Background: Endothelial cell dysfunction from infection by SARS-CoV-2 and inflammatory cytokines leading to hyperinflammatory and hypercoagulable state is thought to be the mechanism of arterial thromboembolism (ATE) in COVID-19 patients. COVID-19 infection is known to be an independent risk factor for acute stroke and myocardial infarction (MI). However, data on the risk factors of ATE in hospitalized COVID-19 patients is limited.
Methods: This retrospective, multicenter cohort study included adult patients admitted to one quaternary care and three community hospitals with PCR-proven SARS-CoV-2 infection between 3/1/2020 and 12/31/2020. The composite outcome was in-hospital ATE events, including acute ischemic stroke, MI, and other ATE identified by ICD-10 codes. Student t-test was conducted for continuous variables and the Chi-square test for categorical variables. Multivariate logistic regression using forward selection was conducted. All statistical tests were 2-sided with an α level of 0.05. All data was analyzed using R version 4.0.4.
Results: The cohort included 3531 patients with 371 (10.5%) patients who developed acute ATE. There were 398 ATE events: 270 patients had MI, 43 had stroke, 85 had other ATE, 12 had MI + stroke, 13 had MI + other ATE, and 2 had stroke + other ATE. The model suggested that initial systolic blood pressure (BP) \u3c90 mmHg and \u3e160 mmHg; elevated initial biomarkers including B-type natriuretic peptide (\u3e100 pg/mL), troponin-I (\u3e0.03 ng/mL), lactate dehydrogenase (\u3e192 U/L), creatine phosphokinase (male \u3e280 U/L and female \u3e155 U/L), C-reactive protein (\u3e0.5 mg/dL), leukocytes (\u3e11 K/uL), lactate (\u3e2.2 mmol/L), and aspartate aminotransferase (\u3e41 U/L); presenting hypoalbuminemia (\u3c3.5 g/dL) and hypomagnesemia (\u3c1.8 mg/dL); age \u3e60; male sex; and history of cerebrovascular accident (CVA), coronary artery disease (CAD), hyperthyroidism, and cigarette smoking were associated with an increased risk of ATE (all p\u3c0.05).
Conclusion: Hypo or hypertension on admission, elevated inflammatory and cardiac markers, hypoalbuminemia, hypomagnesemia, smoking, and comorbidities including CAD and CVA are associated with ATE in hospitalized COVID-19 patients
