Journal Article

Thrombosis in hospitalized patients with viral respiratory infections versus COVID-19

Yuriditsky, Eugene, Horowitz, James M., Hochman, Judith S., Subashchandran, Varun, Smilowitz, Nathaniel R., Berger, Jeffrey S., Reynolds, Harmony R.

2021

Overview

We evaluated the incidence of thrombosis in patients hospitalized with non-COVID-19 acute viral respiratory illnesses nationwide from 2012 to 2014 and compared this to the incidence among patients hospitalized with COVID-19 at a large health system in New York. Non-COVID-19 viral respiratory illness was complicated by acute MI in 2.8% of hospitalizations, VTE in 1.6%, ischemic stroke in 0.7%, and other systemic embolism in 0.1%. The proportion of hospitalizations complicated by thrombosis was lower in patients with viral respiratory illness in 2002-2014 than in COVID-19 (5% vs 16%; P< .001). Thrombosis is a prominent feature of the novel Coronavirus disease 2019 (COVID-19). The incidence of thrombosis during hospitalization for non-COVID-19 viral respiratory infections is uncertain. We evaluated the incidence of thrombosis in patients hospitalized with non-COVID-19 acute viral respiratory illnesses compared to COVID-19. Adults age >18 years hospitalized with a non-COVID-19 viral respiratory illness between 2002 and 2014 were identified. The primary study outcome was a composite of venous and arterial thrombotic events, including myocardial infarction (MI), acute ischemic stroke, and venous thromboembolism (VTE), as defined by ICD-9 codes. The incidence of thrombosis in non-COVID-19 viral respiratory illnesses was compared to the recently published incidence of thrombosis in COVID-19 from 3,334 patients hospitalized in New York in 2020. Among 954,521 hospitalizations with viral pneumonia from 2002 to 2014 (mean age 62.3 years, 57.1% female), the combined incidence of arterial and venous thrombosis was 5.0%. Acute MI occurred in 2.8% of hospitalizations, VTE in 1.6%, ischemic stroke in 0.7%, and other systemic embolism in 0.1%. Patients with thrombosis had higher in-hospital mortality (14.9% vs 3.3%, P< .001) than those without thrombosis. The proportion of hospitalizations complicated by thrombosis was lower in patients with viral respiratory illness in 2002-2014 than in COVID-19 (median age 64; 39.6% female) in 2020 (5% vs 16%; P< .001) In a nationwide analysis of hospitalizations for viral pneumonias, thrombosis risk was lower than that observed in patients with COVID-19. Investigations into mechanisms of thrombosis and risk reduction strategies in COVID-19 and other viral respiratory infections are necessary. [Display omitted]

• Publisher: Elsevier Inc,Elsevier Limited,Mosby
• Subject: Age / Cerebral infarction / Coronaviruses / COVID-19 / COVID-19 - diagnosis / COVID-19 - epidemiology / Embolism / Embolisms / Female / Hospitalization / Hospitalization - statistics & numerical data / Hospitals / Humans / Illnesses / Infections / Influenza / Ischemia / Ischemic Stroke - diagnosis / Ischemic Stroke - epidemiology / Ischemic Stroke - etiology / Male / Middle Aged / Mortality / Myocardial infarction / Myocardial Infarction - diagnosis / Myocardial Infarction - epidemiology / Myocardial Infarction - etiology / Pneumonia / Pneumonia, Viral - complications / Pneumonia, Viral - diagnosis / Research Letters / Respiratory diseases / Respiratory tract infection / Respiratory Tract Infections - complications / Respiratory Tract Infections - diagnosis / Respiratory Tract Infections - virology / Risk Assessment / Risk management / SARS-CoV-2 - isolation & purification / Stroke / Thromboembolism / Thrombosis / Thrombosis - epidemiology / Thrombosis - virology / United States - epidemiology / Venous Thromboembolism - diagnosis / Venous Thromboembolism - epidemiology / Venous Thromboembolism - etiology / Viral diseases