scholarly journals Comparison of deep vein thrombosis risks in acute respiratory distress syndrome Caused by COVID-19 and Bacterial Pneumonia: A Retrospective Cohort Study

2022 ◽  
Author(s):  
Na Cui ◽  
Chunguo Jiang ◽  
Chenlu Yang ◽  
Liming Zhang ◽  
Xiaokai Feng
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Cohort Study ◽  
Deep Vein Thrombosis ◽  
Respiratory Distress Syndrome ◽  
Retrospective Cohort ◽  
Bacterial Pneumonia ◽  
Distress Syndrome ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Abstract Background: High incidence of deep vein thrombosis (DVT) has been observed in patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 and those by bacterial pneumonia. However, it is also important to differentiate between these two groups of patients. Study Design and Methods: We performed a retrospective cohort study to investigate the difference of DVT between the two independent cohorts of ARDS and eventually enrolled 240 patients, 105 of whom with ARDS caused by COVID-19 and 135 by bacterial pneumonia. We analyzed demographics and clinical characteristics for patients with and without DVT in these two cohorts and explored the main differences and similarities between them.Results: The 28-days incidence of DVT in COVID-19 cohort was higher than that in bacterial pneumonia cohort (57.1% vs 41.5%, P=0.016). Taking death as competitive risk, Fine-Gray test showed no significant difference in 28-day cumulative incidence of DVT between these two groups (P=0.220). Fine-Gray competing risk analysis showed an association between CK (creatine kinase isoenzyme)-MB levels, PaO2 (partial pressure of arterial oxygen)/FiO2 (fraction of inspired oxygen) ratios, D-dimer levels and DVT in COVID-19 cohort and an association between serum creatinine levels, IMV, and DVT in bacterial pneumonia cohort. The sensitivity and specificity of corresponding receiver operating characteristic curve originating from the combination of CK-MB levels, PaO2/FiO2 ratios and D-dimer levels ≥ 0.5 µg/mL was not inferior to those of the Padua prediction score and the Wells score for screening for DVT in COVID-19 cohort.Conclusions: Compared with patients with ARDS caused by bacterial pneumonia, the incidence of DVT is higher by logistic model in patients with ARDS caused by COVID-19, and the risk factors for DVT are completely different. Our novel prediction model can aid early identifying patients with high risk for DVT.

scholarly journals Deep vein thrombosis in acute respiratory distress syndrome caused by bacterial pneumonia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Cui ◽  
Song Mi ◽  
Chunguo Jiang ◽  
Wanlu Sun ◽  
Wenping Mao ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Deep Vein Thrombosis ◽  
Serum Creatinine ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Bacterial Pneumonia ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by acute hypoxaemia, and few studies have reported the incidence of deep vein thrombosis (DVT) in direct ARDS caused by bacterial pneumonia. We performed a study to evaluate the prevalence, risk factors, prognosis and potential thromboprophylaxis strategies of DVT in these patients. Methods Ninety patients were included. Demographic, and clinical data, laboratory data and outcome variables were obtained, and comparisons were made between the DVT and non-DVT groups. Results Of the 90 patients, 40 (44.4%) developed lower extremity DVT. Compared with non-DVT patients, DVT patients had higher systemic inflammatory response syndrome (SIRS) scores, lower serum creatinine levels, higher D-dimer levels, and higher rates of sedative therapy and invasive mechanical ventilation (IMV). Multivariate analysis showed an association between the SIRS score (OR 3.803, P = 0.027), level of serum creatinine (OR 0.988, P = 0.001), IMV (OR 5.822, P = 0.002) and DVT. The combination of SIRS score, serum creatinine level and IMV has a sensitivity of 80.0% and a specificity of 74.0% for screening for DVT. The survival rate within 28 days after ARDS in the DVT group was significantly lower than that in the non-DVT group (P = 0.003). There was no difference in the prevalence of DVT between the 41 patients who received thromboprophylaxis and the 49 patients who did not receive thromboprophylaxis (41.5% vs 46.9%; P = 0.603). Conclusions The prevalence of DVT is high in hospitalized patients with direct ARDS caused by bacterial pneumonia and may be associated with adverse outcomes. The current thromboprophylaxis strategies may need to be further optimized.

