학술논문
Hemorrhage, Disseminated Intravascular Coagulopathy, and Thrombosis Complications Among Critically Ill Patients with COVID-19: An International COVID-19 Critical Care Consortium Study
Document Type
Academic Journal
Author
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, Bingwen Eugene; 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; Al-Dabbous, Tala; Alfoudri, Huda; Shamsah, Mohammed; Elapavaluru, Subbarao; Berg, Ashley; Horn, Christina; Mayasi, Yunis; Schroll, Stephan; Meyer, Dan; Velazco, Jorge; Ploskanych, Ludmyla; Fikes, Wanda; Bagewadi, Rohini; Dao, Marvin; White, Haley; Berrios Laviena, Alondra; Ehlers, Ashley; Shalabi-McGuire, Maysoon; Witt, Trent; Grazioli, Lorenzo; Lorini, Luca; Wilson Grandin, E.; Nunez, Jose; Reyes, Tiago; O’Briain, Diarmuid; Hunter, Stephanie; Ramanan, Mahesh; Affleck, Julia; Hurkadli Veerendra, Hemanth; Rai, Sumeet; Russell-Brown, Josie; Nourse, Mary; Joseph, Mark; Mitchell, Brook; Tenzer, Martha; Abe, Ryuzo; Jin Cho, Hwa; Seok Jeong, In; Rahman, Nadeem; Kakar, Vivek; Brozzi, Nicolas; Mehkri, Omar; Krishnan, Sudhir; Duggal, Abhijit; Houltham, Stuart; Graf, Jerónimo; Diaz, Roderigo; Orrego, Roderigo; Delgado, Camila; González, Joyce; Soledad Sanchez, Maria; Piagnerelli, Michael; Valenzuela Sarrazin, Josefa; Zabert, Gustavo; Espinosa, Lucio; Delgado, Paulo; Delgado, Victoria; Rincón, Diego Fernando Bautista; Yanten, Angela Maria Marulanda; Bustamante Duque, Melissa; Brodie, Daniel; Elhazmi, Alyaa; Al-Hudaib, Abdullah; Callahan, Maria; Azhari Taufik, M.; Yasmin Wardoyo, Elizabeth; Gunawan, Margaretha; Trisnaningrum, Nurindah S; Irawany, Vera; Rayhan, Muhammad; Panigada, Mauro; Pesenti, Antonio; Zanella, Alberto; Grasselli, Giacomo; Colombo, Sebastiano; Martinet, Chiara; Florio, Gaetano; Antonelli, Massimo; Carelli, Simone; Grieco, Domenico L.; Asaki, Motohiro; Hoshino, Kota; Salazar, Leonardo; Monsalve, Mary Alejandra Mendoza; Laffey, John; McNicholas, Bairbre; Cosgrave, David; McCaffrey, Joseph; Bone, Allison; Hakeem, Yusuff; Winearls, James; Tallott, Mandy; Thomson, David; Arnold-Day, Christel; Cupido, Jerome; Fanie, Zainap; Miller, Malcom; Seymore, Lisa; van Straaten, Dawid; Ait Hssain, Ali; Aliudin, Jeffrey; Alqahtani, Al-Reem; Mohamed, Khoulod; Mohamed, Ahmed; Tan, Darwin; Villanueva, Joy; Zaqout, Ahmed; Kurtzman, Ethan; Ademi, Arben; Dobrita, Ana; El Aoudi, Khadija; Segura, Juliet; Giwangkancana, Gezy; Ohshimo, Shinichiro; Osatnik, Javier; Joosten, Anne; Torres, Antoni; Yang, Minlan; Motos, Ana; Luna, Carlos; Arancibia, Francisco; Williams, Virginie; Noel, Alexandre; Luque, Nestor; Fantini, Marina; García, Ruth Noemi Jorge; Chicote Alvarez, Enrique; Greti, Anna; Ceccato, Adrian; Sanchez, Angel; Loza