.: ORİJİNAL ARAŞTIRMA
COVID-19 Yoğun Bakım Hastalarında Tromboembolik Olay Sıklığı ve Uluslararası Tromboz ve Hemostaz DerneğiYaygın Damar İçi Pıhtılaşma Skorunun Prediktif Değeri: Retrospektif Analiz
Frequency of Thromboembolic Events and Predictive Value of International Society for Thrombosis and Hemostasis Disseminated Intravascular Coagulation Score in COVID-19 Intensive Care Patients: Retrospective Analysis
Turkiye Klinikleri J Anest Reanim. 2023;21(2):39-46
doi: 10.5336/anesthe.2023-96270
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] hastalarında, hastalığın ciddiyetini belirleme ve sonucu tahmin etmede yardımcı olarak sepsis ilişkili koagülopati, Ardışık Organ Yetmezliği Skoru ve Uluslararası Tromboz ve Hemostaz Derneği [International Society for Thrombosis and Hemostasis (ISTH)] yaygın damar içi pıhtılaşma [disseminated intravascular coagulation (DIC)] skoru gibi klinik skorlama sistemleri, kullanılabilmektedir. Bu çalışmada, yoğun bakım ünitesinde yatan COVID-19 hastalarında tromboembolik olay geçirme riskini belirlemek ve ISTH DIC skorlama sisteminin bu konudaki yararlılığını araştırmak amaçlanmıştır. Gereç ve Yöntemler: Anesteziyoloji kliniği 3. düzey COVID-19 yoğun bakımlarında 1 Temmuz 2020-1 Ocak 2022 tarihleri arasında yatan tüm hasta dosyaları retrospektif olarak incelendi. Hastaların demografik özellikleri, klinik ve laboratuvar bulguları, hastanede ve yoğun bakımda yatış süreleri ve sağkalımları kaydedildi. Hastalar tromboembolik olay gelişen (tromboz grubu) ve gelişmeyen hastalar (kontrol grubu) olmak üzere 2 gruba ayrıldı. Bulgular: Çalışmaya toplamda 1172 hasta dâhil edildi. Tromboembolik olay gelişen 136 hasta vardı. En sık görülen tromboembolik olay akut koroner sendromdu. Tromboz grubunda mortalite oranı daha yüksekti (p=0,012). ISTH DIC skoru hastaların büyük çoğunluğunda 2-5 puan arasındaydı ve gruplar arasında farklılık gözlenmedi (p=0,160). Sonuç: COVID-19 enfeksiyonu nedeniyle yoğun bakımda tedavi gören hastalarda tromboembolik olay görülme insidansı yüksektir ve mortalite üzerinde etkilidir. ISTH DIC skoru, yoğun bakım ihtiyacı olan COVID-19 hastalarında tromboembolik olay gelişimini öngörmede yeterli görünmemektedir.
Anahtar Kelimeler: COVID-19; tromboembolizm; tromboz; yaygın damar içi pıhtılaşma
Amaç: Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] hastalarında, hastalığın ciddiyetini belirleme ve sonucu tahmin etmede yardımcı olarak sepsis ilişkili koagülopati, Ardışık Organ Yetmezliği Skoru ve Uluslararası Tromboz ve Hemostaz Derneği [International Society for Thrombosis and Hemostasis (ISTH)] yaygın damar içi pıhtılaşma [disseminated intravascular coagulation (DIC)] skoru gibi klinik skorlama sistemleri, kullanılabilmektedir. Bu çalışmada, yoğun bakım ünitesinde yatan COVID-19 hastalarında tromboembolik olay geçirme riskini belirlemek ve ISTH DIC skorlama sisteminin bu konudaki yararlılığını araştırmak amaçlanmıştır. Gereç ve Yöntemler: Anesteziyoloji kliniği 3. düzey COVID-19 yoğun bakımlarında 1 Temmuz 2020-1 Ocak 2022 tarihleri arasında yatan tüm hasta dosyaları retrospektif olarak incelendi. Hastaların demografik özellikleri, klinik ve laboratuvar bulguları, hastanede ve yoğun bakımda yatış süreleri ve sağkalımları kaydedildi. Hastalar tromboembolik olay gelişen (tromboz grubu) ve gelişmeyen hastalar (kontrol grubu) olmak üzere 2 gruba ayrıldı. Bulgular: Çalışmaya toplamda 1172 hasta dâhil edildi. Tromboembolik olay gelişen 136 hasta vardı. En sık görülen tromboembolik olay akut koroner sendromdu. Tromboz grubunda mortalite oranı daha yüksekti (p=0,012). ISTH DIC skoru hastaların büyük çoğunluğunda 2-5 puan arasındaydı ve gruplar arasında farklılık gözlenmedi (p=0,160). Sonuç: COVID-19 enfeksiyonu nedeniyle yoğun bakımda tedavi gören hastalarda tromboembolik olay görülme insidansı yüksektir ve mortalite üzerinde etkilidir. ISTH DIC skoru, yoğun bakım ihtiyacı olan COVID-19 hastalarında tromboembolik olay gelişimini öngörmede yeterli görünmemektedir.
