Division of Critical Care Medicine, Department of Internal Medicine, 2013Montefiore Medical Center, Bronx, NY, USA.
Department of Epidemiology and Population Health, 2006Albert Einstein College of Medicine, Bronx, NY, USA.
J Intensive Care Med. 2021 Dec;36(12):1483-1490. doi: 10.1177/0885066620964392. Epub 2020 Oct 6.
Covid-19 associated coagulopathy (CAC) is associated with prothrombotic state and thromboembolism. However, true incidence of thromboembolic events is difficult to determine in the ICU setting. The aim of our study was to investigate the cumulative incidence of thromboembolic events in Covid-19 patients needing intensive care unit (ICU) admission and assessing the utility of point of care ultrasound (POCUS) to screen for and diagnose lower extremity deep venous thrombosis (DVT).
We conducted a prospective observational study between April 22nd and May 26th, 2020 where all adult patients with the diagnosis of Covid-19 pneumonia admitted to 8 ICUs of Montefiore Medical Center were included. POCUS exam was performed on all patients at day 1 of ICU admission and at day 7 and 14 after the first exam.
The primary outcome was to study the cumulative incidence of thromboembolic events in Covid-19 patients needing ICU admission. A total of 107 patients were included. All patients got POCUS exam on day 1 in the ICU, 62% got day 7 and 41% got day 14 exam. POCUS diagnosed 17 lower extremity DVTs on day 1, 3 new on day 7 and 1 new on day 14. Forty patients developed 52 thromboembolic events, with the rate of 37.3%. We found a high 45-day cumulative incidence of thromboembolic events of 37% and a high 45-day cumulative incidence of lower and upper extremity DVT of 21% and 10% respectively. Twelve (30%) patients had failure of therapeutic anticoagulation. Occurrence of a thromboembolic event was not associated with a higher risk of mortality (HR 1.08, p value = .81).
Covid-19 patients in ICU have a high cumulative incidence of thromboembolic events, but not associated with higher mortality. POCUS is an excellent tool to help screen and diagnose DVT during a pandemic.
Covid-19 相关凝血病（CAC）与血栓前状态和血栓栓塞相关。然而，在 ICU 环境中，很难确定血栓栓塞事件的真实发生率。我们的研究目的是调查需要 ICU 入院的 Covid-19 患者中血栓栓塞事件的累积发生率，并评估床边超声（POCUS）筛查和诊断下肢深静脉血栓形成（DVT）的效用。
我们进行了一项前瞻性观察研究，时间为 2020 年 4 月 22 日至 5 月 26 日，纳入了所有被诊断为 Covid-19 肺炎并收入 Montefiore 医疗中心 8 个 ICU 的成年患者。所有患者在 ICU 入院第 1 天、第 7 天和第 14 天进行 POCUS 检查。
主要结局是研究需要 ICU 入院的 Covid-19 患者中血栓栓塞事件的累积发生率。共纳入 107 例患者。所有患者在 ICU 入院第 1 天接受 POCUS 检查，62%在第 7 天接受检查，41%在第 14 天接受检查。POCUS 在第 1 天诊断出 17 例下肢 DVT，第 7 天新增 3 例，第 14 天新增 1 例。40 例患者发生 52 例血栓栓塞事件，发生率为 37.3%。我们发现血栓栓塞事件的 45 天累积发生率较高，为 37%，下肢和上肢 DVT 的 45 天累积发生率分别为 21%和 10%。12 例（30%）患者存在抗凝治疗失败。血栓栓塞事件的发生与更高的死亡率无关（HR 1.08，p 值=0.81）。
ICU 中的 Covid-19 患者有很高的血栓栓塞事件累积发生率，但与死亡率增加无关。POCUS 是在大流行期间帮助筛查和诊断 DVT 的极好工具。