Vazquez, Ana; Roche-Campo, Ferran; Franch-Llasat, Diego; Tuazon, Divina; Amato, Marcelo; Cassimiro, Luciana; Pola, Flavio; Ribeiro, Francis; Fonseca, Guilherme; Dalton, Heidi; Desai, Mehul; Osborn, Erik; Deeb, Hala; Arcadipane, Antonio; Martucci, Gennaro; Panarello, Giovanna; Vitiello, Chiara; Bianco, Claudia; Occhipinti, Giovanna; Rossetti, Matteo; Cuffaro, Raffaele; Cho, Sung-Min; Whitman, Glenn; Shimizu, Hiroaki; Moriyama, Naoki; Kim, Jae-Burm; Kitamura, Nobuya; Gebauer, Johannes; Yokoyama, Toshiki; Al-Fares, Abdulrahman; Buabbas, Sarah; Alamad, Esam; Alawadhi, Fatma; Alawadi, Kalthoum; Tanaka, Hiro; Hashimoto, Satoru; Yamazaki, Masaki; Oh, Tak-Hyuck; Epler, Mark; Forney, Cathleen; Kruse, Louise; Feister, Jared; Williamson, Joelle; Grobengieser, Katherine; Gnall, Eric; Golden, Sasha; Caroline, Mara; Shapiro, Timothy; Karaj, Colleen; Thome, Lisa; Sher, Lynn; Vanderland, Mark; Welch, Mary; McDermott, Sherry; Brain, Matthew; Mineall, Sarah; Kimura, Dai; Brazzi, Luca; Sales, Gabriele; Montrucchio, Giorgia; Ogston, Tawnya; Nagpal, Dave; Fischer, Karlee; Lorusso, Roberto; Rangappa, Rajavardhan; Rai, Sujin; Appu, Argin; Esperatti, Mariano; Angélica Fuentes, Nora; Eugenia Gonzalez, Maria; O’Briain, Diarmuid; Carton, Edmund G.; Sen, Ayan; Palacios, Amanda; Rainey, Deborah; Samoukoviv, Gordan; Campisi, Josie; Durham, Lucia; Neumann, Emily; Seefeldt, Cassandra; Falcucci, Octavio; Emmrich, Amanda; Guy, Jennifer; Johns, Carling; Potzner, Kelly; Zimmermann, Catherine; Espinal, Angelia; Buchtele, Nina; Schwameis, Michael; Korhnfehl, Andrea; Brock, Roman; Staudinger, Thomas; Stecher, Stephanie-Susanne; Barnikel, Michaela; Antón, Sófia; Pawlikowski, Alexandra; Zaaqoq, Akram; Anh Galloway, Lan; Merley, Caitlin; Nichol, Alistair; Csete, Marc; Quesada, Luisa; Saba, Isabela; Kasugai, Daisuke; Hiraiwa, Hiroaki; Tanaka, Taku; Marwali, Eva; Purnama, Yoel; Rahayu Dewayanti, Santi; Ardiyan; Arifa Juzar, Dafsah; Siagian, Debby; Chen, Yih-Sharng; Ogino, Mark; Ratsep, Indrek; Post, Andra-Maris; Sillaots, Piret; Krund, Anneli; Lehiste, Merili-Helen; Lepik, Tanel; Manetta, Frank; Mihelis, Effe; Claire Sarmiento, Iam; Narasimhan, Mangala; Varrone, Michael; Komats, Mamoru; Garcia-Diaz, Julia; Harmon, Catherine; Veena Satyapriya, S.; Bhatt, Amar; Mokadam, Nahush A.; Uribe, Alberto; Gonzalez, Alicia; Shi, Haixia; McKeown, Johnny; Pasek, Joshua; Fiorda, Juan; Echeverria, Marco; Moreno, Rita; Zakhary, Bishoy; Cavana, Marco; Cucino, Alberto; Foti, Giuseppe; Giani, Marco; Fumagalli, Benedetta; Chiumello, Davide; Castagna, Valentina; Dell’Amore, Andrea; Navalesi, Paolo; Shum, Hoi-Ping; Vuysteke, Alain; Usman, Asad; Acker, Andrew; Smood, Benjamin; Mergler, Blake; Sertic, Federico; Subramanian, Madhu; Sperry, Alexandra; Rizer, Nicolas; Burhan, Erlina; Rasmin, Menaldi; Akmal, Ernita; Sitompul, Faya; Lolong, Navy; Naivedh, Bhat; Erickson, Simon; Barrett, Peter; Dean, David; Daugherty, Julia; Loforte, Antonio; Khan, Irfan; Abraar Quraishi, Mohammed; DeSantis, Olivia; So, Dominic; Kandamby, Darshana; Mandei, Jose M.; Natanael, Hans; YudhaLantang, Eka; Lantang, Anastasia; Oto Wijaya, Surya; Jung, Anna; Ng, George; Yiu Ng, Wing; Yeung Ng, Pauline; Fang, Shu; Tabah, Alexis; Ratcliffe, Megan; Duroux, Maree; Adachi, Shingo; Nakao, Shota; Blanco, Pablo; Prieto, Ana; Sánchez, Jesús; Nicholson, Meghan; Butt, Warwick; Serratore, Alyssa; Delzoppo, Carmel; Janin, Pierre; Yarad, Elizabeth; Totaro, Richard; Coles, Jennifer; Pujo, Bambang; Balk, Robert; Vissing, Andy; Kapania, Esha; Hays, James; Fox, Samuel; Yantosh, Garrett; Mishin, Pavel; Yuliarto, Saptadi; Hari