Anahtar Kelimeler: COVID-19; tromboembolizm; tromboz; yaygın damar içi pıhtılaşma
ABSTRACT
Objective: Clinical scoring systems such as the sepsisassociated coagulopathy, Sequential Organ Failure Score, and International Society for Thrombosis and Hemostasis (ISTH) disseminated intravascular coagulation (DIC) score can be used to assist in determining the severity of the disease and predicting outcomes in patients with coronavirus disease-2019 (COVID-19). In this study, we aimed to determine the risk of thromboembolic events in patients with COVID-19 in the intensive care unit (ICU) and the usefulness of the ISTH DIC scoring system in this regard. Material and Methods: All patient data in the 3rd-level COVID-19 anesthesia ICUs between July 1, 2020 and January 1, 2022 were extracted. Patients' demographic, clinical, laboratory and outcome data with length of stay in the hospital and ICU were recorded. The patients were divided into two groups those who developed thromboembolic events (thrombosis group) and those who did not (control group). Results: A total of 1172 patients were enrolled in this study. There were 136 patients who had thromboembolic events. The most common thromboembolic event was acute coronary syndrome. The mortality rate was higher in the thrombosis group (p=0.012). The ISTH DIC score was between 2-5 points in the majority of patients, and there was no difference between the groups (p=0.160). Conclusion: The incidence of thromboembolic events in patients with COVID-19 in the ICU is high and effective in mortality. The ISTH DIC score does not seem sufficient to predict the development of thromboembolic events in COVID-19 patients in the ICU.
Keywords: COVID-19; thromboembolism; thrombosis; disseminated intravascular coagulation
Objective: Clinical scoring systems such as the sepsisassociated coagulopathy, Sequential Organ Failure Score, and International Society for Thrombosis and Hemostasis (ISTH) disseminated intravascular coagulation (DIC) score can be used to assist in determining the severity of the disease and predicting outcomes in patients with coronavirus disease-2019 (COVID-19). In this study, we aimed to determine the risk of thromboembolic events in patients with COVID-19 in the intensive care unit (ICU) and the usefulness of the ISTH DIC scoring system in this regard. Material and Methods: All patient data in the 3rd-level COVID-19 anesthesia ICUs between July 1, 2020 and January 1, 2022 were extracted. Patients' demographic, clinical, laboratory and outcome data with length of stay in the hospital and ICU were recorded. The patients were divided into two groups those who developed thromboembolic events (thrombosis group) and those who did not (control group). Results: A total of 1172 patients were enrolled in this study. There were 136 patients who had thromboembolic events. The most common thromboembolic event was acute coronary syndrome. The mortality rate was higher in the thrombosis group (p=0.012). The ISTH DIC score was between 2-5 points in the majority of patients, and there was no difference between the groups (p=0.160). Conclusion: The incidence of thromboembolic events in patients with COVID-19 in the ICU is high and effective in mortality. The ISTH DIC score does not seem sufficient to predict the development of thromboembolic events in COVID-19 patients in the ICU.
Keywords: COVID-19; thromboembolism; thrombosis; disseminated intravascular coagulation
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