Incidence of thrombotic complications in critically ill ICU patients with COVID-19
Incidence of thrombotic complications in critically ill ICU patients with COVID-19
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DOI：
10.1016/j.thromres.2020.04.013
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发表时间：
2020-07-01
影响因子：
7.5
通讯作者：
Endeman, H.
中科院分区：
文献类型：
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作者：
Klok, F. A.;Kruip, M. J. H. A.;Endeman, H.
引言：由于过度炎症、缺氧、制动和弥散性血管内凝血，新型冠状病毒肺炎（COVID - 19）可能易诱发静脉和动脉血栓栓塞。然而，关于血栓并发症发生率的报告尚未见报道。
方法：我们评估了荷兰两所大学医院和一所教学医院重症监护病房（ICU）收治的所有COVID - 19患者中，症状性急性肺栓塞（PE）、深静脉血栓形成、缺血性脑卒中、心肌梗死或全身性动脉栓塞复合结局的发生率。
结果：我们研究了184例确诊为COVID - 19肺炎的ICU患者，其中23例死亡（13%），22例存活出院（12%），139例（76%）在2020年4月5日仍在ICU。所有患者至少接受了标准剂量的血栓预防。复合结局的累积发生率为31%（95%置信区间20 - 41），其中计算机断层肺血管造影（CTPA）和/或超声检查确诊的静脉血栓栓塞（VTE）为27%（95%置信区间17 - 37%），动脉血栓事件为3.7%（95%置信区间0 - 8.2%）。肺栓塞是最常见的血栓并发症（n = 25，81%）。年龄（调整后的风险比（aHR）为每年1.05，95%置信区间1.004 - 1.01）以及凝血功能障碍（定义为凝血酶原时间自发延长>3秒或活化部分凝血活酶时间>5秒，aHR为4.1，95%置信区间1.9 - 9.1）是血栓并发症的独立预测因素。
结论：COVID - 19感染的ICU患者中血栓并发症的发生率为31%，显著较高。我们的研究结果强化了对入住ICU的所有COVID - 19患者严格应用药物血栓预防的建议，并且强烈提示即使在缺乏随机证据的情况下，也应将预防剂量提高至高预防剂量。
Introduction: COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available.Methods: We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital.Results: We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications.Conclusion: The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.