Santoso, Kohar; Djajalaksana, Susanthy; Zainul Fatoni, Arie; Fukuda, Masahiro; Liu, Keibun; Pelosi, Paolo; Battaglini, Denise; Masa Jiménez, Juan Fernando; Bastos, Diego; Gaião, Sérgio; Rusmawatiningtyas, Desy; Cho, Young-Jae; Hwan Lee, Su; Kawasaki, Tatsuya; Munshi, Laveena; Sakiyalak, Pranya; Nitayavardhana, Prompak; Seitz, Tamara; Arora, Rakesh; Kent, David; Marino, Daniel; Parwar, Swapnil; Cheng, Andrew; Miller, Jennene; Fujitani, Shigeki; Shimizu, Naoki; Madhok, Jai; Owyang, Clark; Buscher, Hergen; Reynolds, Claire; Maasikas, Olavi; Beljantsev, Aleksan; Mihnovits, Vladislav; Akimoto, Takako; Aizawa, Mariko; Horibe, Kanako; Onodera, Ryota; Hodgson, Carol; Burrell, Aidan; Young, Meredith; George, Timothy; Shekar, Kiran; McGuinness, Niki; Irvine, Lacey; Flynn, Brigid; Endo, Tomoyuki; Sugiyama, Kazuhiro; Shimizu, Keiki; Fan, Eddy; Exconde, Kathleen; Ichiba, Shingo; Lussier, Leslie; Lotz, Gösta; Malfertheiner, Maximilian; Maier, Lars; Dreier, Esther; Permata Kusumastuti, Neurinda; McCloskey, Colin; Dabaliz, Al-Awwab; Elshazly, Tarek B; Smith, Josiah; Szuldrzynski, Konstanty S.; Bielański, Piotr; Hakeem, Yusuff; Wille, Keith; Murthy, Srinivas; Parhar, Ken Kuljit S.; Fiest, Kirsten M.; Codan, Cassidy; Shahid, Anmol; Fayed, Mohamed; Evans, Timothy; Garcia, Rebekah; Gutierrez, Ashley; Shimizu, Hiroaki; Song, Tae; Rose, Rebecca; Bennett, Suzanne; Richardson, Denise; Peek, Giles; Arora, Lovkesh; Rappapport, Kristina; Rudolph, Kristina; Sibenaller, Zita; Stout, Lori; Walter, Alicia; Herr, Daniel; Vedadi, Nazli; Bartlett, Robert; Pesenti, Antonio; Thompson, Shaun; Hoffman, Julie; Ying, Xiaonan; Kennedy, Ryan; Elhadi, Muhammed; Griffee, Matthew; Ciullo, Anna; Kida, Yuri; Ferrer Roca, Ricard; Riera, JordI; Contreras, Sofia; Alegre, Cynthia; Kay, Christy; Fischer, Irene; Renner, Elizabeth; Taniguci, Hayato; Fraser, John; Li Bassi, Gianluigi; Suen, Jacky; Barnett, Adrian; White, Nicole; Gibbons, Kristen; Forsyth, Simon; Corley, Amanda; Pearse, India; Hinton, Samuel; Abbate, Gabriella; Hassan, Halah; Heinsar, Silver; Karnik, Varun A; Ki, Katrina; O’Neill, Hollier F.; Obonyo, Nchafatso; Pretti Pimenta, Leticia; Reid, Janice D.; Sato, Kei; Shekar, Kiran; Vuorinen, Aapeli; Wildi, Karin S.; Wilson, Emily S.; Yerkovich, Stephanie; Lee, James; Plotkin, Daniel; Wanjiru Citarella, Barbara; Merson, Laura; Hartley, Emma; Lubis, Bastian; Ikeyama, Takanari; Bhaskar, Balu; Jung, Jae-Seung; McGuinness, Shay; Eastwood, Glenn; Rossi Marta, Sandra; Guarracino, Fabio; Gerle, Stacy; Coxon, Emily; Claro, Bruno; Loverde, Daniel; Patil, Namrata; Parrini, Vieri; McBride, Angela; Negaard, Kathryn; Ratsch, Angela; Abdelaziz, Ahmad; David Uribe, Juan; Peris, Adriano; Sanders, Mark; Emerson, Dominic; Kamal, Muhammad; Povoa, Pedro; Francis, Roland; Cherif, Ali; Joseph, Sunimol; Di Nardo, Matteo; Heard, Micheal; Kyle, Kimberly; Blackwell, Ray A; Piagnerelli, Michael; Biston, Patrick; Won Jeong, Hye; Smith, Reanna; Prawira, Yogi; Montrucchio, Giorgia; Huerta Garcia, Arturo; Salterain, Nahikari; Meyns, Bart; Moreno, Marsha; Walia, Rajat; Mehta, Amit; Schweda, Annette; Supriatna, Moh; Kirakli, Cenk; Williams, Melissa; Hoon