Thrombosis in pre- and post-vaccination phase of COVID-19

Abstract Acute infections may be complicated by thrombosis occurring in the venous and arterial circulation. This may be observed in patients with community-acquired pneumonia (CAP) and also in patients with coronavirus 2019 (COVID-19), that is a pandemic characterized by severe acute respiratory syndrome (SARS-CoV-2) needing mechanical ventilation and intensive care unit treatment. However, the type and rate of thrombosis can vary according to the cause of pneumonia as is more frequently complicated by arterial thrombosis in CAP, while an equal incidence of venous and arterial thrombosis occurs in SARS-CoV-2. The mechanisms of disease are overall platelet-related in CAP while activation of both platelets and clotting system is implicated in the pathogenesis of thrombosis in SARS-CoV-2; this finding could imply a different therapeutic approach of the two settings. Thrombosis may also occur in subjects vaccinated against SARS-CoV-2 even if its incidence is not so high (1/100 000); this rare effect occurs more prevalently in young women, is independent from known risk factors of thrombosis, is caused by antibodies against platelet PF4 and is counteracted by treatment with immunoglobulin and glucocorticoids.

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Diagnosis and management of community-acquired pneumonia

10.1093/med/9780199600830.003.0116 ◽

2016 ◽

Author(s):

Antoni Torres ◽

Adamantia Liapikou

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Community Acquired Pneumonia ◽

Atypical Pathogens ◽

High Prevalence ◽

Refractory Septic Shock ◽

Pneumococcal Bacteraemia ◽

Severe Community Acquired Pneumonia ◽

Reason For Admission ◽

Selection Of

Severe community-acquired pneumonia (SCAP) remains the most common infectious reason for admission to the intensive care unit (ICU), reaching a mortality rate of 30–40%. The microbial pattern of the SCAP has changed with S. pneumoniae still the leading pathogen, but a decrease of atypical pathogens, especially Legionella and an increase of viral and polymicrobial pneumonias. IDSA/ATS issued guidelines on the management of CAP including specific criteria to identify patients for ICU admission with good predictive value. The first selection of antimicrobial therapy should be started early covering all likely pathogens, depending on the presence of the risk factors for Pseudomonas aeruginosa infection. Combination therapy may be useful in patients with non-refractory septic shock and severe sepsis pneumococcal bacteraemia as well. The challenges include the emergence of new pathogens as community-acquired methicillin-resistant Staphylococcus aureus, new influenza virus subtypes and the high prevalence of multidrug resistance, mainly from institutionalizing patients.

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Risk factors for mortality from severe community-acquired pneumonia in hospitalized children transferred to the pediatric intensive care unit

Pediatrics & Neonatology ◽

10.1016/j.pedneo.2020.06.005 ◽

2020 ◽

Vol 61 (6) ◽

pp. 577-583 ◽

Cited By ~ 1

Author(s):

Tingting Shi ◽

Chen Chen ◽

Li Huang ◽

Huifeng Fan ◽

Gen Lu ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Community Acquired Pneumonia ◽

Hospitalized Children ◽

Severe Community Acquired Pneumonia

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Severe Community-acquired Pneumonia in an Intensive Care Unit: Risk Factors for Mortality

Internal Medicine ◽

10.2169/internalmedicine.44.710 ◽

2005 ◽

Vol 44 (7) ◽

pp. 710-716 ◽

Cited By ~ 35

Author(s):

Akihiro YOSHIMOTO ◽

Hiroyuki NAKAMURA ◽

Masaki FUJIMURA ◽

Shinji NAKAO

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Community Acquired Pneumonia ◽

Unit Risk ◽

Severe Community Acquired Pneumonia

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Arterial and venous thrombosis in coronavirus 2019 disease (Covid-19): relationship with mortality

Internal and Emergency Medicine ◽

10.1007/s11739-020-02621-8 ◽

2021 ◽

Author(s):

Francesco Violi ◽

Giancarlo Ceccarelli ◽

Roberto Cangemi ◽

Francesco Cipollone ◽

Damiano D’Ardes ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Venous Thrombosis ◽

Arterial Thrombosis ◽

Cox Regression ◽

Thrombotic Event ◽

White Blood Cells ◽

Intensive Care Unit Treatment ◽

Cox Regression Analysis ◽

D Dimer

Abstract Background Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse. Methods Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered. Results Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8–12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4–5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28–0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59–4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014–1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277–0.723; p = 0.001) predicted morality. Conclusions Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.

