Characteristics of deep vein thrombosis in the critically ill COVID-19 patient - an observational cohort study with Doppler ultrasound measurements.

OBJECTIVE: COVID-19 is associated with an increased prevalence of deep venous thrombosis (DVT), mainly in the lower limbs. However, the characteristics and rheological conditions, which contribute to facilitating DVT occurrence have been poorly investigated. We aimed to report DVT characteristics, vein diameters and peak blood flow velocities (PBFV) in the common femoral veins (CFVs) of critically ill COVID-19 patients. PATIENTS AND METHODS: We conducted a prospective single-center cohort study in March-October 2020 including all consecutive mechanically ventilated COVID-19 adults. Doppler ultrasound of the lower limbs was performed systematically during the first week of hospitalization. In DVT-free patients, a second Doppler ultrasound was performed seven days later. Data are expressed as medians (interquartile ranges) or percentages. Comparisons were performed using Mann-Whiney and Wilcoxon signed-rank tests or Fischer's exact tests, as appropriate. RESULTS: Fifty-five patients [age, 63 years (56-74); female/male ratio, 0.62; body-mass index, 29 kg/m2 (26-33); hypertension, 47%; diabetes, 38%; ischemic heart disease, 11%] were included. DVT was diagnosed in 19 patients (35%) including in 5 femoral (9%), 2 popliteal (4%) and 12 below-the-knee sites (22%). CFV diameter was increased to 12.0 mm (11.0-15.0) (normal range, 9.1-12) and PBFV reduced to 11.9 cm/s (8.8-15.8) (normal range, 21.3-49.2) [right-side values]. In four patients who had ultrasound before intubation, CFV diameter increased from 12.5 mm (11.8-13.3) before to 14 mm (13.6-15.3) after intubation (p = 0.008). CONCLUSIONS: DVT in the CFV occurred in 9% of the critically ill COVID-19 patients with an overall 35%-DVT prevalence. Venous return difficulty evidenced by larger than normal CFV diameters and lower than normal PBFVs may have facilitated proximal DVT occurrence.

Relationship between kalemia and intensive care unit admission or death in hospitalized COVID-19 patients: A cohort study.

BACKGROUND: SARS-CoV-2 uses Angiotensin-Converting Enzyme 2 as a viral gateway to the cell and could interact with the renin-angiotensin-aldosterone system. Other studies have shown kalemia abnormalities in patients with severe forms of coronavirus disease 2019. Our goal was to assess the prognosis value of kalemia within ten days of symptom offset in the COVID-19 hospitalized population. METHODS: We analyzed data from a prospective cohort that included 65 patients with COVID-19, admitted between March 15, 2020, and March 21, 2020. The study aimed at determining the relationship between baseline kalemia and the admission to an intensive care unit (ICU) or death. RESULTS: The median age of the patients was 65 [54-79] years old, and 66.2% of the patients were men. Baseline kalemia under 3.8mmol/l occurred in 31 patients (48%), including 11 patients (35.5%) who were admitted to an ICU and one patient (3.2%) who died before ICU admission. In the primary end-point analysis, the adjusted hazard ratios for admission to an ICU or death were 3.52 [95% confidence interval (CI), 1.12 to 11.04] among patients with low baseline kalemia. CONCLUSION: Our study suggests that low kalemia levels within ten days of the first symptom onset might be associated with an increased risk of intensive care unit admission or death. The future perspective should be to better understand this relationship.

Relationship between kalemia and ICU admission or death in hospitalized COVID-19 patients: A monocentric cohort study

Introduction: Coronavirus disease 2019 (COVID-19) use Angiotensin-Converting Enzyme 2 (ACE-2) as a viral gateway and could have interactions with the RAA system. Other studies have found kalemia abnormalities associated with severe forms of COVID-19.Our goal was to assess the prognosis value of kalemia in severe COVID-19 hospitalized population. Methods: We analyzed data from a monocentric prospective observational cohort that included 65 patients PCR-confirmed positive for COVID-19 who were admitted at HEGP in Paris, between 15 to 21 March, 2020. The study aimed to determine the relationship between baseline kalemia and the primary composite outcome defined as admission to an intensive care unit (ICU) or death. Baseline kalemia was defined as the presence of a kalemia under 3.8 mmol/L within 10 days of the first symptom onset. Results: We included 65 patients with PCR COVID-19 positive test. Median age was 65 years old and 66.2% were male. Baseline kalemia under 3.8 mmol/l occurred in 31 patients (48%) including 11 patients (35.5%) who were hospitalized in ICU and 1 patient (3.2%) who died before ICU admission. In the primary end-point analysis based on multiple imputations for missing data, the adjusted hazard ratios for admission to ICU or death were 3.52 [95%(CI), 1.12 to 11.04] among patients who presented a kalemia under 3.8 mmol/L within 10 days of the first symptom onset. Moreover, we did find an adjusted association between baseline kalemia and the minimum hemoglobin level presented by the patients during the hospital stay (odds ratio, 0.80;95% CI, 0.64 to 0.99) (Fig. 1). Conclusion: Our study suggests that the presence of a kalemia under 3.8 mmol/L within 10 days of the first symptom onset might be associated with an increased risk of intensive care unit or death, and the minimum hemoglobin level presented by the patients during the hospital stay. Future intervention studies aimed for correcting this hypokalemia with ARBs to improve prognosis are ongoing.