Hemorrhage, Disseminated Intravascular Coagulopathy, and Thrombosis Complications Among Critically Ill Patients with COVID-19: An International COVID-19 Critical Care Consortium Study.

Autor:	Fanning JP; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom., Weaver N; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.; School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia., Fanning RB; Northern Hospital, Northern Health, Melbourne, VIC, Australia.; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia., Griffee MJ; Department of Anesthesiology and Perioperative Medicine, Sections of Critical Care and Perioperative Echocardiography, University of Utah, Salt Lake City, UT.; Department of Anesthesiology, Anesthesiology Service, Veteran Affairs Medical Center, Salt Lake City, UT., Cho SM; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.; Division of Neuroscience Critical Care, Department of Neurology and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD., Panigada M; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Department of Anesthesia, Intensive Care and Emergency. Milano, Lombardia, Italy., Obonyo NG; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.; Initiative to Develop African Research Leaders (IDeAL)/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.; Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom., Zaaqoq AM; Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC.; Department of Medicine, Georgetown University, Washington, DC., Rando H; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD., Chia YW; Department of Cardiology, Tan Tock Seng Hospital, Singapore.; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Fan BE; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.; Department of Haematology, Tan Tock Seng Hospital, Singapore.; Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore., Sela D; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia., Chiumello D; Department of Anesthesia and Intensive Care, Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, San Paolo University Hospital of Milan, Milan, Italy., Coppola S; Department of Anesthesia and Intensive Care, Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, San Paolo University Hospital of Milan, Milan, Italy., Labib A; Medical Intensive Care Unit, Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar., Whitman GJR; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD., Arora RC; Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada., Kim BS; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD., Motos A; Harrington Heart and Vascular Institute, University Hospitals - Cleveland Medical Center, Cleveland, OH.; Division of Cardiac Surgery, Department of Surgery, Case Western Reserve University, Cleveland, OH., Torres A; Harrington Heart and Vascular Institute, University Hospitals - Cleveland Medical Center, Cleveland, OH.; Division of Cardiac Surgery, Department of Surgery, Case Western Reserve University, Cleveland, OH.; Centro de Investigación Biomedica En Red - Enfermedades Respiratorias (CIBERES), Madrid, Spain.; Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Universitat de Barcelona, Barcelona, Spain., Barbé F; Harrington Heart and Vascular Institute, University Hospitals - Cleveland Medical Center, Cleveland, OH.; Servei de Pneumologia, Hospital Clinic, University of Barcelona, Spain., Grasselli G; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Department of Anesthesia, Intensive Care and Emergency. Milano, Lombardia, Italy.; Institució Catalana de Recerca i Estudis Avançats, Spain., Zanella A; Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Department of Anesthesia, Intensive Care and Emergency. Milano, Lombardia, Italy.; Institució Catalana de Recerca i Estudis Avançats, Spain., Etchill E; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD., Usman AA; Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Leida, Spain., Feth M; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., White NM; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.; Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA., Suen JY; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia., Li Bassi G; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.; Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA.; Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Military Medical Center Ulm, Ulm, Germany., Peek GJ; Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Military Medical Center Ulm, Ulm, Germany., Fraser JF; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.; Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA.; Queensland University of Technology, Brisbane, QLD, Australia., Dalton H; Department of Cardiology, Tan Tock Seng Hospital, Singapore.; Congenital Heart Centre, University of Florida, Gainesville, FL.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2023 May 01; Vol. 51 (5), pp. 619-631. Date of Electronic Publication: 2023 Feb 28.
DOI:	10.1097/CCM.0000000000005798
Abstrakt:	Objectives: To determine the prevalence and outcomes associated with hemorrhage, disseminated intravascular coagulopathy, and thrombosis (HECTOR) complications in ICU patients with COVID-19. Design: Prospective, observational study. Setting: Two hundred twenty-nine ICUs across 32 countries. Patients: Adult patients (≥ 16 yr) admitted to participating ICUs for severe COVID-19 from January 1, 2020, to December 31, 2021. 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). 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. Competing Interests: Dr. J. P. Fanning received funding from the Australian-American Fulbright Commission and Metro North Clinical Research Fellowship, Queensland Government, Australia. Drs. Suen, Li Bassi, and Fraser received support for article research from the Bill and Melinda Gates Foundation. Dr. Cho is funded by National Heart, Lung, and Blood Institute 1K23HL157610. Dr. Rando received funding from the American Heart Association. Dr. Whitman disclosed that he is 50% owner of a patent for a medical device for GWBN, LLC and that he received funding from Cellphire/Avania as principal investigator for a national study. Dr. Arora received funding from Edwards LifeSciences and Avir Pharma. Dr. Grasselli received funding from Getinge, Fisher & Paykel, Draeger Medical, Merck Sharp and Dohme, Cook Medical, and GlaxoSmithKline. Dr. Usman received support for article research from the National Institutes of Health. Drs. Suen’s and Li Bassi’s institutions received funding from The Bill and Melinda Gates Foundation. Dr. Suen is funded by the Advance Queensland fellowship program, Queensland Government, Australia. Dr. Li Bassi’s institution received funding from Fisher & Paykel. Dr. Li Bassi is a recipient of the Biomedical international training research programme for excellent clinician-scientists (BITRECS) fellowship; the “BITRECS” project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement no. 754550 and from the “La Caixa” Foundation (ID 100010434), under the agreement LCF/PR/GN18/50310006. Dr. Dalton received funding from extracorporeal membrane oxygenation concepts, entegrion, and hemocue. The remaining authors have disclosed that they do not have any potential conflicts of interest. (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.)
Databáze:	MEDLINE
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