Royal Brompton Hospital, London, United Kingdom.
National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Crit Care Med. 2021 May 1;49(5):804-815. doi: 10.1097/CCM.0000000000004890.
Severe coronavirus disease 2019 is associated with an extensive pneumonitis and frequent coagulopathy. We sought the true prevalence of thrombotic complications in critically ill patients with severe coronavirus disease 2019 on the ICU, with or without extracorporeal membrane oxygenation.
We undertook a single-center, retrospective analysis of 72 critically ill patients with coronavirus disease 2019-associated acute respiratory distress syndrome admitted to ICU. CT angiography of the thorax, abdomen, and pelvis were performed at admission as per routine institution protocols, with further imaging as clinically indicated. The prevalence of thrombotic complications and the relationship with coagulation parameters, other biomarkers, and survival were evaluated.
Coronavirus disease 2019 ICUs at a specialist cardiorespiratory center.
Seventy-two consecutive patients with coronavirus disease 2019 admitted to ICU during the study period (March 19, 2020, to June 23, 2020).
None.
All but one patient received thromboprophylaxis or therapeutic anticoagulation. Among 72 patients (male:female = 74%; mean age: 52 ± 10; 35 on extracorporeal membrane oxygenation), there were 54 thrombotic complications in 42 patients (58%), comprising 34 pulmonary arterial (47%), 15 peripheral venous (21%), and five (7%) systemic arterial thromboses/end-organ embolic complications. In those with pulmonary arterial thromboses, 93% were identified incidentally on first screening CT with only 7% suspected clinically. Biomarkers of coagulation (e.g., d-dimer, fibrinogen level, and activated partial thromboplastin time) or inflammation (WBC count, C-reactive protein) did not discriminate between patients with or without thrombotic complications. Fifty-one patients (76%) survived to discharge; 17 (24%) patients died. Mortality was significantly greater in patients with detectable thrombus (33% vs 10%; p = 0.022).
There is a high prevalence of thrombotic complications, mainly pulmonary, among coronavirus disease 2019 patients admitted to ICU, despite anticoagulation. Detection of thrombus was usually incidental, not predicted by coagulation or inflammatory biomarkers, and associated with increased risk of death. Systematic CT imaging at admission should be considered in all coronavirus disease 2019 patients requiring ICU.
严重的 2019 年冠状病毒病与广泛的肺炎和频繁的凝血功能障碍有关。我们旨在调查重症 2019 年冠状病毒病患者在 ICU 中是否存在血栓并发症，以及这些并发症是否与体外膜肺氧合有关。
我们对因急性呼吸窘迫综合征而入住 ICU 的 72 例 2019 年冠状病毒病患者进行了单中心回顾性分析。根据机构常规方案，对患者进行胸部、腹部和骨盆 CT 血管造影检查，并根据临床指征进行进一步的影像学检查。评估了血栓并发症的发生率，以及与凝血参数、其他生物标志物和生存率的关系。
专门的心肺呼吸中心的 2019 年冠状病毒病 ICU。
在研究期间（2020 年 3 月 19 日至 6 月 23 日），连续有 72 例 2019 年冠状病毒病患者入住 ICU。
无。
除 1 例患者外，其余患者均接受了预防性抗凝或治疗性抗凝。在 72 例患者（男：女=74%；平均年龄：52±10；35 例接受体外膜肺氧合）中，42 例患者（58%）有 54 例血栓并发症，包括 34 例肺动脉血栓（47%）、15 例外周静脉血栓（21%）和 5 例（7%）系统性动脉血栓/终末器官栓塞并发症。在肺动脉血栓患者中，93%的患者在首次筛查 CT 时偶然发现，只有 7%的患者临床上怀疑有血栓。凝血标志物（如 D-二聚体、纤维蛋白原水平和活化部分凝血活酶时间）或炎症标志物（白细胞计数、C 反应蛋白）不能区分有或无血栓并发症的患者。51 例（76%）患者存活出院；17 例（24%）患者死亡。有血栓的患者死亡率显著更高（33%比 10%；p=0.022）。
尽管进行了抗凝治疗，但仍有很高比例的重症 2019 年冠状病毒病患者在入住 ICU 时发生血栓并发症，主要为肺血栓。血栓的检测通常是偶然的，不能通过凝血或炎症标志物预测，与死亡风险增加有关。所有需要入住 ICU 的 2019 年冠状病毒病患者都应考虑在入院时进行系统的 CT 成像。
