Presentation Details
| Nationally Representative Data on Co-diagnosis, Mortality and Healthcare Burden of Venous Thromboembolism in Hospitalized COVID-19 patients: Results from the National Inpatient Sample Giuseppe Maiocco1, Krish Khurana2, Nareg H.Roubinian3, Stephanie Bitner1, Waqas Azhar1, Hareena Sangha4, Nikhil Gupta5, Evan M.Bloch6, Michael B.Streiff6, Aaron A.R.Tobian6, Ruchika Goel1, 6, 7. 1Southern Illinois University School of Medicine, Springfield, IL, USA.2SIU School of Medicine P4P program, Springfield, IL, USA.3Vitalant Research Institute, San Francisco, CA, USA.4University of Texas Southwestern School of Medicine, Dallas, TX, USA.5Case Western Reserve University School of Medicine, Cleveland, OH, USA.6Johns Hopkins University School of Medicine, Baltimore, MD, USA.7Vitalant Corporate Medical Affairs, Scottsdale, AZ, USA |
Abstract
INTRODUCTION: COVID-19 increases the risk of thrombosis via multiple mechanistic pathways. Given heterogeneity of studies pertaining to COVID-19 and thrombosis, the reported prevalence of venous thromboembolism (VTE) [deep vein thrombosis (DVT)/pulmonary embolism (PE)] in COVID-19 varies. We evaluated the co-diagnosis, mortality, and healthcare burden of VTE in COVID-19 hospitalizations during the first nine months of the pandemic (April-December 2020) in the United States (US) using a nationally representative database. METHODS: The Nationwide Inpatient Sample Healthcare Cost and Utilization Project (HCUP-NIS) is the largest all-payer inpatient database in the US, approximating a 20% stratified sample of inpatient discharges from >5000 hospitals across 48 states. Data from the 2020 HCUP-NIS was used to generate nationally representative estimates of COVID-19 associated thrombotic events; CCSR and ICD-10 codes were used to identify hospital discharges in which diagnoses of COVID-19 and VTE were listed. Given limited cases of COVID-19 in the US from January-March 2020, analysis was restricted to April-December 2020. Age and gender Adjusted Odds Ratios (aOR) were calculated and statistical comparisons of proportions and medians as applicable were performed via STATA V18.0. RESULT: Of 23,856,131 US hospitalizations from April to December 2020; 1,630,410 (6.8%) listed COVID-19 as a diagnosis(Table 1A). Of these, 81,450 (5.0%) had co-diagnosis of VTE [45,860(56%) PE, 44,765(55%) DVT, and 9,175(11%) PE and DVT]. Median age (interquartile range (IQR)) for admissions with COVID-19 and VTE was 66(55-77) years with 98.7% admissions classified as having major/severe underlying illness. VTE in COVID-19 occurred at significantly higher rates than non-COVID-19 admissions (aOR(95%CI) (aOR)=1.37(1.35-1.39);p<.0001). By clot location, the odds of PE was higher in COVID-19 hospitalizations (aOR=1.78(1.74-1.82);p<.0001), with subsegmental PE occurring more commonly (aOR=2.00(1.89-2.12);p<.0001). Odds of DVT were also elevated in COVID-19 hospitalizations (aOR=1.02(1.00-1.05);p=.03), with lower extremity (aOR=1.24(1.21-1.27);p<.0001) and upper extremity (aOR=1.20(1.14-1.26);p=<.0001) DVTs occurring more frequently. MORTALITY: Overall rates of all-cause mortality were significantly higher in COVID-19 hospitalizations than general admissions (12.9% vs. 2.9%, aOR=5.00(4.94-5.07);p<.0001),Table 1B). Further, all-cause mortality for COVID-19 admissions with VTE was nearly twice as compared to those without VTE (aOR=1.98(1.90-2.06);p<.0001). Likewise, all-cause mortality was higher independently for both DVT (aOR=2.19(2.08-2.31);p<.0001) and PE (aOR=1.61(1.52-1.70);p<.0001). HEALTHCARE BURDEN: COVID-19 hospitalizations with VTE were associated with significantly longer median(IQR) length of stay than COVID-19 without VTE [9(4-18)days versus 5(3-9)days; (p<.0001)] and nearly twice median hospital charges [$84,417($39,188-$204,888) versus $44,091($23,680-$87,622);p<.0001)](Table 2A). CO-DIAGNOSES/PROCEDURES: Most common co-diagnoses in admissions with COVID-19 and VTE included respiratory failure (57.7%), renal failure (39.4%), diabetes (37.6%), hypertension (37.3%), and obesity (36.7%)(Figure 2). Highest coded procedural interventions in COVID-19 and VTE admissions were mechanical ventilation (32.6%), central line placement (25.0%), Remdesivir administration (24.3%), airway insertion (22.8%), and transfusion of convalescent plasma (12.4%) (Table 2B). CONCLUSIONS: These nationally representative data show that VTE was a frequent complication among hospitalized patients with COVID-19 during the first year of the pandemic. VTE in COVID-19 is associated with significantly higher all-cause mortality, length of hospitalization, and total hospital expenditures than COVID-19 admissions without VTE. These findings highlight the healthcare burden of COVID associated venous thromboses.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.