scholarly journals Prevalence, Risk, and Outcome of Deep Vein Thrombosis in Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Na Cui ◽  
Chunguo Jiang ◽  
Hairong Chen ◽  
Liming Zhang ◽  
Xiaokai Feng
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Deep Vein Thrombosis ◽  
Serum Creatinine ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Distress Syndrome ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background: Few data exist on deep vein thrombosis (DVT) in patients with acute respiratory distress syndrome (ARDS), a group of heterogeneous diseases characterized by acute hypoxemia.Study Design and Methods: We retrospectively enrolled 225 adults with ARDS admitted to the Beijing Chao-Yang Hospital and the First Affiliated Hospital of Shandong First Medical University between 1 January 2015 and 30 June 2020. We analyzed clinical, laboratory, and echocardiography data for groups with and without DVT and for direct and indirect ARDS subgroups.Results: Ninety (40.0%) patients developed DVT. Compared with the non-DVT group, patients with DVT were older, had lower serum creatinine levels, lower partial pressure of arterial oxygen/fraction of inspired oxygen, higher serum procalcitonin levels, higher Padua prediction scores, and higher proportions of sedation and invasive mechanical ventilation (IMV). Multivariate analysis showed an association between age, serum creatinine level, IMV, and DVT in the ARDS cohort. The sensitivity and specificity of corresponding receiver operating characteristic curves were not inferior to those of the Padua prediction score and the Caprini score for screening for DVT in the three ARDS cohorts. Patients with DVT had a significantly lower survival rate than those without DVT in the overall ARDS cohort and in the groups with direct and indirect ARDS.Conclusions: The prevalence of DVT is high in patients with ARDS. The risk factors for DVT are age, serum creatinine level, and IMV, which predict DVT and are not inferior to the Padua prediction score and the Caprini score. DVT is associated with decreased survival in patients with ARDS.

scholarly journals Prevalence, Risk, and Outcome of Deep Vein Thrombosis in Acute Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Na Cui ◽  
Chunguo Jiang ◽  
Hairong Chen ◽  
Yuan Gao ◽  
Lifeng Yu ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Deep Vein Thrombosis ◽  
Serum Creatinine ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Distress Syndrome ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background: Few data exist on deep vein thrombosis (DVT) in patients with acute respiratory distress syndrome (ARDS), a group of heterogeneous diseases characterized by acute hypoxemia.Study Design and Methods: We retrospectively enrolled 225 adults with ARDS admitted to the Beijing Chao-Yang Hospital and the First Affiliated Hospital of Shandong First Medical University between 1 January 2015 and 30 June 2020. We analyzed clinical, laboratory, and echocardiography data for groups with and without DVT and for direct and indirect ARDS subgroups.Results: Ninety (40.0%) patients developed DVT. Compared with the non-DVT group, patients with DVT were older, had lower serum creatinine levels, lower partial pressure of arterial oxygen/fraction of inspired oxygen, higher serum procalcitonin levels, higher Padua prediction scores, and higher proportions of sedation and invasive mechanical ventilation (IMV). Multivariate analysis showed an association between age, serum creatinine level, IMV, and DVT in the ARDS cohort. The sensitivity and specificity of corresponding receiver operating characteristic curves were not inferior to those of the Padua prediction score and the Caprini score for screening for DVT in the three ARDS cohorts. Patients with DVT had a significantly lower survival rate than those without DVT in the overall ARDS cohort and in the groups with direct and indirect ARDS.Conclusions: The prevalence of DVT is high in patients with ARDS. The risk factors for DVT are age, serum creatinine level, and IMV, which predict DVT and are superior to the Padua prediction score and the Caprini score. DVT is associated with decreased survival in patients with ARDS.

scholarly journals A Retrospective cohort study on the risk factors of deep vein thrombosis (DVT) for patients with traumatic fracture at Honghui Hospital

