Arterial thromboembolism (ATE) and mortality among COVID-19 patients in the intensive care unit (ICU): prevalence and risk factors

Objective: To investigate the prevalence of arterial thromboembolic (TE) complications including stroke, peripheral arterial disease (PAD) and myocardial infarction (MI) and mortality among COVID-19 patients admitted to an ICU at a single centre hospital in the area of Klang Valley, Malaysia. The proportions of patients with ATE complication who died, and factors associated with the occurrence of ATE were explored. Method(s): 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 in this retrospective Malaysian cohort study. ATE event is a combination of >=1 stroke, PAD and MI. Result(s): 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, 21 (3.9%) developed stroke, 39 (7.3%) MI, 1(0.2%) PAD and 22.8% died despite adequate thromboprophylaxis. In total, only 58 (10.9%) developed ATE event during their ICU admission. Significantly higher proportions of COVID-19 patients admitted to ICU who developed complications of 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, proportion of underlying hypertension, stroke, IHD, diabetes, kidney disease, troponin, D-Dimer were significantly greater among those with ATE events. Predictors of ATE event on multivariate logistic regression analysis were duration of ICU admission [OR 1.0 (95% CI 1.00-1.04)] and troponin [OR 1.3 (95% CI 1.1-1.4)] level. Conclusion(s): The overall prevalence of ATE complication among the severely ill COVID-19 patients was low (10.9%) with the overall mortality of 22.8% despite adequate thromboprophylaxis. Key predictors of ATE events included increased troponin level and duration of ICU admission. Perhaps a more aggressive preventive strategies can be undertaken to prevent further increase in the prevalence of arterial thromboembolism and death.

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

Introduction: The emerging complications of thromboembolism (TE) in COVID-19 patients have led to severe consequences such as death. Nonetheless, the prevalence of TE complications among COVID-19 patients in the Intensive Care Unit (ICU) in Malaysia is unknown. The aim of this study is 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 in Hospital Sungai Buloh. Material(s) and Method(s): In this retrospective Malaysian cohort study, patients admitted to a single centre ICU with polymerase chain reaction (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. Result(s): 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, comorbidities, 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(s): 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.

COVID-19 mortality rate during period of delta and omicron predominance in Malaysia: A descriptive study

Introduction: COVID-19 was the most feared infectious disease in the last few years which caused a high number of mortalities. Hospital Sungai Buloh was the main COVID-19 referral centre since the pandemic started. A large database of COVID-19 patients was available for this study and used to describe the rate of mortality among patients who were 40 years and above;who were admitted to Hospital Sungai Buloh during periods of Delta and Omicron predominance. Material(s) and Method(s): Medical records of COVID-19 patients who were admitted in Hospital Sungai Buloh during the period of Delta and Omicron predominance were reviewed retrospectively and analyzed. Result(s): Patient mortality during the period of Delta predominance from May-July 2021 (755 patients) was higher com[pared to the period of Omicron predominance from January-April 2022 (180 cases). Majority of the deceased patients were male (59.1%). Conclusion(s): This descriptive study serves as a baseline research for more studies in future using the same dataset. More data cleaning is required to produce more results.

COVID-19 category during period of delta and omicron predominance in Malaysia: A descriptive study

Introduction: During the COVID-19 pandemic, numerous variants of SARS-CoV-2 have emerged that have been found to differ in transmissibility and severity. Assessments of the severity of the SARS-CoV-2 delta and omicron variant are vital to evaluate the public health influence related to its rapid global dissemination. Material(s) and Method(s): Medical records of COVID-19 patients who were hospitalized in Hospital Sungai Buloh during the period of Delta and Omicron predominance were reviewed retrospectively and analyzed. Result(s): Delta wave was studied between May 2021 and July 2021, among the 5815 individuals with SARS-CoV-2 infection, the highest number of cases were seen in May which was 2410 (41.4%) cases followed by 1762 (30.3%) in June and 1643 (28.2%) cases in July. Individuals were vaccinated, and vaccination was associated with a lower risk of hospitalization compared with cases with no doses or only one dose of vaccine. Compared with delta infection, omicron infection was lesser. The Omicron wave was studied between January 2022 and March 2022. Among the 2820 individuals with SARS-CoV-2 infection, the highest number of cases were seen in March which was 1173 (41.5%), followed by 985 (34.9%) cases in February and 662 (23.4%) cases in January. The booster vaccine was started to be administered during this period and reduced equally the risk of symptomatic and asymptomatic infection. Conclusion(s): This descriptive study aids as a baseline study for more studies in the future using the same dataset. Laborious data cleaning is currently in the process to produce more forceful and steadfast results.

COVID-19 hospitalisation during period of delta and omicron predominance in Malaysia: A descriptive study

Introduction: Hospital Sungai Buloh is the main COVID-19 referral centre since the pandemic started. Having a large database of COVID-19 patients, this study describes the demographic characteristics of patients who were admitted to Hospital Sungai Buloh during periods of Delta and Omicron predominance. Material(s) and Method(s): Medical records of COVID-19 patients who were hospitalized in Hospital Sungai Buloh during the period of Delta and Omicron predominance were reviewed retrospectively and analyzed. Result(s): Patient admissions during the period of Delta predominance from May-July 2021 (5815 patients) are higher than during the period of Omicron predominance from January-April 2022 (3144 subjects). Among 8959 COVID-19 patients, 55.6% of them were in the age group 60-79 years old (4977 patients). Majority were male (50.7%), Malaysian (98.5%) and diagnosed as Category 4 COVID-19 upon admission (48.6%). A total of 935 (10.4%) patients died during hospitalisation. Conclusion(s): This descriptive study serves as a baseline research for more studies in future using the same dataset. Rigorous data cleaning is currently being performed to produce more robust and reliable results.

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.