TY - JOUR
T1 - 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
AU - ISARIC Clinical Characterisation Group
AU - Griffee, Matthew J.
AU - Bozza, Patricia T.
AU - Reyes, Luis Felipe
AU - Eddington, Devin P.
AU - Rosenberger, Dorothea
AU - Merson, Laura
AU - Citarella, Barbara Wanjiru
AU - Fanning, Jonathon P.
AU - Alexander, Peta M.A.
AU - Fraser, John
AU - Dalton, Heidi
AU - Cho, Sung Min
AU - Abdukahil, Sheryl Ann
AU - Abdulkadir, Nurul Najmee
AU - Abe, Ryuzo
AU - Abel, Laurent
AU - Abrous, Amal
AU - Absil, Lara
AU - Acker, Andrew
AU - Adam, Elisabeth
AU - Adrião, Diana
AU - Al Ageel, Saleh
AU - Ahmed, Shakeel
AU - Ainscough, Kate
AU - Aisa, Tharwat
AU - Hssain, Ali Ait
AU - Tamlihat, Younes Ait
AU - Akimoto, Takako
AU - Akmal, Ernita
AU - Akwani, Chika
AU - Al Qasim, Eman
AU - Alalqam, Razi
AU - Alberti, Angela
AU - Al-dabbous, Tala
AU - Alegesan, Senthilkumar
AU - Alessi, Marta
AU - Alex, Beatrice
AU - Alexandre, Kévin
AU - Al-Fares, Abdulrahman
AU - Alfoudri, Huda
AU - Ali, Imran
AU - Alidjnou, Kazali Enagnon
AU - Aliudin, Jeffrey
AU - Alkhafajee, Qabas
AU - Allavena, Clotilde
AU - Allou, Nathalie
AU - Alves, João
AU - Alves, Rita
AU - Alves, João Melo
AU - Dishon, Yael
N1 - Publisher Copyright:
© 2023 The Author(s)
PY - 2023/7
Y1 - 2023/7
N2 - 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.
AB - 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.
KW - COVID-19
KW - SARS-CoV-2
KW - developing countries
KW - disseminated intravascular coagulation
KW - hemorrhage
KW - ischemic stroke
KW - thromboembolism
KW - thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85167416327&partnerID=8YFLogxK
U2 - 10.1016/j.rpth.2023.102142
DO - 10.1016/j.rpth.2023.102142
M3 - Article
C2 - 37601011
AN - SCOPUS:85167416327
SN - 2475-0379
VL - 7
JO - Research and Practice in Thrombosis and Haemostasis
JF - Research and Practice in Thrombosis and Haemostasis
IS - 5
M1 - 102142
ER -