Background
Methods
Study design and setting
Outcomes
Data collection and definitions
Statistical methods
Results
Demographics and clinical characteristics
Characteristic | Study cohort | ICNARC comparator as of May 22, 2020 (n = 9026) |
---|---|---|
Age (years), median (IQR) | 57 (49–64) | 60 (51–67) |
Sex, n (%) | ||
Male | 124 (66.3) | 6403 (71.0) |
Female | 63 (33.7) | 2619 (29.0) |
Time period between symptom onset and hospital admission (days), median (IQR) | 7 (5–9) | – |
APACHE II score | ||
Mean (SD) | 13.8 (6.3) | 14.7 (5.3) |
Median (IQR) | 13 (10–13) | 14 (11–18) |
PaO2/FiO2 ratio (mmHg), median (IQR) | 135 (103–182) | 118.5 (84.7–165) |
PaO2/FiO2 ratio, n (%) | ||
< 100 mmHg (< 13.3 kPa) | 45 (24.0) | 2982 (36.8) |
100–200 mmHg (13.3–26.6 kPa) | 105 (56.1) | 3961 (48.9) |
≥ 200 mmHg (≥ 26.7 kPa) | 37 (19.8) | 1161 (14.3) |
Body mass index (kg m−2) | 28 (25–32) | – |
Categories, n (%) | ||
< 18.5 | 2 (1.1) | 56 (0.7) |
18.5 < 25 | 50 (26.7) | 2118 (25.4) |
25< 30 | 65 (34.7) | 2932 (35.1) |
30 < 40 | 53 (28.3) | 2595 (31.1) |
40+ | 14 (7.4) | 643 (7.7) |
Ethnicity, n (%) | ||
White | 141 (76.6) | 5468 (66.8) |
Asian | 19 (10.3) | 1245 (15.2) |
Black | 16 (8.7) | 797 (9.7) |
Other | 8 (4.3) | 537 (6.6) |
Co-morbidities, n (%) | ||
Hypertension | 71 (43.1) | – |
Diabetes | 54 (30.2) | – |
Ischaemic heart disease | 16 (8.4) | – |
Previous stroke | 5 (3.6) | – |
COPD or asthma | 38 (24.2) | – |
Previous PE/DVT | 7 (5.5) | – |
Malignancy | 15 (6.4) | – |
Chronic kidney disease | 12 (8.2) | – |
None | 61 (32.6) | – |
Clinical Frailty Scale, n (%) | ||
1–2 | 142 (77) | – |
3–4 | 36 (19) | – |
5+ | 7 (4) | – |
Advanced cardiovascular support, n (%) | 47 (25.1) | 2119 (28.8) |
Advanced renal support, n (%) | 80 (42.8) | 1848 (25.2) |
Respiratory support, n (%) | ||
Non-invasive ventilation | 42 (22.5) | |
Invasive ventilation | 167 (89.3) | 5330 (72.5) |
Prone position | 101 (54.0) | – |
ECMO | 5 (2.7) | – |
No. of patients with thrombotic complications, n (%) | 81 (43.3) | – |
Pulmonary embolism | 42 (22.5) | – |
Deep vein thrombosis | 22 (11.8) | – |
Arterial complications | – | |
Arterial ischaemia (peripheral or intestinal) | 12 (6.4) | – |
Cerebrovascular accident | 8 (4.3) | – |
Myocardial infarction | 5 (2.7) | – |
Extracorporeal circuit disruption | 23 (12.3) | – |
ICU outcomes, as of May 15, 2020, n (%) | ||
Died in ICU | 59 (31.6) | 3302 (44.3) |
Still alive in ICU | 33 (17.6) | – |
Discharged from ICU | 95 (50.8) | 4145 (55.7) |
Thrombotic and haemorrhagic complications
Characteristic | n = 15 |
---|---|
Age (years), median (IQR) | 60 (51–71) |
Sex, n (%) | |
Male | 14 (93.3) |
Female | 1 (6.7) |
Admission APACHE II score, median (IQR) | 14 (9–16) |
Bleeding complications, n (%) | 15 (8.0) |
Gastrointestinal | 6 (3.2) |
Intracranial | 5 (2.7) |
Other (epistaxis (n = 1), Tracheostomy (n = 1), GU (n = 2)) | 4 (2.1) |
Severity of bleeding, n (%) | |
Major | 9 (60) |
Non-major | 6 (40) |
Anticoagulation, n (%) | |
Prophylactic | 8 (53.3) |
Therapeutic | 5 (33.3) |
Data not available | 2 (13.4) |
Time interval between ICU admission and bleeding episode (days), median (IQR) | 15 (6–25) |
No. requiring red blood cell transfusion, n (%) | 7 (46.7) |
SOFA score at time of bleed, median (IQR) | 9 (5–12) |
Organ support requirement (n = 12), n | |
0–1 advanced organ support requirement | 6 |
