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Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients

Thromboprophylaxis is a mainstay of treatment of hospitalized COVID-19 patients, due to the high occurrence of thrombotic events. This increases the risk of bleeding. However, data on bleeding events and associated risk factors are scarce. Thus, we aimed to investigate the incidence, predictors and...

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Autores principales: Lucijanic, Marko, Tjesic-Drinkovic, Ida, Piskac Zivkovic, Nevenka, Pastrovic, Frane, Rob, Zrinka, Bacevac, Mersiha, Sedinic Lacko, Martina, Dzambas, Eleonora, Medic, Barbara, Vukoja, Ivan, Busic, Iva, Grgurevic, Ivica, Luksic, Ivica, Barsic, Bruno
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455881/
https://www.ncbi.nlm.nih.gov/pubmed/37629556
http://dx.doi.org/10.3390/life13081699
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author Lucijanic, Marko
Tjesic-Drinkovic, Ida
Piskac Zivkovic, Nevenka
Pastrovic, Frane
Rob, Zrinka
Bacevac, Mersiha
Sedinic Lacko, Martina
Dzambas, Eleonora
Medic, Barbara
Vukoja, Ivan
Busic, Iva
Grgurevic, Ivica
Luksic, Ivica
Barsic, Bruno
author_facet Lucijanic, Marko
Tjesic-Drinkovic, Ida
Piskac Zivkovic, Nevenka
Pastrovic, Frane
Rob, Zrinka
Bacevac, Mersiha
Sedinic Lacko, Martina
Dzambas, Eleonora
Medic, Barbara
Vukoja, Ivan
Busic, Iva
Grgurevic, Ivica
Luksic, Ivica
Barsic, Bruno
author_sort Lucijanic, Marko
collection PubMed
description Thromboprophylaxis is a mainstay of treatment of hospitalized COVID-19 patients, due to the high occurrence of thrombotic events. This increases the risk of bleeding. However, data on bleeding events and associated risk factors are scarce. Thus, we aimed to investigate the incidence, predictors and clinical outcomes associated with major bleeding in hospitalized COVID-19 patients. We retrospectively evaluated a cohort of 4014 consecutively hospitalized COVID-19 patients treated in a tertiary-level institution in the period 3/2020–3/2021. Bleeding of any kind was documented in 322 (8%) and major bleeding in 129 (3.2%) patients. A total of 129 (40.1%) bleeding events were present at the time of hospital admission, and 193 (59.9%) occurred during hospitalization. In the multivariate logistic regression analysis, intensive-care-unit treatment (adjusted odds ratio (aOR) 6.55; p < 0.001), atrial fibrillation (aOR 2.55; p = 0.029), higher white-blood-cell count (WBC) (aOR 1.03; p = 0.021), lower hemoglobin (aOR 0.97; p = 0.002) and history of bleeding (aOR 17.39; p < 0.001) were recognized as mutually independent predictors of major bleeding. Major bleeding was significantly associated with increased in-hospital mortality compared to non-major-bleeding patients (59.7% vs. 34.8%, p < 0.001), especially if occurring during hospitalization. Median time from major bleeding to death was 5 days. Bleeding events are frequent in hospitalized COVID-19 patients, with a significant proportion of patients presenting at the time of hospital admission, and others almost universally exposed to anticoagulant and corticosteroid therapies. Major bleeding is associated with high mortality, especially if occurring during hospitalization. The recognition of patients at risk and implementation of timely interventions are of high clinical importance.
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spelling pubmed-104558812023-08-26 Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients Lucijanic, Marko Tjesic-Drinkovic, Ida Piskac Zivkovic, Nevenka Pastrovic, Frane Rob, Zrinka Bacevac, Mersiha Sedinic Lacko, Martina Dzambas, Eleonora Medic, Barbara Vukoja, Ivan Busic, Iva Grgurevic, Ivica Luksic, Ivica Barsic, Bruno Life (Basel) Article Thromboprophylaxis is a mainstay of treatment of hospitalized COVID-19 patients, due to the high occurrence of thrombotic events. This increases the risk of bleeding. However, data on bleeding events and associated risk factors are scarce. Thus, we aimed to investigate the incidence, predictors and clinical outcomes associated with major bleeding in hospitalized COVID-19 patients. We retrospectively evaluated a cohort of 4014 consecutively hospitalized COVID-19 patients treated in a tertiary-level institution in the period 3/2020–3/2021. Bleeding of any kind was documented in 322 (8%) and major bleeding in 129 (3.2%) patients. A total of 129 (40.1%) bleeding events were present at the time of hospital admission, and 193 (59.9%) occurred during hospitalization. In the multivariate logistic regression analysis, intensive-care-unit treatment (adjusted odds ratio (aOR) 6.55; p < 0.001), atrial fibrillation (aOR 2.55; p = 0.029), higher white-blood-cell count (WBC) (aOR 1.03; p = 0.021), lower hemoglobin (aOR 0.97; p = 0.002) and history of bleeding (aOR 17.39; p < 0.001) were recognized as mutually independent predictors of major bleeding. Major bleeding was significantly associated with increased in-hospital mortality compared to non-major-bleeding patients (59.7% vs. 34.8%, p < 0.001), especially if occurring during hospitalization. Median time from major bleeding to death was 5 days. Bleeding events are frequent in hospitalized COVID-19 patients, with a significant proportion of patients presenting at the time of hospital admission, and others almost universally exposed to anticoagulant and corticosteroid therapies. Major bleeding is associated with high mortality, especially if occurring during hospitalization. The recognition of patients at risk and implementation of timely interventions are of high clinical importance. MDPI 2023-08-07 /pmc/articles/PMC10455881/ /pubmed/37629556 http://dx.doi.org/10.3390/life13081699 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lucijanic, Marko
Tjesic-Drinkovic, Ida
Piskac Zivkovic, Nevenka
Pastrovic, Frane
Rob, Zrinka
Bacevac, Mersiha
Sedinic Lacko, Martina
Dzambas, Eleonora
Medic, Barbara
Vukoja, Ivan
Busic, Iva
Grgurevic, Ivica
Luksic, Ivica
Barsic, Bruno
Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients
title Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients
title_full Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients
title_fullStr Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients
title_full_unstemmed Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients
title_short Incidence, Risk Factors and Mortality Associated with Major Bleeding Events in Hospitalized COVID-19 Patients
title_sort incidence, risk factors and mortality associated with major bleeding events in hospitalized covid-19 patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455881/
https://www.ncbi.nlm.nih.gov/pubmed/37629556
http://dx.doi.org/10.3390/life13081699
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