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Observational Study
. 2023 Nov;14(11):1312-1317.
doi: 10.1111/jdi.14068. Epub 2023 Aug 15.

Factors associated with bleeding complications in patients with coronavirus disease 2019 admitted to intensive care units: A multicenter retrospective cohort study

Dan Imai  1 , Emi Ushigome  1 , Masahide Hamaguchi  1 , Satoru Hashimoto  2 , Michiaki Fukui  1
Affiliations
Observational Study

Factors associated with bleeding complications in patients with coronavirus disease 2019 admitted to intensive care units: A multicenter retrospective cohort study

Dan Imai et al. J Diabetes Investig. 2023 Nov.

Abstract

Aims/introduction: Diabetes is a major risk factor for coronavirus disease 2019 (COVID-19) severity. We aimed to retrospectively investigate the rates of patients with no diabetes, untreated diabetes, treated diabetes, COVID-19-related diabetes and the factors associated with bleeding complications in a cohort of patients with severe COVID-19.

Materials and methods: This was a multicenter, retrospective, observational study. Participants were COVID-19 patients enrolled in the Cross-sectional ICU Information Search System (CRISIS) from February 2020 to March 2022. Patients were classified into four groups according to diabetes status and treatment status. Hemorrhagic complications were defined as bleeding requiring transfusion of four or more red blood cell units, a drop of hemoglobin of ≥2 g in 24 h and retroperitoneal, airway or intracranial bleeding. Logistic regression analysis was carried out to examine factors associated with bleeding complications.

Results: A total of 1,076 patients were included in the analysis. The rates of patients in the no diabetes, untreated diabetes, treated diabetes and COVID-19-related diabetes groups were 17.4, 23.0, 23.9 and 35.7%, respectively. Bleeding complications were observed in 7.5% of all patients. Glycated hemoglobin level and renal failure were significantly correlated with bleeding complications (odds ratio 1.16, 95% confidence interval 1.02-1.33 and 2.77, 95% confidence interval 1.16-6.63, respectively). Patients with diabetes, including those with COVID-19-related diabetes, accounted for approximately 83% of all cases.

Conclusions: In patients with severe COVID-19 with high glycated hemoglobin and renal failure, we recommend additional attention to the course of COVID-19, given the risk of bleeding complications.

Keywords: Bleeding complication; COVID-19; Diabetes.

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Conflict of interest statement

The authors declare no conflict of interest.

Approval of the research protocol: All procedures were approved by the local Research Ethics Committee (ERB‐C‐1711).

Informed consent: Informed consent was obtained from all participants or their relatives whenever possible, and if this was impossible, the ethics committee approved a waiver of informed consent.

Registry and the registration no. of the study/trial: Approval date of Registry was 2020/08/20 and the Registration No. of the study was lUMIN000041450.

Animal studies: N/A.

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