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dc.contributor.authorMirsadraee, Saeed
dc.contributor.authorGorog, Diana
dc.contributor.authorMahon, CF
dc.contributor.authorRawal, B
dc.contributor.authorSemple, TR
dc.contributor.authorNicol, Ed
dc.contributor.authorArachchillage, Deepa RJ
dc.contributor.authorDevaraj, A
dc.contributor.authorS, Price
dc.contributor.authorDesai, SR
dc.contributor.authorRidge, CA
dc.contributor.authorSingh, S
dc.contributor.authorPadley, SPG
dc.date.accessioned2021-01-27T00:11:38Z
dc.date.available2021-01-27T00:11:38Z
dc.date.issued2021-01-06
dc.identifier.citationMirsadraee , S , Gorog , D , Mahon , CF , Rawal , B , Semple , TR , Nicol , E , Arachchillage , D RJ , Devaraj , A , S , P , Desai , SR , Ridge , CA , Singh , S & Padley , SPG 2021 , ' Prevalence of Thrombotic Complications in ICU-Treated Patients With Coronavirus Disease 2019 Detected With Systematic CT Scanning ' , Critical Care Medicine . https://doi.org/10.1097/CCM.0000000000004890
dc.identifier.issn0090-3493
dc.identifier.urihttp://hdl.handle.net/2299/23757
dc.descriptionCopyright © by 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
dc.description.abstractObjective: Severe Coronavirus disease 2019 (COVID-19) is associated with an extensive pneumonitis, and frequent coagulopathy. We sought the true incidence of thrombotic complications in critically ill patients with severe COVID-19 on the intensive care unit (ICU), with or without extracorporeal membrane oxygenation (ECMO). Design: We undertook a single-centre, retrospective analysis of 72 critically ill patients with COVID-19 associated acute respiratory distress syndrome admitted to ICU. CT angiography of the thorax, abdomen and pelvis were performed on 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.. Setting: COVID-19 ICUs at a specialist cardiorespiratory centre. Patients: Seventy two consecutive patients with COVID-19 admitted to ICU during the study period (19/03/2020-23/06/2020). Interventions: None. Measurements and Main Results: All but one patient received thromboprophylaxis or therapeutic anticoagulation. Amongst 72 patients (M:F=74%; mean age: 52+10; 35 on ECMO), there were 54 thrombotic complications in 42 patients (58%), comprising 34 pulmonary arterial (47%), 15 peripheral venous (21%), and 5 (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 (eg. D-dimer, Fibrinogen level, APTT) or inflammation (white cell count, CRP), 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). Conclusions: There is a high incidence of thrombotic complications, mainly pulmonary, amongst COVID-19 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 COVID-19 patients requiring ICU.en
dc.format.extent398219
dc.language.isoeng
dc.relation.ispartofCritical Care Medicine
dc.titlePrevalence of Thrombotic Complications in ICU-Treated Patients With Coronavirus Disease 2019 Detected With Systematic CT Scanningen
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.contributor.institutionBasic and Clinical Science Unit
dc.contributor.institutionSchool of Life and Medical Sciences
dc.contributor.institutionDepartment of Clinical, Pharmaceutical and Biological Science
dc.description.statusPeer reviewed
dc.date.embargoedUntil2022-01-06
rioxxterms.versionofrecord10.1097/CCM.0000000000004890
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue


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