Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux universitaires de Strasbourg, Service de Réanimation Médicale, Nouvel Hôpital Civil, Strasbourg, France.
ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération Hospitalo-Universitaire (FHU) OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
PLoS One. 2019 Feb 22;14(2):e0211680. doi: 10.1371/journal.pone.0211680. eCollection 2019.
Ilio-psoas hematoma is a potentially lethal condition that can arise during hospital stay. However, neither the incidence nor the prognosis of patients whose stay in intensive care units (ICU) is complicated by a iatrogenic ilio-psoas hematoma is known.
A bicentric retrospective study was conducted to compile the patients who developed an ilio-psoas hematoma while they were hospitalized in ICU between January 2009 and December 2016. Their biometric characteristics, pre-existing conditions, the circumstances in which the hematoma was diagnosed, the treatments they received and their prognosis were recorded.
Forty patients were diagnosed with an ilio-psoas hematoma during their ICU stay. The incidence of this complication was 3.8 cases for 1000 admissions, taking into account only patients who stayed more than three days in ICU. The median age of patients was 74 years old and the median time between admission and the diagnosis of ilio-psoas hematoma was 12.6 days. A large proportion of them was obese (42.5%) and/or under dialysis (50%) prior to developing their hematoma. Ninety-five percent of the patients had heparin at prophylactic or therapeutic doses. Only 10% of them were above the therapeutic range of anticoagulation. The ICU mortality rate was of 50% following this complication (versus a general mortality rate of 22% for the patients without IPH over the same period of time). Patients with IPH that were complicated by disseminated intravascular coagulopathy had a significantly higher mortality rate than those with IPH and no disseminated intravascular coagulopathy (OR 6.91, 95% CI [1.28; 58.8], p = 0.04).
Age, anticoagulation, a high body mass index and dialysis seem to be risk factors of developing an ilio-psoas hematoma in ICU. Iatrogenic ilio-psoas hematomas complicated by disseminated intravascular coagulopathies are more at risk of leading to death. It is noteworthy that activated partial thromboplastin time above the therapeutic range was not a good predictor of developing a hematoma for patients who received unfractioned heparin therapy.
髂腰肌血肿是一种潜在的致命疾病，可能在住院期间发生。然而，在重症监护病房（ICU）住院期间发生医源性髂腰肌血肿的患者的发病率和预后尚不清楚。
进行了一项两中心回顾性研究，以收集 2009 年 1 月至 2016 年 12 月期间在 ICU 住院期间发生髂腰肌血肿的患者。记录了他们的人体测量特征、既往疾病、血肿诊断的情况、接受的治疗以及预后。
40 例患者在 ICU 住院期间被诊断为髂腰肌血肿。考虑到仅 ICU 住院超过 3 天的患者，该并发症的发病率为每 1000 例患者 3.8 例。患者的中位年龄为 74 岁，从入院到诊断为髂腰肌血肿的中位时间为 12.6 天。他们中的很大一部分人在发生血肿前肥胖（42.5%）和/或接受透析（50%）。95%的患者接受预防性或治疗性剂量的肝素。只有 10%的患者抗凝治疗处于治疗范围之上。该并发症后 ICU 死亡率为 50%（而同期无 IPH 的患者总体死亡率为 22%）。并发弥散性血管内凝血的 IPH 患者的死亡率明显高于无弥散性血管内凝血的 IPH 患者（OR 6.91，95%CI [1.28;58.8]，p=0.04）。
年龄、抗凝、高体重指数和透析似乎是 ICU 发生髂腰肌血肿的危险因素。并发弥散性血管内凝血的医源性髂腰肌血肿更有死亡风险。值得注意的是，接受未分级肝素治疗的患者，活化部分凝血活酶时间高于治疗范围并不是发生血肿的良好预测指标。