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e024247 ◽  
Author(s):  
Wenjuan Zhang ◽  
Ying Huai ◽  
Wei Wang ◽  
Kaiyue Xue ◽  
Lei Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Deep Vein Thrombosis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Laboratory ◽  
Vein Thrombosis ◽  
Traumatic Fracture ◽  
Deep Vein ◽  
D Dimer

ObjectiveTo explore the risk factors of perioperative deep vein thrombosis (DVT) in patients with traumatic fracture after orthopaedic surgery and their potential diagnostic values in clinical.DesignRetrospective cohort study.SettingClinical Laboratory of Honghui Hospital, Xi’an JiaoTong University College of Medicine, Xi’an, Shaanxi, China.Materials and methodsA retrospective cohort study was conducted with surgically treated fracture patients in Honghui Hospital from 1 May 2016 to 31 February 2017.χ2test, independent sample t test and regression analysis were applied to examine the correlation between perioperative DVT and the factors of preoperative time, fracture sites, D-dimer value and chronic diseases (hypertension, diabetes and coronary disease).Results462 patients were enrolled for analysis. The preoperative time of patients with DVT was significantly longer than that of non-DVT patients (7.14±5.51 vs 5.45±3.75) (P<0.01).χ2test showed the significant differences in the rate of DVT among patients with different fracture sites (P<0.01). By the receiver-operating characteristic curve analysis, the cut-off value of preoperative D-dimer and postoperative D-dimer in diagnosing perioperative DVT was 4.01 µg/mL and 5.03 µg/mL, respectively. Area under the curve was 0.593 (95% CI 0.533 to 0.652) and 0.728 (95% CI 0.672 to 0.780), respectively. The sensitivity and specificity of preoperative D-dimer for DVT diagnosis were 71.30% and 44.83%, and as for postoperative D-dimer were 63.90% and 70.51%.ConclusionsFracture site was correlated to the incidence of DVT; prolonged preoperative time and increased D-dimer value were independent risk factors for DVT in patients with lower extremity traumatic fractures.

scholarly journals Etiology-associated heterogeneity in acute respiratory distress syndrome: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sheng-Yuan Ruan ◽  
Chun-Ta Huang ◽  
Ying-Chun Chien ◽  
Chun-Kai Huang ◽  
Jung-Yien Chien ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Cohort Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Bacterial Pneumonia ◽  
Distress Syndrome ◽  
Hemodynamic Instability ◽  
Significant Difference

Abstract Background Heterogeneity in acute respiratory distress syndrome (ARDS) has led to many statistically negative clinical trials. Etiology is considered an important source of pathogenesis heterogeneity in ARDS but previous studies have usually adopted a dichotomous classification, such as pulmonary versus extrapulmonary ARDS, to evaluate it. Etiology-associated heterogeneity in ARDS remains poorly described. Methods In this retrospective cohort study, we described etiology-associated heterogeneity in gas exchange abnormality (PaO2/FiO2 [P/F] and ventilatory ratios), hemodynamic instability, non-pulmonary organ dysfunction as measured by the Sequential Organ Failure Assessment (SOFA) score, biomarkers of inflammation and coagulation, and 30-day mortality. Linear regression was used to model the trajectory of P/F ratios over time. Wilcoxon rank-sum tests, Kruskal–Wallis rank tests and Chi-squared tests were used to compare between-etiology differences. Results From 1725 mechanically ventilated patients in the ICU, we identified 258 (15%) with ARDS. Pneumonia (48.4%) and non-pulmonary sepsis (11.6%) were the two leading causes of ARDS. Compared with pneumonia associated ARDS, extra-pulmonary sepsis associated ARDS had a greater P/F ratio recovery rate (difference = 13 mmHg/day, p = 0.01), more shock (48% versus 73%, p = 0.01), higher non-pulmonary SOFA scores (6 versus 9 points, p < 0.001), higher d-dimer levels (4.2 versus 9.7 mg/L, p = 0.02) and higher mortality (43% versus 67%, p = 0.02). In pneumonia associated ARDS, there was significant difference in proportion of shock (p = 0.005) between bacterial and non-bacterial pneumonia. Conclusion This study showed that there was remarkable etiology-associated heterogeneity in ARDS. Heterogeneity was also observed within pneumonia associated ARDS when bacterial pneumonia was compared with other non-bacterial pneumonia. Future studies on ARDS should consider reporting etiology-specific data and exploring possible effect modification associated with etiology.

