2019冠状病毒疾病危重症与重症患者合并心律失常的心电图分析

目的:分析2019冠状病毒疾病(COVID-19)危重症和重症患者心律失常的发生情况。方法:回顾性分析COVID-19危重症(117例)和重症(311例)患者的临床资料,比较2组患者心律失常发生情况、血浆氨基末端B型脑钠肽(NT-proBNP)、心肌肌钙蛋白I(c Tn I)、血氧饱和度(Sp O2)、D-二聚体及超敏C反应蛋白(hs-CRP)水平等。采用单因素和多因素logistic回归分析,研究COVID-19患者发生心律失常的相关因素。结果:COVID-19患者心律失常发生率43. 9%,最常见的心律失常依次为:窦性心动过速、右束支阻滞、心房扑动或心房颤动、窦性心动过缓及房性早搏;危重症组与重症组患者中窦性心动过速、心房扑动或心房颤动、房性早搏的发生率比较,差异有统计学意义(P 0. 05或P 0. 01)。单因素logistic回归分析显示:高血压、Sp O2≤93%、c Tn I、NT-proBNP、D-二聚体及hs-CRP水平升高、危重症与COVID-19患者发生窦性心动过速相关(P均0. 05)。年龄、脑卒中、Sp O2≤93%、c Tn I、NT-proBNP、D-二聚体水平升高、危重症与COVID-19患者发生心房扑动或心房颤动相关(P均0. 05)。多因素logistic回归分析显示:高血压、c Tn I水平升高、危重症是COVID-19患者发生窦性心动过速的独立相关因素(P均0. 05);年龄、NT-proBNP水平升高是COVID-19患者发生心房扑动或心房颤动的独立相关因素(P均0. 05)。结论:COVID-19患者易发生心律失常,常见心律失常为窦性心动过速、心房扑动或心房颤动。心肌损伤、高血压病史及危重症是引起COVID-19患者发生窦性心动过速的主要原因;年龄及NT-proBNP水平升高是COVID-19患者发生心房扑动或心房颤动的主要原因。     

Thromboelastography findings in critically ill COVID-19 patients

Journal of Thrombosis and Thrombolysis - The rate of venous and arterial thrombotic events among patients infected with severe acute respiratory syndrome coronavirus-2 (SAR-CoV-2) is high. This may...     

Evaluation of coagulation status using clot waveform analysis in general ward patients with COVID-19

Journal of Thrombosis and Thrombolysis - Coronavirus disease (COVID-19)-related systemic cytokine response induces the production of procoagulant factors, which predisposes patients to a...     

DVT incidence and risk factors in critically ill patients with COVID-19

Journal of Thrombosis and Thrombolysis - Few data are available on the incidence of deep vein thrombosis (DVT) in critically ill COVID-19 with thrombosis prophylaxis. This study retrospectively...     

凝血功能异常对新冠肺炎重症患者的预后意义

目的分析新型冠状病毒肺炎(corona virus disease 2019, COVID-19)患者凝血功能的临床特征,及其对重症化的预测和预后意义。 方法收集2020年2月至4月在武汉泰康同济医院确诊的COVID-19患者356例的凝血功能指标,分析其与COVID-19重症化、预后的关联。 结果356例患者入院时,普通型200例,重型118例,危重38型例。出院时,普通型190例,重型107例,危重型59例。患者凝血酶原时间(prothrombin time, PT)越长、D二聚体越高(D-dimer, DD)D-二聚体越高(D-dimer, D-dimer)、血小板计数越低,诊断为重型和危重型的概率越高(P<0.05)。年龄显著影响重症化(P<0.05,OR＝1.054),年龄每增加1,重症化概率提升0.054倍。PT能显著影响重症化(P<0.05,OR＝1.245),PT每提升1,重症化概率提升0.245倍。 结论高龄、心血管系统基础疾病、PT延长、D二聚体升高,是COVID-19患者重症化的高危因素和预测、预后重要因素。     

Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia

Journal of Thrombosis and Thrombolysis - Critically ill patients with COVID-19 pneumonia suffered both high thrombotic and bleeding risk. The effect of SARS-CoV-2 on coagulation and fibrinolysis is...     

