ABSTRACT
BACKGROUND:
Although an association has been made between coronavirus disease 2019 (COVID-19) and microvascular disease, data on vascular complications (other than venous thromboembolism) are sparse.
OBJECTIVE:
To investigate the vascular complications in severely ill patients hospitalized with COVID-19 and their association with all-cause mortality.
DESIGN AND SETTING:
This cohort study was conducted at the Universidade Federal de São Paulo, Brazil.
METHODS:
All 305 consecutive patients diagnosed with COVID-19 and hospitalized in the intensive care unit (ICU) of a tertiary university hospital from April 2 to July 17, 2021, were included and followed up for 30 days.
RESULTS:
Of these, 193 (63.3%) were male, and the mean age was 59.9 years (standard deviation = 14.34). The mortality rate was 56.3% (172 patients), and 72 (23.6%) patients developed at least one vascular complication during the follow-up period. Vascular complications were more prevalent in the non-survivors (28.5%) than in the survivors (17.3%) group and included disseminated intravascular coagulation (DIC, 10.8%), deep vein thrombosis (8.2%), acrocyanosis (7.5%), and necrosis of the extremities (2%). DIC (adjusted odds ratio (aOR) 2.30, 95% confidence interval (CI) 1.01–5.24, P = 0.046) and acrocyanosis (aOR 5.21, 95% CI 1.48–18.27, P = 0.009) were significantly more prevalent in the non-survivors than in the survivors group.
CONCLUSION:
Vascular complications in critically ill COVID-19 patients are common (23.6%) and can be closely related to the mortality rate (56.3%) until 30 days after ICU admission. Macrovascular complications have direct implications for mortality, which is the main outcome of the management of COVID-19.
REGISTRATION:
RBR-4qjzh7 (https://ensaiosclinicos.gov.br/rg/RBR-4qjzh7).
KEY WORDS (MeSH terms):
Mortality; COVID-19; Cohort studies; Peripheral vascular diseases; Critical care
AUTHORS’ KEY WORDS:
Vascular complications; SARS-CoV-2 infection; Retrospective analysis; 30-days follow-up
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The researchers assumed an OR of 1 for control baseline characteristics.aOR = adjusted odds ratio; N = total number of patients; n = number of events.*P < 0.05 (nominal regression multinomial logistics; IBM SPSS Statistics for Windows).
The researchers assumed an OR of 1 for control baseline characteristics.aOR = adjusted odds ratio; N = total number of patients; n = number of events.*P < 0.05 (nominal regression multinomial logistics; IBM SPSS Statistics for Windows); †disseminated intravascular coagulation, deep vein thrombosis, acrocyanosis, necrosis of extremities, acute arterial occlusion, and rhabdomyolysis.
The researchers assumed an OR of 1 for control baseline characteristics.aOR = adjusted odds ratio; N = total number of patients; n = number of events.*P < 0.05 (nominal regression multinomial logistics; IBM SPSS Statistics for Windows).
The researchers assumed an OR of 1 for control baseline characteristics.aOR = adjusted odds ratio; N = total number of patients; n = number of events.*P < 0.05 (nominal regression multinomial logistics; IBM SPSS Statistics for Windows).
FiO2 = fraction of inspired oxygen; INR = international normalized ratio; N = total number of patients; n = number of events; NR = normalized ratio; aOR, adjusted odds ratio; pCO2, partial pressure of carbon dioxide; pO2, partial pressure of oxygen.*P < 0.05 (t-test).
D0 = date of admission; D7 = day 7; D14 = day 14; D30 = day 30; NS = non-survivors; S = survivors.*Values in mg/L.