PMID- 36867727 OWN - NLM STAT- MEDLINE DCOM- 20230417 LR - 20240211 IS - 1530-0293 (Electronic) IS - 0090-3493 (Print) IS - 0090-3493 (Linking) VI - 51 IP - 5 DP - 2023 May 1 TI - Hemorrhage, Disseminated Intravascular Coagulopathy, and Thrombosis Complications Among Critically Ill Patients with COVID-19: An International COVID-19 Critical Care Consortium Study. PG - 619-631 LID - 10.1097/CCM.0000000000005798 [doi] AB - 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. CI - Copyright (c) 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. FAU - Fanning, Jonathon P AU - Fanning JP AD - Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. AD - Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. FAU - Weaver, Natasha AU - Weaver N AD - Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. AD - School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia. FAU - Fanning, Robert B AU - Fanning RB AD - Northern Hospital, Northern Health, Melbourne, VIC, Australia. AD - Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia. FAU - Griffee, Matthew J AU - Griffee MJ AD - Department of Anesthesiology and Perioperative Medicine, Sections of Critical Care and Perioperative Echocardiography, University of Utah, Salt Lake City, UT. AD - Department of Anesthesiology, Anesthesiology Service, Veteran Affairs Medical Center, Salt Lake City, UT. FAU - Cho, Sung-Min AU - Cho SM AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. AD - Division of Neuroscience Critical Care, Department of Neurology and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD. FAU - Panigada, Mauro AU - Panigada M AD - Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Department of Anesthesia, Intensive Care and Emergency. Milano, Lombardia, Italy. FAU - Obonyo, Nchafatso G AU - Obonyo NG AD - Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. AD - Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Initiative to Develop African Research Leaders (IDeAL)/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya. AD - Wellcome Trust Centre for Global Health Research, Imperial College London, London, United Kingdom. FAU - Zaaqoq, Akram M AU - Zaaqoq AM AD - Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC. AD - Department of Medicine, Georgetown University, Washington, DC. FAU - Rando, Hannah AU - Rando H AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. FAU - Chia, Yew Woon AU - Chia YW AD - Department of Cardiology, Tan Tock Seng Hospital, Singapore. AD - Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. AD - Yong Loo Lin School of Medicine, National University of Singapore, Singapore. FAU - Fan, Bingwen Eugene AU - Fan BE AD - Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. AD - Yong Loo Lin School of Medicine, National University of Singapore, Singapore. AD - Department of Haematology, Tan Tock Seng Hospital, Singapore. AD - Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore. FAU - Sela, Declan AU - Sela D AD - Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. AD - Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. FAU - Chiumello, Davide AU - Chiumello D AD - Department of Anesthesia and Intensive Care, Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, San Paolo University Hospital of Milan, Milan, Italy. FAU - Coppola, Silvia AU - Coppola S AD - Department of Anesthesia and Intensive Care, Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, San Paolo University Hospital of Milan, Milan, Italy. FAU - Labib, Ahmed AU - Labib A AD - Medical Intensive Care Unit, Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. FAU - Whitman, Glenn J R AU - Whitman GJR AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. FAU - Arora, Rakesh C AU - Arora RC AD - Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. FAU - Kim, Bo S AU - Kim BS AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. FAU - Motos, Anna AU - Motos A AD - Harrington Heart and Vascular Institute, University Hospitals - Cleveland Medical Center, Cleveland, OH. AD - Division of Cardiac Surgery, Department of Surgery, Case Western Reserve University, Cleveland, OH. FAU - Torres, Antoni AU - Torres A AD - Harrington Heart and Vascular Institute, University Hospitals - Cleveland Medical Center, Cleveland, OH. AD - Division of Cardiac Surgery, Department of Surgery, Case Western Reserve University, Cleveland, OH. AD - Centro de Investigacion Biomedica En Red - Enfermedades Respiratorias (CIBERES), Madrid, Spain. AD - Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Universitat de Barcelona, Barcelona, Spain. FAU - Barbe, Ferran AU - Barbe F AD - Harrington Heart and Vascular Institute, University Hospitals - Cleveland Medical Center, Cleveland, OH. AD - Servei de Pneumologia, Hospital Clinic, University of Barcelona, Spain. FAU - Grasselli, Giacomo AU - Grasselli G AD - Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Department of Anesthesia, Intensive Care and Emergency. Milano, Lombardia, Italy. AD - Institucio Catalana de Recerca i Estudis Avancats, Spain. FAU - Zanella, Alberto AU - Zanella A AD - Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Department of Anesthesia, Intensive Care and Emergency. Milano, Lombardia, Italy. AD - Institucio Catalana de Recerca i Estudis Avancats, Spain. FAU - Etchill, Eric AU - Etchill E AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. FAU - Usman, Asad Ali AU - Usman AA AD - Translational Research in Respiratory Medicine, Respiratory Department, Hospital Universitari Aranu de Vilanova and Santa Maria, IRBLleida, Leida, Spain. FAU - Feth, Maximilian AU - Feth M AD - Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. FAU - White, Nicole M AU - White NM AD - Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. AD - Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA. FAU - Suen, Jacky Y AU - Suen JY AD - Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. AD - Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. FAU - Li Bassi, Gianluigi AU - Li Bassi G AD - Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. AD - Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA. AD - Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Military Medical Center Ulm, Ulm, Germany. FAU - Peek, Giles J AU - Peek GJ AD - Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Military Medical Center Ulm, Ulm, Germany. FAU - Fraser, John F AU - Fraser JF AD - Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia. AD - Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. AD - Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA. AD - Queensland University of Technology, Brisbane, QLD, Australia. FAU - Dalton, Heidi AU - Dalton H AD - Department of Cardiology, Tan Tock Seng Hospital, Singapore. AD - Congenital Heart Centre, University of Florida, Gainesville, FL. CN - COVID-19 Critical Care Consortium LA - eng SI - ANZCTR/ACTRN12620000421932 GR - INV-034765/GATES/Bill & Melinda Gates Foundation/United States GR - K23 HL157610/HL/NHLBI NIH HHS/United States GR - L30 HL159698/HL/NHLBI NIH HHS/United States GR - T32 GM112596/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20230228 PL - United States TA - Crit Care Med JT - Critical care medicine JID - 0355501 SB - IM CIN - Crit Care Med. 2023 May 1;51(5):688-691. PMID: 37052441 EIN - Crit Care Med. 2023 Aug 1;51(8):e178. PMID: 37439654 MH - Adult MH - Humans MH - *COVID-19/complications/epidemiology/therapy MH - Prospective Studies MH - Critical Illness MH - *Thrombosis/epidemiology/etiology MH - Critical Care MH - Hemorrhage/epidemiology/etiology MH - Retrospective Studies PMC - PMC10089926 COIS- 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 Sklodowska-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. EDAT- 2023/03/04 06:00 MHDA- 2023/04/17 06:41 PMCR- 2023/04/12 CRDT- 2023/03/03 14:33 PHST- 2023/04/17 06:41 [medline] PHST- 2023/03/04 06:00 [pubmed] PHST- 2023/03/03 14:33 [entrez] PHST- 2023/04/12 00:00 [pmc-release] AID - 00003246-202305000-00007 [pii] AID - 10.1097/CCM.0000000000005798 [doi] PST - ppublish SO - Crit Care Med. 2023 May 1;51(5):619-631. doi: 10.1097/CCM.0000000000005798. Epub 2023 Feb 28.