Profile of natural anticoagulant,coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients

Journal of Thrombosis and Thrombolysis - The outbreak of novel coronavirus disease 2019 (COVID-19) has now become a global pandemic. Coagulopathy has been reported widely in critically ill COVID-19...     

Treatment limitations and clinical outcomes in critically ill frail patients with and without COVID-19 pneumonitis

Background

The presence of treatment limitations in patients with frailty at intensive care unit (ICU) admission is unknown. We aimed to evaluate the presence and predictors of treatment limitations in patients with and without COVID-19 pneumonitis in those admitted to Australian and New Zealand ICUs.

Methods

This registry-based multicenter, retrospective cohort study included all frail adults (≥16 years) with documented clinical frailty scale (CFS) scores, admitted to ICUs with admission diagnostic codes for viral pneumonia or acute respiratory distress syndrome (ARDS) over 2 years between January 01, 2020 and December 31, 2021. Frail patients (CFS ≥5) coded as having viral pneumonitis or ARDS due to COVID-19 were compared to those with other causes of viral pneumonitis or ARDS for documented treatment limitations.

Results

884 frail patients were included in the final analysis from 129 public and private ICUs. 369 patients (41.7%) had confirmed COVID-19. There were more male patients in COVID-19 (55.3% vs 47.0%; p = 0.015). There were no differences in age or APACHE-III scores between the two groups. Overall, 36.0% (318/884) had treatment limitations, but similar between the two groups (35.8% [132/369] vs 36.1% [186/515]; p = 0.92). After adjusting for confounders, increasing frailty (OR = 1.72; 95%-CI 1.39–2.14), age (OR = 1.05; 95%-CI 1.04–1.06), and presence of chronic respiratory condition (OR = 1.58; 95%-CI 1.10–2.27) increased the likelihood of instituting treatment limitations. However, the presence of COVID-19 by itself did not influence treatment limitations (odds ratio [OR] = 1.39; 95%-CI 0.98–1.96).

Conclusions

The proportion of treatment limitations was similar in patients with frailty with or without COVID-19 pneumonitis at ICU admission.     

Lipoprotein-complexed C-reactive protein and the biphasic transmittance waveform in critically ill patients

The 'biphasic transmittance waveform' (BTW) refers to a decrease in light transmittance that often occurs prior to clotting in coagulation assays of critically ill patient plasmas. It correlates with disseminated intravascular coagulation and mortality. The present work shows that the BTW is due to the rapid formation of a precipitate and a coincident change in turbidity in re-calcified plasma. The precipitate was isolated from patient plasma and contained lipids typical of very low density lipoprotein (VLDL), plus the proteins apolipoprotein B-100 and C-reactive protein (CRP). Precipitation also occurred in normal plasma supplemented with CRP. In addition, CRP precipitated with VLDL and intermediate density lipoprotein, but not low density lipoprotein or high density lipoprotein. The Kd value for the CRP/VLDL interaction is 340 nM. The IC50 value of Ca2+ for complex formation is 5.0 mM, and epsilon-aminocaproic acid inhibits the process. In 15 plasmas with the BTW from critically ill patients, CRP was highly elevated (77-398 microg/mL) and VLDL cholesterol ranged from 0.082 to 1.32 mM. The magnitude of the turbidity change on re-calcification correlated well with the calculated level of the CRP/VLDL complex. Thus, the Ca2+-dependent formation of a complex between CRP and VLDL accounts for the BTW.     

COVID-19: the role of excessive cytokine release and potential ACE2 down-regulation in promoting hypercoagulable state associated with severe illness

Journal of Thrombosis and Thrombolysis - The novel coronavirus disease (COVID-19) has become a universally prevalent infectious disease. The causative virus of COVID-19 is severe acute respiratory...