2026-04-18T07:52:56Zhttps://recercat.cat/oai/request

oai:recercat.cat:10459.1/4632832025-09-15T18:28:33Zcom_2072_3622col_2072_479130

Hemorrhage, Disseminated Intravascular Coagulopathy, and Thrombosis Complications Among Critically Ill Patients with COVID 19: An International COVID-19 Critical Care Consortium Study 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 Illa, Ferran Grasselli, Giacomo Zanella, Alberto Etchill, Eric Usman, Asad Ali Feth, Maximilian White, Nicole M. Suen, Jacky Y. Bassi, Gianluigi Li Peek , Giles J. Fraser, John F . Dalton, Heidi COVID-19 Extracorporeal membrane oxygenation Hemorrhage Intensive care unit Thrombosis OBJECTIVES: To determine the prevalence and outcomes associated with hem orrhage, 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) can nula 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 (me dian 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. 2023 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion https://doi.org/10.1097/CCM.0000000000005798 0090-3493 1530-0293 https://hdl.handle.net/10459.1/463283 eng Reproducció del document publicat a: https://doi.org/10.1097/CCM.0000000000005798 Critical Care Medicine, 2023, vol. 51, núm. 5, p. 619-631 cc-by (c) The Author(s), 2023 Attribution 4.0 International info:eu-repo/semantics/openAccess http://creativecommons.org/licenses/by/4.0/ Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.