Biomarkers for the prediction of venous thromboembolism in critically ill COVID-19 patients
Romein W. G. Dujardin, Bashar N. Hilderink, Wolmet E. Haksteen, Saskia Middeldorp, Alexander P. J. Vlaar, Jecko Thachil, Marcella C.A. Müller, Nicole P. Juffermans
Abstract
BACKGROUND: Venous thromboembolism (VTE) is a frequent complication in critically ill patients with coronavirus disease 2019 (COVID-19) and is associated with mortality. Early diagnosis and treatment of VTE is warranted. OBJECTIVE: To develop a prediction model for VTE in critically ill COVID-19 patients. PATIENTS AND METHODS: ratio, platelet count, international normalized ratio, activated partial thromboplastin time as well as levels of fibrinogen, antithrombin, D-dimer and C-reactive protein (CRP). Multivariate analysis was done using binary linear regression. RESULTS: Variables associated with VTE in both univariate and multivariate analysis were D-dimer and CRP with an area under the curve (AUC) of 0.64, P = 0.023 and 0.75, P = 0.045, respectively. Variables indicating hypoxemia were not predictive. The ROC curve of D-dimer and CRP combined had an AUC of 0.83, P < 0.05. Categorized values of D-dimer and CRP were used to compute a mean absolute risk for the combination of these variables with a high positive predictive value. The predicted probability of VTE with a D-dimer > 15 in combination with a CRP > 280 was 98%. The negative predictive value of D-dimer was low. CONCLUSION: Elevated CRP and D-dimer have a high positive predictive value for VTE in critically ill COVID-19 patients. We developed a prediction table with these biomarkers that can aid clinicians in the timing of imaging in patients with suspected VTE.