Prevalence of deep vein thrombosis in symptomatic COVID-19 patients presenting to the Emergency Department: correlation with inflammatory markers and acute respiratory distress syndrome

Abstract

OBJECTIVE: To study the prevalence of deep venous thrombosis (DVT) in COVID-19 patients presenting to the Emergency Department of Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and its association with inflammatory markers (C-Reactive Protein), D-dimer and severity of ARDS (pO2/FiO2 ratio). PATIENTS AND METHODS: Symptomatic adult patients diagnosed COVID-19 positive by RT-PCR for SARS-CoV-2 who presented to the Emergency Department of the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India were screened for lower extremity deep vein thrombosis using compression venous ultrasonography and Doppler scanning. C-reactive protein (quantitative), D-dimer and arterial blood gas analysis for pO2/FiO2 ratio were obtained for all patients. The DVT and no DVT groups were compared with respect to C-Reactive Protein levels, D-dimer levels and pO2/FiO2 ratios and the continuous variables were analysed using Mann-Whitney U test. p-value <0.05 was considered significant. RESULTS: 70 adult COVID-19 patients (SARS-CoV-2 positive by RT-PCR) presenting to the Emergency Department of a tertiary care hospital in north India were enrolled from April 1, 2021 to June 30, 2021. 3 (4.3%) out 70 patients had DVT; of these, two had severe ARDS and one had moderate ARDS. The pO2/FiO2 ratios in the non-DVT group (Median [Quartiles]- 118 [74, 236.5]) did not differ significantly compared to the DVT group (Median [Quartiles]- 88 [64, 98.5]) (Mann-Whitney U=152, p=0.139). The C-Reactive Protein (CRP) values (mg/L) in the non-DVT group (Median [Quartiles]- 40 [23, 66]) did not differ significantly compared to the DVT group (Median [Quartiles]- 75 [59.5, 91.5]) (Mann-Whitney U=44, p=0.104). The D-dimer values in the non-DVT group (Median [Quartiles]- 369 [243, 642]) were significantly lower compared to the DVT group (Median [Quartiles]- 820 [790, 938]) (Mann-Whitney U=7, p=0.007). CONCLUSIONS: There is small but definitive risk of DVT in symptomatic COVID-19 patients presenting to the Emergency Department. The presence of DVT in COVID-19 patients was directly associated with raised D-Dimer levels, but did not show significant association with severity of ARDS and C-Reactive Protein (CRP) levels.

Keywords

• covid-19
• deep vein thrombosis
• c-reactive protein
• d-dimer
• acute respiratory distress syndrome