ABSTRACT
SARS-CoV-2 entered the world by storm when it made its appearance at the end of 2019 in Wuhan, China. The severity can range from asymptomatic infection, which occurs in approximately 33% of infected patients, to death. Worldwide deaths due to SARS-CoV-2 are currently approximated at 3.8 million people with close to 600,000 deaths in the United States alone, reiterating the significant impact this virus has on the population. SARS-CoV-2 can affect systems of the body such as respiratory, gastrointestinal tract, neurological, cardiac, renal, and even skeletal muscle tissue. A few cases of rhabdomyolysis are reported in SARS-CoV-2 infection, but the significant level of creatinine kinase in the hundreds of thousands is rare. Our case demonstrates the rarity of SARS-CoV-2 manifestation in a 33-year-old African American male with severe rhabdomyolysis with a creatinine kinase on the admission of 362,445 IU/L. The patient was treated aggressively with intravenous fluids, monitoring electrolytes, renal function, and respiratory status closely. His management includes liberal administration of fluid to treat his rhabdomyolysis, without compromising his respiratory status. He was subsequently discharged home after seven days of hospitalization. We strive to share this information in hopes to share our management for future similar cases.
ABSTRACT
BACKGROUND: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality. METHODS: A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions. RESULTS: Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users. CONCLUSIONS: Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.