ABSTRACT
Purpose: Coronavirus disease 2019 (COVID-19) caused by the novel SARS-CoV-2 has been a burden on healthcare systems with numerous hospital and intensive care unit (ICU) admissions, the most severe of which requiring invasive mechanical ventilation (IMV).The aim of this study is to analyze characteristics of COVID-19-related ARDS patients requiring IMV in order to determine early clinical and physiological predictors of mortality. Methods: : This is a retrospective observational cohort study carried out in the medical ICU of Farhat Hached University hospital in Sousse, Tunisia, between March 3 rd 2020 and December 31 st 2021. All consecutive patients with confirmed SARS-CoV-2 infection admitted to the ICU and requiring IMV were included. Demographic, clinical, physiological and ventilator data were collected. Univariate and multivariate cox regression models and Kaplan–Meier overall survival curves were used to identify risk factors of mortality. Results: : 732 patients were admitted to the ICU, 465(63.5%) had a confirmed COVID-19 infection, 247(53.1%) required IMV. Median [IQR] age was 67[59-74] years; and pre-ICU management delay, 4[3-7] days. 149(60.3%) were on standard oxygenation; High-Flow Nasal Oxygen, 20(8.1%); Non-Invasive Positive Pressure Ventilation, 56(22.7%) and already on IMV, 15(6.1%). SAPS II, 31[27-37]; P/F ratio, 96[76.3-139.8]. At day1 of IMV, tidal volume, 6.5[6-7] ml; PEEP, plateau and driving pressures, respectively, 10[8-10], 27[24-28] and 16[14-19] cmH2O; P/F ratio, 126.3[90.3-170.8]; ventilatory ratio, 2.36±0.89 and mechanical power, 36.0[29.3-45.2] J/min. Median length of stay, 12[7-17] days and median IMV duration, 8[5-12] days. Mortality rate, 84.6%. Early independent factors predicting mortality were age, pre-ICU management delay and ventilatory ratio at day1 of IMV. Conclusion: In invasively ventilated COVID-19-related ARDS patients, older age, longer pre-ICU management delay and higher ventilatory ratio at day1 of invasive mechanical ventilation, were independent risk factors of mortality.
Subject(s)
COVID-19ABSTRACT
The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak from December 2019 causing millions of deaths all over the world and the lack of specific treatment for severe forms of coronavirus disease 2019 (COVID-19) has led to vaccines development in record time with emergency use authorization in several countries increasing the risk of vaccine safety issues. Recently, several cases of Thrombotic Thrombocytopenic Purpura (TTP) have been reported following COVID-19 vaccination. TTP represents a life-threatening consumptive coagulopathy requiring urgent diagnosis and prompt treatment. It is a rare disease characterized by thrombocytopenia, microangiopathic hemolytic anemia and ischemic end-organ lesions. It can be either congenital or acquired. Various events such viral infections, medication, pregnancy, malignancies, and vaccinations may cause TTP. Clinicians should consider this diagnosis when evaluating thrombocytopenia in the post-vaccine period. Here, we report two cases of acquired TTP following Sinopharm COVID-19 vaccine (BBIBP-CorV) and Sinovac COVID-19 vaccine (CoronaVac). Diagnosis was based on clinical presentation and confirmed with severe reduction in the activity of von Willebrand factor-cleaving protease ADAMTS-13 and the presence of inhibitory autoantibodies. The two patients were successfully treated with corticosteroids, plasma exchange therapy and rituximab in the acute phase. In the literature, the reported cases of TTP induced by COVID-19 vaccination occurred after Adenoviral Vector DNA- and SARS-CoV-2 mRNA-Based COVID-19 Vaccines. To the best of our knowledge, this is the first report of acquired TTP after inactivated virus COVID-19 vaccines. A short literature review regarding acquired TTP patients following COVID-19 vaccines is also included.