Thromboembolic complication among COVID-19 patients in the intensive care unit (ICU): a single-centre study from a Malaysian perspective

Funding Acknowledgements Type of funding sources: None. Introduction The emerging complications of thromboembolism (TE) in COVID-19 patients have led to severe consequence such as death. Nonetheless, the prevalence of TE complications among COVID-19 patients in the Intensive Care Unit (ICU) in Malaysia is unknown. Objective To investigate the prevalence of thromboembolic (TE) complications including venous [deep vein thrombosis (DVT), pulmonary embolism (PE), and line related thrombosis] and arterial [stroke, peripheral arterial disease and myocardial infarction (MI)] thrombosis and mortality among COVID-19 patients admitted to an ICU at a single centre hospital. The proportions of patients with TE complication who died, and factors associated with the occurrence of thrombotic complications were explored. Methods In this retrospective Malaysian cohort study, patients admitted to a single centre ICU with PCR confirmed of SARS-CoV-2 virus and received adequate thromboprophylaxis within February 2020-2021 were included. Thromboembolic (TE) event is a combination of venous and arterial thrombosis. Results Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU admission, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. Of 534 patients, 4 (0.7%) developed DVT, 198 (37.1%) PE and 2 (0.4%) line related thrombosis. Meanwhile, 21 (3.9%) developed stroke, 39 (7.3%) MI, 1(0.2%) PAD and 22.8% died despite adequate thromboprophylaxis. In total, 240 (44.9%) developed TE event during their ICU admission. 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. Age, duration of ICU admission, obesity, white cell count (WCC), troponin, D-Dimer and corticosteroid use were significantly greater among those with TE events. Demographics, co-morbidities, other laboratory parameters and inflammatory markers were similar in COVID-19 patients with and without TE events. Predictors of TE events on multivariate logistic regression analysis were age [OR 1.02 (95% CI 1.00-1.03)], obesity [OR 2.84 (95% CI 1.93-4.18)], WCC [OR 1.04 (95% CI 1.00-1.07)], and duration of ICU admission [OR 1.04 (95% CI 1.02-1.06)]. Conclusion In this cohort of severely ill COVID-19 patients, the overall prevalence of TE complication was high (44.9%) with the overall mortality of 22.8% despite adequate thromboprophylaxis. Key predictors of TE events included age, obesity, white cell count, and duration of ICU admission. Perhaps a more aggressive treatment (combination of thromboprophylaxis and enhanced anti-inflammatory treatment) may be needed among COVID-19 patients admitted to ICU with high risk factors to prevent further increase in the incidence of thromboembolism and death.

PERCEPTION OF DELIVERY SERVICES IN MALAYSIA DURING MOVEMENT CONTROL ORDER (MCO)

Delivery services in Malaysia has become a new norm. Malaysians are now comfortable with delivery services during the global pandemic of covid-19. This study had been conducted because there are too many issues about delivery services in Malaysia, although some people using delivery services, and some may not. Reports have suggested that some companies have a bad management of delivery services. For examples, some delivery services companies have technical issues such as (i) slow delivery, (ii) damaged goods, and many other issues. The aim of this paper is to provide an analysis on the perception of Malaysian citizen towards delivery services during the Movement Control Order (MCO). To do so, researchers used a quantitative method to collect data among Malaysian citizens. The total amount of respondents who answered the questionnaire are ii=1310. The research findings suggest that the level of perception towards delivery service in Malaysia during MCO is very high (M=3.17). (C) 2021 Published by European Publisher.

SATISFACTION LEVEL OF MALAYSIANS TOWARDS GOVERNMENT'S CRISIS MANAGEMENT PRACTICE DURING COVID-19

The whole world is alerted with the Covid-19 pandemic outbreak as it is lethal and spread easily. The government have to take quick and effective action for the crisis management and Malaysia is not excluding in taking its own action to ensure the crisis is managed well. In Malaysia, Dr Noor Hisham Abdullah, health director-general stated the international standards and World Health Organization (WHO) satisfied with the way of Malaysia's management and preparedness by enforcing the movement control order (MCO), identifying patients for testing, isolation and treatment in handling the Covid-19 outbreak. Therefore, this study is done to study on satisfaction level of Malaysians towards government's crisis management during Covid-19. This study was conducted by using random sampling technique where it involves 200 respondents from Malaysia. A structured questionnaire was used for data collection. The questionnaire of the research were divided into 4 sections consists of demographic profile, daily press conference and enforcement of Movement Control Order. For the ordinal measurement questions, Liken Scale from strongly agree, agree, neutral, disagree and strongly disagree were used. The questions, an online survey, were created in Google Forms and distributed through social media. (C) 2021 Published by European Publisher.