> 1 advanced organ support requirement | 6 |
Laboratory data at time of bleeding episode (n = 12) | |
Platelet count (× 109/L), median (IQR) | 244 (163–325) |
Prothrombin time (seconds), median (IQR) | 11.3 (10.6–11.8) |
Activate partial thromboplastin time (seconds), median (IQR) | 27.2 (23.6–34.2) |
Fibrinogen (g/L), median (IQR) | 4.8 (2.8–6.3) |
ICU length of stay (days), median (IQR) | 20 (10–35) |
Mortality
Laboratory and thromoboelastography markers
Characteristic | All patients (n = 187) | Thrombotic complication (n = 81) | No thrombosis (n = 106) | p value |
---|---|---|---|---|
Age (years), median (IQR) | 57 (49–64) | 59 (53–66) | 56 (48–63) | 0.046 |
Sex, n (%) | ||||
Female | 63 (32) | 21 (26) | 42 (40) | 0.071 |
Male | 124 (68) | 60 (74) | 64 (60) | – |
APACHE II score, median (IQR) | 13 (10–13) | 14 (11–18) | 13 (9–16) | 0.594 |
ISTH DIC score, median (IQR) | 3 (2–3) | 3 (2–3) | 2 (2–3) | |
Baseline treatments (n = 185), n (%) | ||||
Prophylactic LMWH or UFH, n | 151 | 59 (31.3) | 92 (49.9) | |
Therapeutic LMWH or UFH, n | 27 | 18 (9.9) | 9 (5.0) | |
Vitamin K antagonist, n | 2 | 0 (0) | 2 (1.1) | |
Directly acting oral anticoagulant, n | 2 | 0 (0) | 2 (1.1) | |
No anticoagulant, n | 3 | 3 (1.7) | 0 | |
Laboratory parameters (approximate normal range) | ||||
Haemoglobin (g/L) (120–150) | 121.1 (20.4) | 121.2 (22.9) | 121.0 (18.2) | 0.948 |
Platelet count (×109/L) (150–400) | 241 (186–318) | 238 (179–319) | 243 (193–311) | 0.749 |
White cell count (×109/L) (4.0–11.0) | 9.18 (6.81–12.43) | 9.72 (7.82–12.64) | 8.16 (6.02–11.55) | 0.024 |
Lymphocyte count (×109/L) (1.0–4.0) | 0.80 (0.50–1.10) | 0.80 (0.50–1.10) | 0.80 (0.56–1.10) | 0.321 |
Lactate dehydrogenase | 629 (418–927) | 700 (437–1032) | 579 (415–820) | 0.096 |
Peak troponin T (ng/mL) (n = 62) | 27 (12–57) | 44 (23–66) | 18 (12–39) | 0.008 |
Peak troponin I (ng/L) (n = 103) | 14 (6–61) | 26 (9–194) | 9 (4–32) | < 0.001 |
CRP (mg/L) (0–5) | 202 (128–294) | 209 (143–300) | 187 (121–267) | 0.055 |
Ferritin (mcg/l) (10–200) | 1126 (495–1880) | 1305 (737–2301) | 886 (370–1499) | 0.008 |
Coagulation parameters | ||||
Prothrombin time (seconds) | 12.4 (11.0–14.9) | 12.0 (11.0–13.3) | 12.8 (11.0–14.36) | 0.499 |
D-dimer (ug/mL) | 2587 (950–10,000) | 6139 (1644–10,000) | 1264 (788–5535) | < 0.001 |
Fibrinogen (g/L) | 7.0 (6.0–10.0) | 6.9 (6.0–9.6) | 7.4 (6.0–10.0) | 0.441 |
Thromboelastography parameters (n = 20) (normal ranges) | n = 20 | n = 12 | n = 8 | |
R time (mins) (4.6–9.1) | 7.37 (2.45) | 7.70 (1.87) | 6.86 (3.22) | 0.094 |
CK alpha (angle) (63–78) | 75.7 (3.4) | 75.5 (3.5) | 76.1 (3.3) | 0.156 |
MA (mm) (52–69) | 69.3 (2.26) | 69.3 (1.70) | 69.4 (3.06) | 0.169 |
Platelet contribution to clot strength (%) | 64 (61–73) | 63 (53–69) | 68 (64–77) | 0.552 |
Fibrin contribution to clot strength (%) | 36 (27–39) | 37 (31–47) | 32 (23–36) | – |
Thrombodynamic ratio | 17.1 (11.5–24.6) | 14.1 (11.5–18.0) | 24.5 (13.9–24.8) | 0.201 |
LY30 (0.0–2.6) | 0.00 (0.00–0.05) | 0.00 (0.00–0.00) | 0.00 (0.00–0.48) | 0.240 |
Outcome as of 15 May 2020, n (%) | ||||
Died in ICU | 59 (31.6) | 32 (39.5) | 27 (25.5) | 0.059 |
Still alive in ICU | 33 (17.6) | 17 (21.0) | 16 (15.1) | – |
Discharged alive from ICU | 95 (50.8) | 32 (39.5) | 63 (59.4) | – |
ICU length of stay (days), median (IQR) | 15 (7–21) | 17 (11–27) | 12 (7–13) | 0.003 |