Association Between the Development of Thrombosis and Worsening of Disease Severity in Patients With Moderate COVID-19 on Admission　― From the CLOT-COVID Study

• Published in: Circulation Journal Vol. 87; no. 3; pp. 448 - 455
• Main Authors: Ikeda, Satoshi, Ueno, Yuki, Maemura, Koji, Yachi, Sen, Takeyama, Makoto, Nishimoto, Yuji, Tsujino, Ichizo, Nakamura, Junichi, Yamamoto, Naoto, Nakata, Hiroko, Umetsu, Michihisa, Aikawa, Shizu, Hayashi, Hiroya, Satokawa, Hirono, Okuno, Yoshinori, Iwata, Eriko, Ogihara, Yoshito, Ikeda, Nobutaka, Kondo, Akane, Iwai, Takehisa, Yamada, Norikazu, Ogawa, Tomohiro, Kobayashi, Takao, Mo, Makoto, Yamashita, Yugo, on behalf of the CLOT-COVID Study Investigators
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 24.02.2023
• Subjects: Anticoagulants; Cohort Studies; COVID-19; D-dimer; Diabetes Mellitus; Fibrin Fibrinogen Degradation Products; Hospitalization; Humans; Patient Acuity; Retrospective Studies; SARS-CoV-2; Thrombosis; Venous Thromboembolism - prevention & control; Worsening of the severity; COVID-19; D-dimer; Worsening of the severity; Thrombosis
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-22-0252

Background: The worsening of coronavirus disease 2019 (COVID-19) severity is a critical issue in current clinical settings and may be associated with the development of thrombosis.Methods and Results: This study used patient data obtained in the CLOT-COVID study, a retrospective multicenter cohort study. The demographics of patients with moderate COVID-19 on admission with and without worsened severity during hospitalization were compared and predictors were identified. Of 927 patients with moderate COVID-19 on admission, 182 (19.6%) had worsened severity during hospitalization. Patients with worsening of severity were older, more likely to have hypertension, diabetes, heart disease, and active cancer, and more likely to use pharmacological thromboprophylaxis. Patients with worsening of severity had higher D-dimer levels on admission and were more likely to develop thrombosis and major bleeding during hospitalization than those without worsening. Increased age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01–1.03, P=0.005), diabetes (OR: 1.63, 95% CI: 1.11–2.33, P=0.012), D-dimer levels >1.0 μg/mL on admission (OR: 2.10, 95% CI: 1.45–3.03, P<0.001), and thrombosis (OR: 6.28, 95% CI: 2.72–14.53, P<0.001) were independently associated with worsening of COVID-19 severity.Conclusions: Approximately 20% of patients with moderate COVID-19 had worsened severity during hospitalization. Increased age, diabetes, D-dimer levels >1.0 μg/mL on admission, and the development of thrombosis during hospitalization were significantly associated with worsened COVID-19 severity.