Kim, Kyung; Assad, Alexandra; Giraldo, Estefania; Karolak, Wojtek; Balik, Martin; Pocock, Elizabeth; Gajkowski, Evan; Masafumi, Kanamoto; Barrett, Nicholas; Takeyama, Yoshihiro; Park, Sunghoon; Amin, Faizan; Meilyana Andriyani, Fina; Sudakevych, Serhii; Ratsch, Angela; Vera, Magdalena; Cornejo, Rodrigo; Schwarz, Patrícia; Carolina Mardini, Ana; de Paula, Thais; Serpa Neto, Ary; Villoldo, Andrea; Siciliano Colafranceschi, Alexandre; Ubeda Iglesias, Alejandro; Granjean, Juan; Melro, Lívia Maria Garcia; Fioravante Romualdo, Giovana; Gaia, Diego; Souza, Helmgton; Galas, Filomena; Máñez Mendiluce, Rafael; Sosa, Alejandra; Martinez, Ignacio; Kurosawa, Hiroshi; Salgado, Juan; Hugi-Mayr, Beate; Charbonneau, Eric; Salvatore Barzilai, Vitor; Monteiro, Veronica; Ribeiro de Souza, Rodrigo; Harper, Michael; Suzuki, Hiroyuki; Adams, Celina; Brieva, Jorge; Nyale, George; Saleem Eltatar, Faisal; Fatani, Jihan; Baeissa, Husam; Masri, Ayman AL; Rabie, Ahmed; Yee Hui, Mok; Yamane, Masahiro; Jung, Hanna; Mojisola Margaret, Ayorinde; Nacpil, Newell; Ruck, Katja; Bakken, Rhonda; Jara, Claire; Felton, Tim; Berra, Lorenzo; Shah, Bobby; Chakraborty, Arpan; Cardona, Monika; Capatos, Gerry; Akkanti, Bindu; Orija, Abiodun; Jain, Harsh; Ito, Asami; Housni, Brahim; Low, Sennen; Iihara, Koji; Chavez, Joselito; Ramanathan, Kollengode; Zabert, Gustavo; Naidoo, Krubin; Seppelt, Ian; VanDyk, Marlice; MacDonald, Sarah; Ichiba, Shingo; McGregor, Randy; Siebenaler, Teka; Flynn, Hannah; Lofton, Kristi; Aokage, Toshiyuki; Shigemitsu, Kazuaki; Moscatelli, Andrea; Fiorentino, Giuseppe; Baumgaertel, Matthias; Eddy, Serge; Assy, Jana; Hutahaean, Amelya; Roush, Holly; Sichting, Kay A; Alessandri, Francesco; Burns, Debra; Rabie, Ahmed; Salt, Gavin; Garabedian, Carl P.; Millar, Jonathan; Sim, Malcolm; Mattke, Adrian; McAuley, Danny; Tadili, Jawad; Frenzel, Tim; Bar-Lavie, Yaron; Blandino Ortiz, Aaron; Stone, Jackie; Tabah, Alexis; Attokaran, Antony; Farquharson, Michael; Patel, Brij; Gunning, Derek; Baillie, Kenneth; Watson, Pia; Tamai, Kenji; Ketut Sajinadiyasa, Gede; Kanyawati, Dyah; Salgado, Marcello; Sassine, Assad; Yudo, Bhirowo; McCaul, Scott; Lee, Bongjin; Min Lee, Sang; Afek, Arnon; Iwashita, Yoshiaki; Pujo Semedi, Bambang; Permata Kusumastuti, Neurinda; Metiva, Jack; Van Belle, Nicole; Martin-Loeches, Ignacio; Ivatt, Lenny; Yew Woon, Chia; Mi Kang, Hyun; Smith, Timothy; James, Erskine; Al-Rawas, Nawar; Iwasaki, Yudai; Chan King-Chung, Kenny; Gudzenko, Vadim; Hugi-Mayr, Beate; Taccone, Fabio; Perdhana, Fajar; Lamarche, Yoan; Miguel Ribeiro, Joao; Bradic, Nikola; Van den Bossche, Klaartje; Lansink, Oude; Singh, Gurmeet; Debeuckelaere, Gerdy; Stelfox, Henry T.; Yi, Cassia; Elia, Jennifer; Tribble, Thomas; Shankar, Shyam; Padmanabhan, Raj; Hallinan, Bill; Paoletti, Luca; Leyva, Yolanda; Fykuda, Tatuma; Badulak, Jenelle; Koch, Jillian; Hackman, Amy; Janowaik, Lisa; Hernandez, Deb; Osofsky, Jennifer; Donadello, Katia; Lawang, Aizah; Fine, Josh; Davidson, Benjamin; Vazquez, Andres Oswaldo Razo
Source
Critical Care Medicine. Feb 28, 2023
Subject
Language
English
ISSN
0090-3493
Abstract
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.