Evaluation of coagulation disorders in intubated and non-intubated patients with COVİD-19 diagnosis in the intensive care unit

Objective: It has been known that the need for invasive mechanical ventilation due to severe respiratory failure develops in COVID-19 patients followed in the intensive care unit. It has been reported in the literature that coagulopathy seen in the course of COVID-19 disease is an important cause of mortality and morbidity. Our aim in our study is to evaluate coagulation disorders developing between intubated and non-intubated patients. Material and Method: The data of 812 patients, who were diagnosed with COVID-19 in the Intensive Care Unit of Dicle University Pandemic Hospital, between March 2020 and September 2021 were analyzed retrospectively. The patients were divided into two groups according to the need for invasive mechanical ventilation. Demographic characteristics, laboratory values at the time of diagnosis, coagulopathy development status and survival of the patients were investigated. Results: Of the 812 patients included in the study, 459 (56.5%) were male. The mean age was 66.4 ± 15,2. 257 (31.7%) of the patients received invasive mechanical ventilation support. Coagulopathy was detected in 146 (56.8%) of these patients. Distribution of coagulopathy in intubated patients; 26% disseminated intravascular coagulopathy (DIC), 17.9% acute coronary syndrome (ACS), 10.5% hemorrhage, 5.4% pulmonary thromboembolism (PTE), 5% heparin induced thrombocytopenia (HIT), 3.5% ischemic cerebrovaskuler disease, 1.9% hemorrhagic cerebrovaskuler disease, and 0.8% found as deep vein thrombosis (DVT). We found that 32% of the patients who were not intubated developed coagulopathy, and this difference was statistically significant (p<0.001). We found the mortality rate to be 97.7% in intubated patients. Mortality in non-intubated patients was 38.4%. In our study; coagulopathy development rate was found to be higher in patients with at least one comorbidity (p=0.006). The relationship between the laboratory findings at the time of hospitalization and the rate of coagulopathy development was examined and a statistically significant correlation was found between the hemoglobin, thrombocyte, fibrinogen, d-dimer and INR levels of the patients and the development of coagulopathy (p=0.026, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001). It was observed that 49.8% of the patients who died had at least one coagulopathy condition. This rate was found to be 26.7% in surviving patients, and this difference was statistically significant (p<0.001). Conclusion: It was determined that approximately one third of the COVID-19 patients hospitalized in the intensive care unit needed mechanical ventilation. A coagulation disorder developed in 56.8% of them. It was observed between intubation and the development of coagulopathy and associated with the development of coagulopathy with high d-dimer, fibrinogen and INR levels and low hemoglobin and thrombocyte levels. It was also observed that comorbidity was associated with coagulopathy and mortality. It was observed that 97.7% of the intubated patients died. Recommendation: In severe COVID-19 patients, precautions should be taken for conditions that contribute to the development of coagulopathy and patients should be followed more carefully in terms of coagulopathy. Hypoxia should not be allowed in patients, rehabilitation programs to reduce stasis should be implemented and anticoagulant treatments of patients should not be interrupted.