Frequency of Thrombosis in Covid-19 Patients Compared to Non-Covid-19 Sepsis Patients Admitted to the Intensive Care Unit

Abstract

The COVID-19 pandemic to date is responsible for 6.39 million deaths and has devastated economies and healthcare infrastructure worldwide. In mid-January 2021 in the United States, more than 28,000 Covid-19 patients were admitted to the intensive care unit (ICU) at a given time. Systemic activation of coagulation may be a part of the pathophysiology of COVID-19. Numerous studies have demonstrated that the hypercoagulable state associated with COVID-19 infection may be associated with adverse outcomes and mortality. Historically, studies have also demonstrated high rates of thrombotic events among patients with sepsis. Whether the associated increase in thrombotic events results from COVID-19 specific infection or a general severe infection response is unknown. Understanding the relative contribution of venous thromboembolism (VTE) in COVID-19 severe disease helps risk stratify and clarify thromboembolism management from sepsis guidelines. Moreover, different VTE rates may indicate COVID-19-specific mechanisms warranting further investigation. To delineate the role of VTE in COVID-19 ICU admission and outcomes and to elucidate the pathophysiology of COVID-19 hypercoagulability, we evaluated the rate of thrombotic events across ICU patients with COVID-19 disease and compared the rate with all patients with non-COVID-19 sepsis or septic shock. This retrospective cohort study was approved by the USF Institutional Review Board. A chart review was performed of patients 18 years or older admitted to the ICU at Tampa General Hospital between January 1, 2020, to December 31, 2020, with a diagnosis of COVID-19 or sepsis secondary to other organisms. Sepsis criteria was defined as non-Covid-19 systemic infection and at least two of the following: 1) Temperature >38C or <36C; 2) heart rate >90 3) respiratory rate >20 or PaCO2<32; 4) WBC >12,000 or <4000, or >10% bands. Patients' data were collected, including age, body mass index (BMI), malignancy, heart failure, respiratory failure, rheumatologic disorders, diabetes mellitus type 2 (DM2), and history of hypercoagulable events and incidence of a thrombotic event. Our study evaluated 2,752 patients admitted to the ICU. We found no statistically significant difference in the thrombotic event incidence in COVID-19 patients in the ICU [n=540] compared to non-COVID-19 patients [n=2,212] (15.6 % versus 18.2%, p-value 0.15). Based on these results, further study is required to lower the rate of VTE in COVID-19 and non-COVID-19 sepsis patients admitted to the ICU. It is reasonable to consider similar thromboembolism guidelines between COVID-19 and sepsis. However, comparing additional ICU outcomes such as mortality rates and length of stay is warranted.