1. The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19
- Author
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Sanjay Mishra, Surbhi Shah, Nathan A. Pennell, Clara Hwang, Solange Peters, Jennifer Girard, Yu Shyr, Jaymin M. Patel, Monica Li, Ang Li, Petros Grivas, Ziad Bakouny, Vaibhav Kumar, Dimpy P. Shah, Imo J. Akpan, Pamela C Egan, Rachel P. Rosovsky, Gary H. Lyman, Daniel G. Stover, Michael A. Thompson, Aakash Desai, Corrie A. Painter, Rebecca L. Zon, Julie Fu, Jean M. Connors, Nicole M. Kuderer, Devendra Kc, Amit Kulkarni, Amro Elshoury, Jeremy L. Warner, Chih-Yuan Hsu, Gilbero de Lima Lopes, Rana R. McKay, Andrew Schmidt, Balazs Halmos, Shuchi Gulati, Brian I. Rini, and CCC19 consortium
- Subjects
medicine.medical_specialty ,medicine.drug_class ,clinical decision rules ,Logistic regression ,Risk Assessment ,SARS‐CoV‐2 ,Cohort Studies ,COVID‐19 ,Internal medicine ,Neoplasms ,medicine ,Humans ,cardiovascular diseases ,thrombosis ,business.industry ,SARS-CoV-2 ,Incidence (epidemiology) ,Anticoagulant ,COVID-19 ,Neoplasms/complications ,Neoplasms/epidemiology ,Venous Thromboembolism/diagnosis ,Venous Thromboembolism/epidemiology ,venous thromboembolism ,Cancer ,Original Articles ,Hematology ,Venous Thromboembolism ,medicine.disease ,Thrombosis ,Confidence interval ,Original Article ,Risk assessment ,business ,Corrigendum ,Cohort study - Abstract
Background Hospitalized patients with COVID‐19 have increased risks of venous (VTE) and arterial thromboembolism (ATE). Active cancer diagnosis and treatment are well‐known risk factors; however, a risk assessment model (RAM) for VTE in patients with both cancer and COVID‐19 is lacking. Objectives To assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID‐19. Methods Among patients with cancer in the COVID‐19 and Cancer Consortium registry (CCC19) cohort study, we assessed the incidence of VTE and ATE within 90 days of COVID‐19–associated hospitalization. A multivariable logistic regression model specifically for VTE was built using a priori determined clinical risk factors. A simplified RAM was derived and internally validated using bootstrap. Results From March 17, 2020 to November 30, 2020, 2804 hospitalized patients were analyzed. The incidence of VTE and ATE was 7.6% and 3.9%, respectively. The incidence of VTE, but not ATE, was higher in patients receiving recent anti‐cancer therapy. A simplified RAM for VTE was derived and named CoVID‐TE (Cancer subtype high to very‐high risk by original Khorana score +1, VTE history +2, ICU admission +2, D‐dimer elevation +1, recent systemic anti‐cancer Therapy +1, and non‐Hispanic Ethnicity +1). The RAM stratified patients into two cohorts (low‐risk, 0–2 points, n = 1423 vs. high‐risk, 3+ points, n = 1034) where VTE occurred in 4.1% low‐risk and 11.3% high‐risk patients (c statistic 0.67, 95% confidence interval 0.63–0.71). The RAM performed similarly well in subgroups of patients not on anticoagulant prior to admission and moderately ill patients not requiring direct ICU admission. Conclusions Hospitalized patients with cancer and COVID‐19 have elevated thrombotic risks. The CoVID‐TE RAM for VTE prediction may help real‐time data‐driven decisions in this vulnerable population.
- Published
- 2021