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THROMBOTIC AND HEMORRHAGIC COMPLICATIONS OF COVID-19 IN ADULTS HOSPITALIZED IN HIGH-INCOME COUNTRIES COMPARED WITH THOSE IN ADULTS HOSPITALIZED IN LOW- AND MIDDLE-INCOME COUNTRIES IN AN INTERNATIONAL REGISTRY
SARS-CoV-2
Developing Countries
Disseminated intravascular coagulation
Hemorrhage
Ischemic stroke
Thromboembolism
Thrombosis
ISARIC Clinical Characterisation Group.
Author
Affilliation
University of Utah. Department of Anesthesiology. Salt Lake City, Utah, USA / University of Oxford. Pandemic Sciences Institute. Oxford, United Kingdom.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Immunopharmacology. Rio de Janeiro, RJ, Brazil.
Unisabana Center for Translational Science. School of Medicine. Universidad de La Sabana. Chia, Colombia.
University of Utah School of Medicine. Division of Epidemiology, Department of Internal Medicine. Salt Lake City, Utah, USA.
University of Zurich. Department of Anesthesiology. Zürich, Switzerland.
University of Oxford. Pandemic Sciences Institute. Oxford, United Kingdom.
University of Oxford. Pandemic Sciences Institute. Oxford, United Kingdom.
University of Queensland. Faculty of Medicine. Brisbane, Australia.
Department of Cardiology. Boston Children’s Hospital. Boston, Massachusetts, USA / Department of Pediatrics. Harvard Medical School. Boston, Massachusetts, USA.
University of Queensland. The Prince Charles Hospital. Critical Care Research Group. Brisbane, Australia.
Pediatric Critical Care Medicine. Heart and Vascular Institute. Inova Fairfax Hospital. Annandale, Virginia, USA.
Johns Hopkins University. Divisions of Neuroscience Critical Care and Cardiac Surgery. Departments of Neurology, Surgery, Anesthesia and Critical Care Medicine. Baltimore, Maryland, USA.
Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Immunopharmacology. Rio de Janeiro, RJ, Brazil.
Unisabana Center for Translational Science. School of Medicine. Universidad de La Sabana. Chia, Colombia.
University of Utah School of Medicine. Division of Epidemiology, Department of Internal Medicine. Salt Lake City, Utah, USA.
University of Zurich. Department of Anesthesiology. Zürich, Switzerland.
University of Oxford. Pandemic Sciences Institute. Oxford, United Kingdom.
University of Oxford. Pandemic Sciences Institute. Oxford, United Kingdom.
University of Queensland. Faculty of Medicine. Brisbane, Australia.
Department of Cardiology. Boston Children’s Hospital. Boston, Massachusetts, USA / Department of Pediatrics. Harvard Medical School. Boston, Massachusetts, USA.
University of Queensland. The Prince Charles Hospital. Critical Care Research Group. Brisbane, Australia.
Pediatric Critical Care Medicine. Heart and Vascular Institute. Inova Fairfax Hospital. Annandale, Virginia, USA.
Johns Hopkins University. Divisions of Neuroscience Critical Care and Cardiac Surgery. Departments of Neurology, Surgery, Anesthesia and Critical Care Medicine. Baltimore, Maryland, USA.
Abstract
Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings.
Keywords
COVID-19SARS-CoV-2
Developing Countries
Disseminated intravascular coagulation
Hemorrhage
Ischemic stroke
Thromboembolism
Thrombosis
Publisher
Elsevier
Citation
GRIFFEE, Matthew J. et al. Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry. Research and Practice in Thrombosis and Haemostasis, v. 7, n. 5, p. 1-18, 2023.DOI
10.1016/j.rpth.2023.102142ISSN
2475-0379Notes
Fernando Augusto Bozza - Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento.ISARIC Clinical Characterisation Group.
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