The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19

Ang Li; Nicole M Kuderer; Chih-Yuan Hsu; Yu Shyr; Jeremy L Warner; Dimpy P Shah; Vaibhav Kumar; Surbhi Shah; Amit A Kulkarni; Julie Fu; Shuchi Gulati; Rebecca L Zon; Monica Li; Aakash Desai; Pamela C Egan; Ziad Bakouny; Devendra Kc; Clara Hwang; Imo J Akpan; Rana R McKay; Jennifer Girard; Andrew L Schmidt; Balazs Halmos; Michael A Thompson; Jaymin M Patel; Nathan A Pennell; Solange Peters; Amro Elshoury; Gilbero de Lima Lopes; Daniel G Stover; Petros Grivas; Brian I Rini; Corrie A Painter; Sanjay Mishra; Jean M Connors; Gary H Lyman; Rachel P Rosovsky; CCC19 consortium

doi:10.1111/jth.15463

The CoVID-TE risk assessment model for venous thromboembolism in hospitalized patients with cancer and COVID-19

J Thromb Haemost. 2021 Oct;19(10):2522-2532. doi: 10.1111/jth.15463. Epub 2021 Aug 13.

Authors

Ang Li¹, Nicole M Kuderer², Chih-Yuan Hsu³, Yu Shyr³, Jeremy L Warner^{3

4}, Dimpy P Shah⁵, Vaibhav Kumar⁶, Surbhi Shah⁷, Amit A Kulkarni⁷, Julie Fu⁸, Shuchi Gulati⁹, Rebecca L Zon¹⁰, Monica Li¹¹, Aakash Desai¹², Pamela C Egan¹³, Ziad Bakouny¹⁴, Devendra Kc¹⁵, Clara Hwang¹⁶, Imo J Akpan¹⁷, Rana R McKay¹⁸, Jennifer Girard¹⁹, Andrew L Schmidt¹⁴, Balazs Halmos²⁰, Michael A Thompson²¹, Jaymin M Patel²², Nathan A Pennell²³, Solange Peters²⁴, Amro Elshoury²⁵, Gilbero de Lima Lopes²⁶, Daniel G Stover²⁷, Petros Grivas²⁸, Brian I Rini⁴, Corrie A Painter²⁹, Sanjay Mishra⁴, Jean M Connors¹⁰, Gary H Lyman²⁸, Rachel P Rosovsky³⁰; CCC19 consortium

Affiliations

¹ Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA.
² Advanced Cancer Research Group, Seattle, Washington, USA.
³ Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, USA.
⁴ Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, Tennessee, USA.
⁵ Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, Texas, USA.
⁶ Section of Hematology-Oncology, University of North Carolina, Chapel Hill, North Carolina, USA.
⁷ Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA.
⁸ Hematology Oncology, Tufts Medical Center Cancer Center, Boston & Stoneham, Massachusetts, USA.
⁹ Division of Hematology/Oncology, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁰ Division of Hematology, Brigham and Women's Hospital Boston, Boston, Massachusetts, USA.
¹¹ School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
¹² Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹³ Brown University and Lifespan Cancer Institute, Providence, Rhode Island, USA.
¹⁴ Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
¹⁵ Hartford HealthCare Cancer Institute, Hartford, Connecticutt, USA.
¹⁶ Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan, USA.
¹⁷ Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York, USA.
¹⁸ Moores Cancer Center at the University of California, San Diego, California, USA.
¹⁹ University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA.
²⁰ Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
²¹ Aurora Cancer Care, Advocate Aurora Health, Milwaukee, Wisconsin, USA.
²² Beth Israel Deaconess Medical Center (BIDMC), Boston, Massachusetts, USA.
²³ Cleveland Clinic, Cleveland, Ohio, USA.
²⁴ Lausanne University Hospital, Lausanne, Switzerland.
²⁵ Leukemia Service, Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
²⁶ Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.
²⁷ Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA.
²⁸ University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, Washington, USA.
²⁹ Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
³⁰ Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.

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.

Keywords: COVID-19; SARS-CoV-2; clinical decision rules; thrombosis; venous thromboembolism.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Cohort Studies
Humans
Neoplasms* / complications
Neoplasms* / epidemiology
Risk Assessment
SARS-CoV-2
Venous Thromboembolism* / diagnosis
Venous Thromboembolism* / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding