Hemorrhage, Disseminated Intravascular Coagulopathy, and Thrombosis Complications Among Critically Ill Patients with COVID-19: An International COVID-19 Critical Care Consortium Study.
Citation: Critical Care Medicine. 51(5):619-631, 2023 05 01.PMID: 36867727Institution: MedStar Washington Hospital CenterDepartment: Surgery/Surgical Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | Observational Study | Research Support, N.I.H., Extramural | Research Support, Non-U.S. Gov'tSubject headings: *COVID-19 | *Thrombosis | Adult | COVID-19/co [Complications] | COVID-19/ep [Epidemiology] | COVID-19/th [Therapy] | Critical Care | Critical Illness | Hemorrhage/ep [Epidemiology] | Hemorrhage/et [Etiology] | Humans | Prospective Studies | Retrospective Studies | Thrombosis/ep [Epidemiology] | Thrombosis/et [Etiology] | Year: 2023Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:- 0090-3493
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 36867727 | Available | 36867727 |
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: HECTOR events are frequent complications of severe COVID-19 in ICU patients. Patients receiving ECMO are at particular risk of hemorrhagic complications. Hemorrhagic, but not thrombotic complications, are associated with increased ICU mortality. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
DESIGN: Prospective, observational study.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: HECTOR complications occurred in 1,732 of 11,969 study eligible patients (14%). Acute thrombosis occurred in 1,249 patients (10%), including 712 (57%) with pulmonary embolism, 413 (33%) with myocardial ischemia, 93 (7.4%) with deep vein thrombosis, and 49 (3.9%) with ischemic strokes. Hemorrhagic complications were reported in 579 patients (4.8%), including 276 (48%) with gastrointestinal hemorrhage, 83 (14%) with hemorrhagic stroke, 77 (13%) with pulmonary hemorrhage, and 68 (12%) with hemorrhage associated with extracorporeal membrane oxygenation (ECMO) cannula site. Disseminated intravascular coagulation occurred in 11 patients (0.09%). Univariate analysis showed that diabetes, cardiac and kidney diseases, and ECMO use were risk factors for HECTOR. Among survivors, ICU stay was longer (median days 19 vs 12; p < 0.001) for patients with versus without HECTOR, but the hazard of ICU mortality was similar (hazard ratio [HR] 1.01; 95% CI 0.92-1.12; p = 0.784) overall, although this hazard was identified when non-ECMO patients were considered (HR 1.13; 95% CI 1.02-1.25; p = 0.015). Hemorrhagic complications were associated with an increased hazard of ICU mortality compared to patients without HECTOR complications (HR 1.26; 95% CI 1.09-1.45; p = 0.002), whereas thrombosis complications were associated with reduced hazard (HR 0.88; 95% CI 0.79-0.99, p = 0.03).
OBJECTIVES: To determine the prevalence and outcomes associated with hemorrhage, disseminated intravascular coagulopathy, and thrombosis (HECTOR) complications in ICU patients with COVID-19.
PATIENTS: Adult patients (>= 16 yr) admitted to participating ICUs for severe COVID-19 from January 1, 2020, to December 31, 2021.
SETTING: Two hundred twenty-nine ICUs across 32 countries.
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