1)
23 (14.7)
Middeldorp et al. (PMID: 32369666)
198
61 (mean)
130 (65.7)
Netherlands
Retrospective study
Ultrasound
ICU/non-ICU
198 (100)
26 (13.1)
Bi et al.
420
45 (mean)
200 (47.6)
China
Prospective study
N/R
N/R
N/R
6 (1.4)
Klok et al. (PMID: 32291094)
184
64 (mean)
139 (75.5)
Netherlands
Prospective study
Ultrasound
ICU
184 (100)
1 (0.5)
Karmen-Tuohy et al.
63
61 (mean)
57 (90.5)
USA
Prospective study
N/R
N/R
N/R
2 (3.2)
Llitjos et al. (PMID: 32320517)
26
68 (median)
20 (76.9)
France
Retrospective study
Ultrasound
ICU
8 (30.8)
14 (53.8)
Lodigiani et al. (PMID: 32353746)
388
66 (median)
264 (68.0)
Italy
Retrospective study
Ultrasound
ICU/non-ICU
307 (79.1)
6 (1.7)§
Helms et al. (PMID: 32367170)
150
63 (median)
122 (81.3)
France
Prospective study
Imaging
ICU
150 (100)
3 (2.0)
Stoneham et al. (PMID: 32423903)
274
N/R
N/R
UK
Prospective study
Imaging
N/R
N/R
5 (1.8)
Galeano-Valle et al. (PMID: 32425261)
785
N/R
N/R
Spain
Prospective study
Ultrasound
Non-ICU
780 (99.4)
13 (1.7)
Xing et al. (PMID: 32345353)
20
N/R
12 (60.0)
China
Retrospective study
Ultrasound
N/R
N/R
7 (35.0)
Beyls et al. (PMID: 32414510)
12
62 (median)
10 (83.3)
France
Retrospective study
Ultrasound
N/R
N/R
6 (50.0)
Poissy et al. (PMID: 32330083)
107
N/R
N/R
France
Retrospective study
Ultrasound
ICU
107 (100)
5 (4.7)
Beun et al. (PMID: 32311843)
75
N/R
N/R
Netherlands
Retrospective study
N/R
ICU
N/R
3 (4.0)
Cattaneo et al. (PMID: 32349132)
64
70 (median)
35 (54.7)
Italy
Retrospective study
Ultrasound
Non-ICU
64 (100)
0 (0.0)
Tavazzi et al. (PMID: 32322918)
54
N/R
N/R
Italy
Retrospective study
Ultrasound
ICU
54 (100)
8 (14.8)
Voicu et al. (PMID: 32479784)
56
N/R
42 (75.0)
France
Prospective study
Ultrasound
ICU
49 (87.5)
26 (46.4)
Hippensteel et al. (PMID: 32484907)
91
56.5 (mean)
53 (58.2)
USA
Retrospective study
Ultrasound
ICU
N/R
11 (12.1)
Fraissé et al. (PMID: 32487122)
92
61 (median)
73 (79.3)
France
Retrospective study
N/R
ICU
92 (100)
6 (6.5)
Desborough et al. (PMID: 32485437)
66
59 (median)
48 (72.7)
UK
Retrospective study
Imaging
ICU
66 (100)
6 (9.1)
Al-Samkari et al. (PMID: 32492712)
400
61.8 (mean)
228 (57.0)
USA
Retrospective study
Imaging
N/R
400 (100)
10 (2.5)
Edler et al. (PMID: 32500199)
80
79.2 (mean)
46 (57.5)
Germany
Prospective study
N/R
N/R
N/R
32 (40.0)
Grandmaison et al. (PMID: 32529170)
58
N/R
N/R
Switzerland
Cross-sectional study
Ultrasound
ICU/non-ICU
N/R
28 (48.3)
Artifoni et al. (PMID: 32451823)
71
64 (median)
43 (60.6)
France
Retrospective study
Ultrasound
Non-ICU
70 (98.6)
15 (21.1)
Nahum et al. (PMID: 32469410)
34
62.2 (mean)
25 (73.5)
France
Prospective study
Ultrasound
ICU
34 (100)
27 (79.4)
Zhang et al. (PMID: 32553905)
23
44.7 (mean)
15 (65.2)
China
Prospective study
N/R
ICU/non-ICU
N/R
1 (4.3)
DVT deep vein thrombosis, ICU intensive care unit, N/R not (clearly) reported
*Articles clearly reported the prevalence of DVT in COVID-19 patients treated in ICU or non-ICU
§Data missing for patients
In conclusion, more attention should be paid to the prevention and clinical management of DVT, especially for COVID-19 patients in ICU, and timely assessment of DVT is essential. However, there was considerable heterogeneity in our meta-analysis. In addition, there was significant publication bias in our meta-analysis, although we searched four databases as many and as carefully as possible. Finally, we included non-survival patients who were seriously ill and may exaggerate the prevalence of DVT in COVID-19 patients.

Acknowledgements

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Competing interests

The authors declare that they have no conflict of interests.
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Literatur
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Zurück zum Zitat Middeldorp S, Coppens M, van Haaps TF, Foppen M, Vlaar AP, Müller MCA, Bouman CCS, Beenen LFM, Kootte RS, Heijmans J, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thrombosis Haemostasis. 2020. https://doi.org/10.1111/jth.14888. Middeldorp S, Coppens M, van Haaps TF, Foppen M, Vlaar AP, Müller MCA, Bouman CCS, Beenen LFM, Kootte RS, Heijmans J, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thrombosis Haemostasis. 2020. https://​doi.​org/​10.​1111/​jth.​14888.
Metadaten
Titel
Pooled prevalence of deep vein thrombosis among coronavirus disease 2019 patients
verfasst von
Ying Wang
Li Shi
Haiyan Yang
Guangcai Duan
Yadong Wang
Publikationsdatum
01.12.2020
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 1/2020
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03181-1

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