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Skin Failure Among Critically Ill Patients Afflicted with Coronavirus Disease 2019 (COVID-19).
Greenway, Andrew; Leahy, Nicole; Torrieri, Lisa; An, Anjile; Fink, Sarah A; Witenko, Corey; Shikar, Morgan; Winchell, Robert J; Barie, Philip S; Liu, Susan I.
  • Greenway A; 159947NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
  • Leahy N; 159947NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
  • Torrieri L; 159947NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
  • An A; Weill Cornell Medicine, New York, NY.
  • Fink SA; 159947NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
  • Witenko C; 159947NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
  • Shikar M; 159947NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
  • Winchell RJ; Weill Cornell Medicine, New York, NY.
  • Barie PS; Weill Cornell Medicine, New York, NY.
  • Liu SI; 159947NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.
J Intensive Care Med ; 36(11): 1331-1339, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1443734
ABSTRACT

Objective:

To characterize skin integrity among coronavirus disease 2019 (COVID-19) patients treated in the intensive care unit (ICU), and identify risk factors for skin failure (SF) in these patients.

Design:

The characteristic, profound pro-inflammatory, hypercoagulable state of COVID-19 is manifested by the high severity of illness and extensive organ dysfunction observed in these patients. SF in critically ill patients, although described previously, exhibits a uniquely complex pathogenesis in this population. Patients Retrospective review of all COVID-19 patients (confirmed positive for severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) admitted to a single surgical ICU for at least 48 hours between March-June 2020.

Interventions:

Data were extracted from a COVID-19 institutional data repository that harvested data from electronic health records and other clinical data sources. Demographics; coagulation/inflammation biomarkers; number, location, and stage of SF lesions; resource utilization; and outcomes were captured. Measurements and Main

Results:

64 patients met inclusion criteria; 51 (80%) developed SF (SF+ ). Forty-three (85%) developed stage 3 or higher SF (χ2 = 22.66, P < .0001). Thirty-nine of 51 (76%) SF+ patients developed more than one SF lesion (χ2 = 13.26, P = .0003). SF+ patients manifested a profound pro-inflammatory, hypercoagulable phenotype (lower serum albumin and higher ferritin, interleukin [IL]-6 and D-dimer concentrations [all, P < .001]). Durations of mechanical ventilation, vasopressor therapy, and ICU length of stay were significantly longer (all, P < .05) in the SF + patients.

Conclusions:

The unique characteristics of COVID-19 dermatopathology and the strong correlation between markers of inflammation and development of SF reflect COVID-19-related organ dysfunction and its deleterious effects on the microcirculation. Considering that skin is invaded directly by SARS-CoV-2 and affected by COVID-19-related immune complex deposition and microthrombosis, SF may reflect disease as opposed to pressure injuries related to processes of care. In the context of COVID-19 critical illness, SF should not be considered a "never event."
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / COVID-19 Type of study: Observational study / Prognostic study Limits: Humans Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2021 Document Type: Article