Deep Vein Thrombosis in Critically Ill Patients with COVID-19 Pneumonia: Incidence, Wells Score Diagnostic Performance, and Hospital Prognosis.

Objectives: The risk of major venous thromboembolism (VTE) among patients with COVID-19 is high but varies with disease severity. Estimate the incidence of lower extremity deep venous thrombosis (DVT) in critically ill hospitalized patients with COVID-19, validate the Wells score for DVT diagnosis, and determine patients' prognosis.

Methods: This was an observational follow-up study in the context of the diagnosis and prognosis of DVT. All patients were hospitalized in the intensive care unit (ICU) of the Evandro Chagas National Institute of Infectious Diseases. Participants with COVID-19 pneumonia were included. Lower-limb Doppler to assess DVT was performed at admission and follow-up. Prognosis outcomes were death, length of stay, need for mechanical ventilation, vasopressor use, and hemodialysis. Wells' score sensitivity and specificity were estimated at admission. Survival curves were estimated for patients with DVT and adjusted for the SAPS 3 score.

Results: Between June 2020 and January 2021, 186 patients were included. The DVT incidence was 0.097. A Wells score of 2 or higher had a sensitivity and specificity of 1.00 and 0.94, respectively. Mortality and mechanical ventilation support were higher in participants with DVT. For these outcomes, after SAPS 3 adjustment, participants with DVT had twice the hazard of those without DVT. A web calculator (https://pedrobrasil.shinyapps.io/INDWELL/) is available for predictions.

Conclusions: One can use the Wells score to accurately diagnose DVT in critically ill patients with COVID-19. DVT increases the severity of COVID-19, which highlights the importance of its early diagnosis, treatment, and prophylaxis in the ICU setting.