Nur Farhani Mansor, Izzati Abdul Halim Zaki, Lee Chew Kiok, Eng Kar Seng, Tharmini Ravi, Mohan Pathmanathan, Khang Wen Goh, Long Chiau Ming, Pakhrur Razi, Hanis Hanum Zulkifly
{"title":"入住单中心重症监护病房（ICU）的COVID-19患者中血栓栓塞事件的发生率：一项来自马来西亚人群的流行病学研究。","authors":"Nur Farhani Mansor, Izzati Abdul Halim Zaki, Lee Chew Kiok, Eng Kar Seng, Tharmini Ravi, Mohan Pathmanathan, Khang Wen Goh, Long Chiau Ming, Pakhrur Razi, Hanis Hanum Zulkifly","doi":"10.1080/20523211.2024.2449044","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Thromboembolic (TE) complications in COVID-19 patients are rising globally, contributing significantly to mortality, particularly in severe cases. However, their prevalence, characteristics, and impact on mortality in Malaysia remain unclear.</p><p><strong>Objectives: </strong>This study aimed to determine the prevalence of thromboembolic (TE) events and associated mortality among COVID-19 patients admitted within a single centre intensive care unit (ICU). The proportions of patients with TE events who died, and factors associated with TE events were explored.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients with PCR confirmed SARS-CoV-2 virus and who received thromboprophylaxis within February 2020-2021 were included. TE event is a combination of venous [(deep vein thrombosis (DVT), pulmonary embolism (PE)] and arterial (myocardial infarction (MI), stroke) thromboembolism.</p><p><strong>Results: </strong>Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU stay, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. In total, 240 (44.9%) developed TE event. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%; <i>p</i> = 0.013), PE (47.5% vs 34.0%; <i>p</i> = 0.006), stroke (12.3% vs. 1.5; <i>p</i><0.001) and MI (16.4% vs. 4.6%; <i>p</i><0.001) died. Predictors of TE events were age [HR 1.01 (95% CI 1.00-1.02)], obesity [HR 1.98 (95% CI 1.51-2.6)], D-dimer [HR 1.01 (95% CI 1.00-1.01)], and duration of ICU stay [HR 0.98 (95% CI 0.97-0.99)].</p><p><strong>Conclusion: </strong>In severely ill COVID-19 patients, TE complications were common, and patients with DVT, PE, stroke, or MI faced increased mortality, even with thromboprophylaxis. Age, obesity, elevated D-Dimer levels, and longer ICU stays were significant predictors of TE events. Considering these findings, a more aggressive approach, combining thromboprophylaxis with enhanced anti-inflammatory treatments, may be necessary for high-risk COVID-19 ICU patients to reduce TE events and mortality.</p>","PeriodicalId":16740,"journal":{"name":"Journal of Pharmaceutical Policy and Practice","volume":"18 1","pages":"2449044"},"PeriodicalIF":3.3000,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800336/pdf/","citationCount":"0","resultStr":"{\"title\":\"The prevalence of thromboembolic events among COVID-19 patients admitted to a single centre intensive care unit (ICU): an epidemiological study from a Malaysian population.\",\"authors\":\"Nur Farhani Mansor, Izzati Abdul Halim Zaki, Lee Chew Kiok, Eng Kar Seng, Tharmini Ravi, Mohan Pathmanathan, Khang Wen Goh, Long Chiau Ming, Pakhrur Razi, Hanis Hanum Zulkifly\",\"doi\":\"10.1080/20523211.2024.2449044\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Thromboembolic (TE) complications in COVID-19 patients are rising globally, contributing significantly to mortality, particularly in severe cases. However, their prevalence, characteristics, and impact on mortality in Malaysia remain unclear.</p><p><strong>Objectives: </strong>This study aimed to determine the prevalence of thromboembolic (TE) events and associated mortality among COVID-19 patients admitted within a single centre intensive care unit (ICU). The proportions of patients with TE events who died, and factors associated with TE events were explored.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients with PCR confirmed SARS-CoV-2 virus and who received thromboprophylaxis within February 2020-2021 were included. TE event is a combination of venous [(deep vein thrombosis (DVT), pulmonary embolism (PE)] and arterial (myocardial infarction (MI), stroke) thromboembolism.</p><p><strong>Results: </strong>Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU stay, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. In total, 240 (44.9%) developed TE event. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%; <i>p</i> = 0.013), PE (47.5% vs 34.0%; <i>p</i> = 0.006), stroke (12.3% vs. 1.5; <i>p</i><0.001) and MI (16.4% vs. 4.6%; <i>p</i><0.001) died. Predictors of TE events were age [HR 1.01 (95% CI 1.00-1.02)], obesity [HR 1.98 (95% CI 1.51-2.6)], D-dimer [HR 1.01 (95% CI 1.00-1.01)], and duration of ICU stay [HR 0.98 (95% CI 0.97-0.99)].</p><p><strong>Conclusion: </strong>In severely ill COVID-19 patients, TE complications were common, and patients with DVT, PE, stroke, or MI faced increased mortality, even with thromboprophylaxis. Age, obesity, elevated D-Dimer levels, and longer ICU stays were significant predictors of TE events. Considering these findings, a more aggressive approach, combining thromboprophylaxis with enhanced anti-inflammatory treatments, may be necessary for high-risk COVID-19 ICU patients to reduce TE events and mortality.</p>\",\"PeriodicalId\":16740,\"journal\":{\"name\":\"Journal of Pharmaceutical Policy and Practice\",\"volume\":\"18 1\",\"pages\":\"2449044\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-02-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800336/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pharmaceutical Policy and Practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1080/20523211.2024.2449044\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"HEALTH POLICY & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pharmaceutical Policy and Practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/20523211.2024.2449044","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
引用次数: 0
摘要
在全球范围内，COVID-19患者的血栓栓塞（TE）并发症正在上升，这是导致死亡率上升的重要原因，特别是在重症病例中。然而，它们在马来西亚的流行、特征和对死亡率的影响仍不清楚。目的：本研究旨在确定在单中心重症监护病房（ICU）住院的COVID-19患者中血栓栓塞（TE）事件的发生率和相关死亡率。探讨TE事件患者死亡的比例以及与TE事件相关的因素。方法：在这项回顾性队列研究中，纳入了PCR确诊的SARS-CoV-2病毒患者，并在2020-2021年2月期间接受了血栓预防治疗。TE事件是静脉（深静脉血栓形成（DVT）、肺栓塞（PE））和动脉（心肌梗死（MI）、中风）血栓栓塞的结合。结果：平均（SD）年龄56.6（13.7）岁，男性63.5%，马来人61.6%，ICU住院时间中位数（IQR）为7（3-14）天，64.2%，53.2%和20.9%分别有潜在高血压，糖尿病和肥胖。共240例（44.9%）发生TE事件。出现DVT并发症的COVID-19患者比例明显更高(2.5% vs. 0.2%；p = 0.013), PE (47.5% vs 34.0%；P = 0.006)，卒中(12.3% vs. 1.5；结论：在重症COVID-19患者中，TE并发症很常见，即使采用血栓预防措施，DVT、PE、卒中或MI患者的死亡率也会增加。年龄、肥胖、d -二聚体水平升高和ICU住院时间较长是TE事件的重要预测因素。考虑到这些发现，对于高风险的COVID-19 ICU患者，可能需要一种更积极的方法，将血栓预防与增强的抗炎治疗相结合，以减少TE事件和死亡率。
The prevalence of thromboembolic events among COVID-19 patients admitted to a single centre intensive care unit (ICU): an epidemiological study from a Malaysian population.
Introduction: Thromboembolic (TE) complications in COVID-19 patients are rising globally, contributing significantly to mortality, particularly in severe cases. However, their prevalence, characteristics, and impact on mortality in Malaysia remain unclear.
Objectives: This study aimed to determine the prevalence of thromboembolic (TE) events and associated mortality among COVID-19 patients admitted within a single centre intensive care unit (ICU). The proportions of patients with TE events who died, and factors associated with TE events were explored.
Methods: In this retrospective cohort study, patients with PCR confirmed SARS-CoV-2 virus and who received thromboprophylaxis within February 2020-2021 were included. TE event is a combination of venous [(deep vein thrombosis (DVT), pulmonary embolism (PE)] and arterial (myocardial infarction (MI), stroke) thromboembolism.
Results: Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU stay, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. In total, 240 (44.9%) developed TE event. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%; p = 0.013), PE (47.5% vs 34.0%; p = 0.006), stroke (12.3% vs. 1.5; p<0.001) and MI (16.4% vs. 4.6%; p<0.001) died. Predictors of TE events were age [HR 1.01 (95% CI 1.00-1.02)], obesity [HR 1.98 (95% CI 1.51-2.6)], D-dimer [HR 1.01 (95% CI 1.00-1.01)], and duration of ICU stay [HR 0.98 (95% CI 0.97-0.99)].
Conclusion: In severely ill COVID-19 patients, TE complications were common, and patients with DVT, PE, stroke, or MI faced increased mortality, even with thromboprophylaxis. Age, obesity, elevated D-Dimer levels, and longer ICU stays were significant predictors of TE events. Considering these findings, a more aggressive approach, combining thromboprophylaxis with enhanced anti-inflammatory treatments, may be necessary for high-risk COVID-19 ICU patients to reduce TE events and mortality.
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