LB 02.2 - Hemorrhagic, Coagulopathic, and Thrombotic (HECTOR) Complications Among Critically-Ill Patients with COVID-19: An International COVID-19 Critical Care Consortium Study

Wednesday, July 13, 2022

10:30 AM – 10:45 AM

Location: ICC Auditorium

Presentation Format: Virtual

Presenting Author(s)

Jonathon P. Fanning, BSc, BBS, PhD, FRACP, FANZCA, FCICM

Visiting Fulbright Professor
Johns Hopkins Medicine
Baltimore, Maryland, United States

Co-Author(s)

RF

Robert Fanning

Medical Officer
University of Melbourne
Melbourne, Queensland, Australia
NW

Natasha Weaver

Statistician
University of Newcastle
Newcastle, New South Wales, Australia
MG

Matthew Griffee

Anesthesiologist
University of Utah
Salt Lake City, Utah, United States
SC

Sung-Min Cho

Neurointensivist and Neurologist
Johns Hopkins Medicine
Baltimore, Maryland, United States
MP

Mauro Panigada

Anaesthesiologist
12. Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico di Milano
Milan, Lombardia, Italy
AZ

Akraam Zaaqoq

Intensive care specialist
MedStar Washington Hospital Center, Georgetown University
Washington, District of Columbia, United States
NW

Nicole White

Statistician
Queensland University of Technology
Brisbane, Queensland, Australia
NO

Nchafatso Obonyo

Research Fellow
Initiative to Develop African Research Leaders (IDeAL)/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Wellcome Trust Centre for Global Health Research at Imperial College London, United Kingdom
Kilifi, North-Eastern, Kenya
AL

Ahmed Labib

Intensive care specialist
Hamad General Hospital
Hamad, Al Wakrah, Qatar
YC

Yew Woon Chia

Doctor
Department of Cardiology, Tan Tock Seng Hospital, Singapore
Singapore, Singapore
BF

Bingwen Eugene Fan

Haematologist
National University of Singapoore
Singapore, Singapore
RA

Rakesh Arora

Professor of Cardiac Surgery
University of Manitoba
Winnipeg, Manitoba, Canada
DC

Davide Chiumello

Professor
San Paolo University Hospital
Milan, Lombardia, Italy
AT

Antoni Torres

Professor
Centre de Investigación Bioedica En Red - Enfermedades Respiratorias
Barcelona, Catalonia, Spain
JS

Jacky Y Suen

Senior Research Fellow
University of Queensland
Brisbane, Queensland, Australia
GL

Gianluigi Li Bassi

Associate Professor
University of Queensland
Brisbane, Queensland, Australia
GP

Giles Peek

Professor of Cardiac Surgery
University of Florida
Gainesville, Florida, United States
JF

John Fraser

Professor
University of Queensland
Brisbane, Queensland, Australia
HD

Heidi Dalton

Professor
Inova Fairfax Hospital
Falls Church, Virginia, United States

Background: Hemorrhage, coagulopathy and thrombosis (HECTOR) are reported complications of coronavirus disease 2019 (COVID-19); however, more information is needed on the prevalence of these complications and their associated outcomes in intensive care unit (ICU) settings.

Aims: To determine the prevalence and outcomes of HECTOR complications in ICU patients with COVID-19.

Methods: Observational cohort study spanning 229 ICUs across 32 countries. Patients ≥16 years admitted for severe COVID-19 from 1^stJanuary 2020, through 31^stDecember 2021 were included. Patient characteristics and clinical data were collected. Survival analysis estimated the instantaneous impact of HECTOR complications on ICU-mortality and discharge.

Results:

HECTOR complications occurred in 1,735 (14%) of 11,972 study-eligible patients. Acute thrombosis occurred in 1,249 (10%) patients, including 712 (57%) with pulmonary embolism, 413 (33%) with myocardial infarction, 93 (7.4%) with deep vein thrombosis, and 49 (3.9%) with ischemic stroke. Hemorrhagic complications were reported in 582 (4.9%) patients, including 276 (48%) with gastrointestinal hemorrhage, 83 (14%) with hemorrhagic stroke, and 77 (13%) with pulmonary hemorrhage. Disseminated intravascular coagulation occurred in 11 (0.09%) patients. Univariate analysis identified diabetes, hypertension, cardiac and kidney disease and ECMO as statistically-significant risk factors for HECTOR complications. Patients with versus without HECTOR complications suffered higher ICU-mortality at 28 days (25%vs.13%, p< 0.001), 90 days (32%vs.15%, p< 0.0001) and overall (44%vs.36%, p< 0.001). Among ICU survivors, the ICU stay was longer (median days 19vs.12, p< 0.001). ICU mortality was similar between patients with and without HECTOR complications (HR=1.01, 95%CI 0.92-1.12, p=0.783) where an increased hazard of ICU mortality with hemorrhage (HR=1.26, 1.09-1.45, p=0.002) was balanced by a reduced hazard of thrombosis (HR=0.88, 0.79-0.99, p=0.03). Kaplan-Meier curves are presented in the Figure.

Conclusion(s): HECTOR events are frequent complications of severe COVID-19 in ICU patients. Hemorrhagic, but not thrombotic complications are associated with increased ICU-mortality.