[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia].
[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia].
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DOI：
10.3760/cma.j.issn.0253-2727.2020.0006
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发表时间：
2020-04-14
影响因子：
--
通讯作者：
Li, T S
中科院分区：
文献类型：
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作者：
Zhang, Y;Cao, W;Li, T S
目的：探讨重症监护病房(ICU)重症冠状病毒病2019(新冠肺炎)合并肢体缺血患者的临床及凝血特点。方法：回顾分析2020年2月4日至2月15日武汉市某中心收治的7例新冠肺炎危重患者急性脑缺血的临床资料。对入住ICU前和入住ICU期间的临床和实验室资料进行分析。结果：7例患者的平均年龄为59岁，其中4例为男性。其中3例与潜在的合并症有关。发热、咳嗽、呼吸困难、腹泻是常见的临床症状。所有患者都有肢体缺血的表现，包括手指/脚趾发紫、皮肤大疱病和干性坏疽。D-二聚体、纤维蛋白原和纤维蛋白原降解产物(FDP)在大多数患者显著升高。4例凝血酶原时间(PT)延长。随着COVID-2019病情加重，D-二聚体和FDP水平进行性升高，4例患者确诊为弥散性血管内凝血(DIC)。6例接受低分子肝素(LMWH)治疗后，D-二聚体、FDP下降，但临床症状改善不明显。5例患者最终死亡，从急性缺血到死亡的中位时间为12天。结论：应密切监测危重COVID-2019患者是否存在高凝状态，并可选择患者考虑抗凝治疗。需要更多的临床数据来研究抗凝在COVID-2019年治疗中的作用。目的：探讨重症冠状病毒病2019(新冠肺炎)合并肢体缺血患者的临床和凝血特点。方法：对2020年2月4日至2月15日在武汉某重症监护室(ICU)收治的7例新冠肺炎危重患者进行回顾性研究。对入住ICU前和入住ICU期间的临床和实验室资料进行分析。结果：7例患者的平均年龄为59岁，其中4例为男性。三名患者与潜在的合并症有关。发热、咳嗽、呼吸困难、腹泻是常见的临床症状。所有患者都有肢体缺血的表现，包括手指/脚趾发紫、皮肤大疱病和干性坏疽。D-二聚体、纤维蛋白原和纤维蛋白原降解产物(FDP)在大多数患者显著升高。4例凝血酶原时间延长。随着COVID-2019病情加重，D-二聚体和FDP水平逐渐升高。4例患者诊断为弥散性血管内凝血(DIC)。低分子肝素(LMWH)治疗6例，D-二聚体和FDP下降，但临床症状改善不明显。5例患者最终死亡，从急性缺血到死亡的中位时间为12天。结论：应密切监测危重COVID-2019患者的凝血参数。抗凝治疗的时机和方案仍在根据更多的临床数据进行研究。
Objective: To investigate the clinical and coagulation characteristics of the critical Coronavirus disease 2019 (COVID-19) patients with acro-ischemia in the intensive care unit (ICU). Methods: The retrospective study included 7 critical COVID-19 patients with acro-ischemia in a single center in Wuhan, from Feb 4 to Feb 15, 2020. The clinical and laboratory data before and during the ICU stay were analyzed. Results: The median age of 7 patients was 59 years and 4 of them were men. 3 of them were associated with underlying comorbidities. Fever, cough, dyspnea and diarrhea were common clinical symptoms. All patients had acro-ischemia presentations including finger/toe cyanosis, skin bulla and dry gangrene. D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients. Prothrombin time (PT) were prolonged in 4 patients. D-dimer and FDP levels increased progressively when COVID-2019 exacerbated, and 4 patients were diagnosed with definite disseminated intravascular coagulation (DIC). 6 patients received low molecular weight heparin (LMWH) treatment, after which their D-dimer and FDP decreased, but there was no significant improvement in clinical symptoms. 5 patients died finally and the median time from acro-ischemia to death was 12 days. Conclusions: The existence of hypercoagulation status in critical COVID-2019 patients should be monitored closely, and anticoagulation therapy can be considered in selected patients. More clinical data is needed to investigate the role of anticoagulation in COVID-2019 treatment.Objective: To investigate the clinical and coagulation characteristics in patients with critical Coronavirus disease 2019 (COVID-19) and acro-ischemia. Methods: The retrospective study included 7 critical COVID-19 patients with acro-ischemia in an intensive care unit (ICU) in Wuhan, from Feb 4 to Feb 15, 2020. The clinical and laboratory data before and during the ICU stay were analyzed. Results: The median age of 7 patients was 59 years and 4 of them were men. Three patients were associated with underlying comorbidities. Fever, cough, dyspnea and diarrhea were common clinical symptoms. All patients had acro-ischemia presentations including finger/toe cyanosis, skin bulla and dry gangrene. D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients. Prothrombin time was prolonged in 4 patients. D-dimer and FDP levels progressively elevated consistent with COVID-2019 exacerbation. Four patients were diagnosed with disseminated intravascular coagulation (DIC) . Low molecular weight heparin (LMWH) was administrated in 6 patients, which reduced D-dimer and FDP rather than improved clinical symptoms. Five patients died finally and the median time from acro-ischemia to death was 12 days. Conclusions: Coagulation parameters should be monitored closely in critical COVID-2019 patients. The timing and protocol of anticoagulation therapy are still under investigation based on more clinical data.