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Review paper

COVID-19 associated coagulopathy in septic critically ill patients - a retrospective cohort study

By
Mirza Kovačević Orcid logo ,
Mirza Kovačević
Contact Mirza Kovačević

Department of Anaesthesiology, Resuscitation and Intensive Care, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina

Nermina Rizvanović ,
Nermina Rizvanović

Department of Anaesthesiology, Resuscitation and Intensive Care, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina

Adisa Šabanović Adilović ,
Adisa Šabanović Adilović

School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina

Department of Anaesthesiology, Resuscitation and Intensive Care, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Senada Čaušević
Senada Čaušević

Department of Anaesthesiology, Resuscitation and Intensive Care, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina

Abstract

Aim
To determine the relationship between coagulation disorders and septic condition in COVID-19 critically ill patients.
Methods
Data from 99 patients who presented with COVID-19 acute hypoxemic respiratory failure (CAHRF) were divided into
two groups: Group 1- patients who developed sepsis, and Group 2 - patients who developed septic shock. Age, sex, comorbidities, quick Sequential Organ Failure Assessment (qSOFA) score, vasopressor and inotrope requirement, laboratory findings (platelets, neutrophils, lymphocytes, procalcitonin - PCT, C-reactive protein, fibrinogen, D-dimer, sepsis-induced coagulopathy – SIC, and disseminated intravascular coagulation - DIC score) were recorded on the day of admission and on the day of starting invasive mechanical ventilation. The primary outcome was to establish
COVID-19 associated coagulopathy with sepsis and septic shock; the secondary outcome measure was incidence of coagulopathy in septic COVID-19 critically ill patients.
Results
The most common coagulation abnormality was international normalized ratio (INR) (p=0.019) for Group 2, followed
by the values of inflammatory parameters PCT (p=0.002) and lymphocytes (p=0.011) also for Group 2. The statistical significance of SIC score was observed for both groups (p=0.007) and p=0.012, respectively. Norepinephrine (p=0.000) and dobutamine (p=0.000) for Group 2, qSOFA for both groups (p = 0.000) were
statistically significant.
Conclusion
The observed coagulation abnormalities met the criteria for a SIC diagnosis, therefore, the management of coagulation
disorders at this stage of the disease should follow the management of a septic condition.

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