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Posttraumatic Stress Disorder in Patients Following Intensive Care Unit Treatment: A Review of Studies Regarding Prevalence and Risk Factors

Journal of Trauma & Treatment ◽

10.4172/2167-1222.1000190 ◽

2014 ◽

Vol 03 (02) ◽

Cited By ~ 9

Author(s):

Mette Ratzer ◽

Eugenia Romano

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Posttraumatic Stress Disorder ◽

Intensive Care ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Intensive Care Unit Treatment

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Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: Risk factors for mortality

Journal of Critical Care ◽

10.1016/j.jcrc.2013.08.004 ◽

2013 ◽

Vol 28 (6) ◽

pp. 975-979 ◽

Cited By ~ 15

Author(s):

Aykut Cilli ◽

Hakan Erdem ◽

Zuhal Karakurt ◽

Hulya Turkan ◽

Ozlem Yazicioglu-Mocin ◽

...

Keyword(s):

Risk Factors ◽

Chronic Obstructive Pulmonary Disease ◽

Intensive Care Unit ◽

Intensive Care ◽

Pulmonary Disease ◽

Community Acquired Pneumonia ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Unit Risk

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Bacteraemia and antibiotic-resistant pathogens in community acquired pneumonia: risk and prognosis

European Respiratory Journal ◽

10.1183/09031936.00152514 ◽

2015 ◽

Vol 45 (5) ◽

pp. 1353-1363 ◽

Cited By ~ 25

Author(s):

Antoni Torres ◽

Catia Cillóniz ◽

Miquel Ferrer ◽

Albert Gabarrús ◽

Eva Polverino ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Multivariate Analysis ◽

Intensive Care ◽

Community Acquired Pneumonia ◽

Blood Cultures ◽

Arterial Oxygen ◽

C Reactive Protein ◽

Antibiotic Resistant ◽

Reactive Protein

The sensitivity of blood cultures in the diagnosis of bacteraemia for community-acquired pneumonia is low. Recommendations, by guidelines, to perform blood cultures are discordant. We aimed to determine the incidence, microbial aetiology, risk factors and outcomes of bacteraemic patients with community-acquired pneumonia, including cases with antibiotic-resistant pathogens (ARP).A prospective, observational study was undertaken on consecutive adult patients admitted to the Hospital Clinic of Barcelona (Barcelona, Spain) with community-acquired pneumonia and blood cultures were obtained.Of the 2892 patients included, bacteraemia was present in 297 (10%) patients; 30 (10%) of whom had ARP (multidrug-resistantStreptococcus pneumoniae, methicillin-resistantStaphylococcus aureus,Pseudomonas aeruginosa, and an extended spectrum of beta-lactamase producingEnterobacteriaceae). In multivariate analyses, pleuritic pain, C-reactive protein ≥21.6 mg·dL−1and intensive care unit admissions were independently associated with bacteraemia, while prior antibiotic treatment and pneumococcal vaccine were protective factors. The risk factors for ARP bacteraemia were previous antibiotics and C-reactive protein <22.2 mg·dL−1, while pleuritic pain was the only protective factor in the multivariate analysis. Bacteraemia (excluding ARP), appropriate empiric treatment, neurological disease, arterial oxygen tension/inspiratory oxygen fraction <250, pneumonia severity index risk classes IV and V, and intensive care unit admission were independently associated with a 30-day hospital mortality in the multivariate analysis. Inappropriate therapy was more frequent in ARP bacteraemia, compared with other bacteraemias (27%versus3%, respectively, p<0.001).Antibiotic therapy protected against bacteraemia, but increased specifically the risk of bacteraemia from ARP due to the inappropriate coverage of these pathogens. Identifying patients at risk of ARP bacteraemia would help in deciding appropriate empiric antimicrobial therapy. The results from this study provide evidence concerning community-acquired pneumonia patients in whom blood cultures should not be performed.

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