scholarly journals Prevalence, risk, and outcome of deep vein thrombosis in acute respiratory distress syndrome

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Na Cui ◽  
Chunguo Jiang ◽  
Hairong Chen ◽  
Liming Zhang ◽  
Xiaokai Feng
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Deep Vein Thrombosis ◽  
Serum Creatinine ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Distress Syndrome ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background Few data exist on deep vein thrombosis (DVT) in patients with acute respiratory distress syndrome (ARDS), a group of heterogeneous diseases characterized by acute hypoxemia. Study design and methods We retrospectively enrolled 225 adults with ARDS admitted to the Beijing Chao-Yang Hospital and the First Affiliated Hospital of Shandong First Medical University between 1 January 2015 and 30 June 2020. We analyzed clinical, laboratory, and echocardiography data for groups with and without DVT and for direct (pulmonary) and indirect (extrapulmonary) ARDS subgroups. Results Ninety (40.0%) patients developed DVT. Compared with the non-DVT group, patients with DVT were older, had lower serum creatinine levels, lower partial pressure of arterial oxygen/fraction of inspired oxygen, higher serum procalcitonin levels, higher Padua prediction scores, and higher proportions of sedation and invasive mechanical ventilation (IMV). Multivariate analysis showed an association between age, serum creatinine level, IMV, and DVT in the ARDS cohort. The sensitivity and specificity of corresponding receiver operating characteristic curves were not inferior to those of the Padua prediction score and the Caprini score for screening for DVT in the three ARDS cohorts. Patients with DVT had a significantly lower survival rate than those without DVT in the overall ARDS cohort and in the groups with direct and indirect ARDS. Conclusions The prevalence of DVT is high in patients with ARDS. The risk factors for DVT are age, serum creatinine level, and IMV. DVT is associated with decreased survival in patients with ARDS.

scholarly journals Extracorporeal Membrane Oxygenation in Immunocompromised Patients With Acute Respiratory Distress Syndrome—A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Chiao-Feng Cheng ◽  
You-Yi Chen ◽  
Ming-Chieh Shih ◽  
Yi-Min Huang ◽  
Li-Jung Tseng ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Cohort Study ◽  
Autoimmune Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Retrospective Cohort ◽  
Distress Syndrome ◽  
Pulmonary Hemorrhage ◽  
Immunocompromised Patients ◽  
Immunocompromised Status

Objective: Although the negative impact of immunosuppression on survival in patients with acute respiratory distress syndrome (ARDS) treated by extracorporeal membrane oxygenation (ECMO) is well known, short-term outcomes such as successful weaning rate from ECMO and subgroups benefit most from ECMO remain to be determined. The aims of this study were (1) to identify the association between immunocompromised status and weaning from ECMO in patients of ARDS, and (2) to identify subgroups of immunocompromised patients who may benefit from ECMO.Methods: This retrospective cohort study enrolled patients who received ECMO for ARDS from 2010 to 2020. Immunocompromised status was defined as having a hematological malignancy, active solid tumor, solid organ transplant, or autoimmune disease.Results: This study enrolled 256 ARDS patients who received ECMO, of whom 68 were immunocompromised. The multivariable analysis showed that immunocompromised status was not independently associated with failure to wean from ECMO. In addition, the patients with an autoimmune disease (14/24, 58.3%) and organ transplantation (3/3, 100%) had a numerically higher weaning rate from ECMO than other immunocompromised patients. For causes of ARDS, most patients with pulmonary hemorrhage (6/8, 75%) and aspiration (5/9, 55.6%) could be weaned from ECMO, compared to only a few of the patients with interstitial lung disease (2/9, 22.2%) and sepsis (1/4, 25%).Conclusions: Immunocompromised status was not an independent risk factor of failure to wean from ECMO in patients with ARDS. For patients with pulmonary hemorrhage and aspiration-related ARDS, ECMO may be beneficial as bridge therapy.

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