MORTALITY AND PREVALENCE OF THROMBOEMBOLISM IN ICU PATIENTS WITH SARS-COV-2, IMPLICATIONS FOR CLINICAL PRACTICE FROM A SINGLE CENTER RETROSPECTIVE OBSERVATIONAL STUDY.

Andrea Tinnirello MD, FIPP*, Carola Santi MD and Paolo Gnesin MD

ABSTRACT

Introduction: in March 2019 Italian ICUs faced an enormous amount of COVID-19 related respiratory failures, we report patients’ characteristics, mortality and incidence of thromboembolic events in a single ICU. We investigated whether mortality and thromboembolism were associated with severity scores, respiratory parameters, inflammatory and coagulation markers. Materials and Methods: retrospective observational analysis of 56 ICU patients with COVID-19 respiratory failure. Data were retrieved from patients’ medical records. Results: ICU mortality was 42,8%. Severe hypoxemia was noted on admission with a median pO2/FiO2 of 8934. Higher levels of PEEP at ICU admission (144 in non survivors vs 112 cmH20 in survivors) and at day 7 (135 vs 94 cmH20) were associated with higher mortality rate (p<0.01). Thromboembolic events were detected in 33,9% of patients. D-Dimer levels were increased at admission and at day 7 (49778695 and 35745216 respectively), however, no statistically significant association was found between D-Dimer levels and mortality or thromboembolism rate. LMWH prophylaxis < 100U.I/Kg/day resulted in a tendency towards increased mortality. Conclusions: COVID-19 showed a high mortality rate in ICU patients. Higher levels of PEEP were associated with worse outcome.Thromboembolism is common and patients require higher dosages of LMWH compared to those commonly used in ICU units for DVT prophylaxis. D-Dimer levels were constantly elevated, but no specific predictor of thromboembolism was identified.

Keywords: ARDS; COVID19; Sars; Pneumonia; Thrombosis; coagulation; Heparin.