Avaliação da mortalidade em pacientes com lesões pulmonares associada à trombose venosa na infecção por SARS-COV-2

Abstract

Introduction: The underlying mechanisms by which SARS-CoV-2 predisposes patients to thrombosis are not yet completely understood. The balance between pro-coagulant factors and natural coagulation inhibitors in critically ill COVID-19 patients is essential in preventing and treating complications. Objective: To evaluate mortality in patients with lung injuries resulting from SARS-CoV-2 infection and its association with deep vein thrombosis (DVT) and whether there is a relationship between the degree of lung impairment, the presence or absence of DVT and mortality. Casuistic and Method: A clinical study was carried out to evaluate consecutive patients with clinical suspicion of DVT and SARS-CoV-2 infection in intensive care units (ICU) and wards at the Hospital de Base. DVT was investigated using vascular ultrasound with bilateral deep venous Doppler of the lower limbs. Patients were classified into: Group I without DVT but with lung injury; Group II with DVT and lung injury; Group III with DVT but without lung injury and Group IV (control) without DVT or lung injury. These groups were compared and the extent of lung impairment was investigated about the mortality rate. Results: Of the 492 patients included in this study, 202 had DVT and of these, 193 had some degree of pulmonary involvement (Group II). 228 patients did not have DVT but had some degree of pulmonary involvement (Group I) and 62 patients were not diagnosed with either DVT or pulmonary involvement (Group IV - Control). Mortality in Group II was of 49.22%, while in Group I it was 35.96%, and when compared there is a significant difference (p = 0.01). When comparing the difference in mortality rates of patients without and with DVT, with the same amount of pulmonary involvement (Groups I and II), an increase in mortality was observed in patients in Group II with pulmonary involvement above 25%, compared to Group I. Patients with lung injuries are associated with higher mortality, and this increases even more when there is also the presence of DVT. The combination of more than 25% lung impairment and DVT increased the risk of death when compared to the absence of DVT. Conclusions: Deep vein thrombosis is associated with higher mortality in patients with SARS-CoV-2; a condition that worsens when associated with lung injury. The presence of isolated lung impairment is also linked to higher mortality rates.