Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID19: an international COVID19 critical care consortium study
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...
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Science::Medicine COVID-19 Extracorporeal Membrane Oxygenation |
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Science::Medicine COVID-19 Extracorporeal Membrane Oxygenation Fanning, Jonathon P. Weaver, Natasha Fanning, Robert B. Griffee, Matthew J. Cho, Sung-Min Panigada, Mauro Obonyo, Nchafatso G. Zaaqoq, Akram M. Rando, Hannah Chia, Yew Woon Fan, Eugene Bingwen Sela, Declan Chiumello, Davide Coppola, Silvia Labib, Ahmed Whitman, Glenn J. R. Arora, Rakesh C. Kim, Bo S. Motos, Anna Torres, Antoni Barbé, Ferran Grasselli, Giacomo Zanella, Alberto Etchill, Eric Usman, Asad Ali Feth, Maximilian White, Nicole M. Suen, Jacky Y. Li Bassi, Gianluigi Peek, Giles J. Fraser, John F. Dalton, Heidi Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID19: an international COVID19 critical care consortium study |
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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 COVID19 in ICU patients. Patients receiving ECMO are at particular risk of hemorrhagic complications. Hemorrhagic, but not thrombotic complications, are associated with increased ICU mortality. |
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Lee Kong Chian School of Medicine (LKCMedicine) |
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Lee Kong Chian School of Medicine (LKCMedicine) Fanning, Jonathon P. Weaver, Natasha Fanning, Robert B. Griffee, Matthew J. Cho, Sung-Min Panigada, Mauro Obonyo, Nchafatso G. Zaaqoq, Akram M. Rando, Hannah Chia, Yew Woon Fan, Eugene Bingwen Sela, Declan Chiumello, Davide Coppola, Silvia Labib, Ahmed Whitman, Glenn J. R. Arora, Rakesh C. Kim, Bo S. Motos, Anna Torres, Antoni Barbé, Ferran Grasselli, Giacomo Zanella, Alberto Etchill, Eric Usman, Asad Ali Feth, Maximilian White, Nicole M. Suen, Jacky Y. Li Bassi, Gianluigi Peek, Giles J. Fraser, John F. Dalton, Heidi |
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Article |
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Fanning, Jonathon P. Weaver, Natasha Fanning, Robert B. Griffee, Matthew J. Cho, Sung-Min Panigada, Mauro Obonyo, Nchafatso G. Zaaqoq, Akram M. Rando, Hannah Chia, Yew Woon Fan, Eugene Bingwen Sela, Declan Chiumello, Davide Coppola, Silvia Labib, Ahmed Whitman, Glenn J. R. Arora, Rakesh C. Kim, Bo S. Motos, Anna Torres, Antoni Barbé, Ferran Grasselli, Giacomo Zanella, Alberto Etchill, Eric Usman, Asad Ali Feth, Maximilian White, Nicole M. Suen, Jacky Y. Li Bassi, Gianluigi Peek, Giles J. Fraser, John F. Dalton, Heidi |
author_sort |
Fanning, Jonathon P. |
title |
Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID19: an international COVID19 critical care consortium study |
title_short |
Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID19: an international COVID19 critical care consortium study |
title_full |
Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID19: an international COVID19 critical care consortium study |
title_fullStr |
Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID19: an international COVID19 critical care consortium study |
title_full_unstemmed |
Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID19: an international COVID19 critical care consortium study |
title_sort |
hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with covid19: an international covid19 critical care consortium study |
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2023 |
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https://hdl.handle.net/10356/169957 |
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sg-ntu-dr.10356-1699572023-08-20T15:37:30Z Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID19: an international COVID19 critical care consortium study Fanning, Jonathon P. Weaver, Natasha Fanning, Robert B. Griffee, Matthew J. Cho, Sung-Min Panigada, Mauro Obonyo, Nchafatso G. Zaaqoq, Akram M. Rando, Hannah Chia, Yew Woon Fan, Eugene Bingwen Sela, Declan Chiumello, Davide Coppola, Silvia Labib, Ahmed Whitman, Glenn J. R. Arora, Rakesh C. Kim, Bo S. Motos, Anna Torres, Antoni Barbé, Ferran Grasselli, Giacomo Zanella, Alberto Etchill, Eric Usman, Asad Ali Feth, Maximilian White, Nicole M. Suen, Jacky Y. Li Bassi, Gianluigi Peek, Giles J. Fraser, John F. Dalton, Heidi Lee Kong Chian School of Medicine (LKCMedicine) Tan Tock Seng Hospital Yong Loo Lin School of Medicine, NUS Khoo Teck Puat Hospital Science::Medicine COVID-19 Extracorporeal Membrane Oxygenation 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 COVID19 in ICU patients. Patients receiving ECMO are at particular risk of hemorrhagic complications. Hemorrhagic, but not thrombotic complications, are associated with increased ICU mortality. Published version Supported, in part, by the COVID-19 Critical Care Consortium. Also supported, in part, by The Bill & Melinda Gates Foundation, grant number INV-034765; The University of Queensland; The Wesley Medical Research; The Prince Charles Hospital Foundation; and The Health Research Board of Ireland. Presented, in part, at the International Society of Thrombosis and Haemostasis 2022 Congress, London, United Kingdom, July 13, 2022. 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. 2023-08-16T04:16:37Z 2023-08-16T04:16:37Z 2023 Journal Article Fanning, J. P., Weaver, N., Fanning, R. B., Griffee, M. J., Cho, S., Panigada, M., Obonyo, N. G., Zaaqoq, A. M., Rando, H., Chia, Y. W., Fan, E. B., Sela, D., Chiumello, D., Coppola, S., Labib, A., Whitman, G. J. R., Arora, R. C., Kim, B. S., Motos, A., ...Dalton, H. (2023). Hemorrhage, disseminated intravascular coagulopathy, and thrombosis complications among critically ill patients with COVID19: an international COVID19 critical care consortium study. Critical Care Medicine, 51(5), 619-631. https://dx.doi.org/10.1097/CCM.0000000000005798 0090-3493 https://hdl.handle.net/10356/169957 10.1097/CCM.0000000000005798 36867727 2-s2.0-85152604997 5 51 619 631 en Critical Care Medicine © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. application/pdf |