Thrombocytopenia Secondary to COVID-19: Outcomes Analysis in Terms of Thrombotic Microangiopathy, Acute Kidney Injury, and Mortality

Bahareh Gheiasi; Fakhredin Taghinezhad; Darshik Kumar Patel; Ebrahim Salimi; Mashallah Babashahi; Aliashraf  Mozafari

doi:10.18502/ijhoscr.v18i1.14740

Bahareh Gheiasi Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
Fakhredin Taghinezhad Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
Darshik Kumar Patel Department of Intensive Care Medicine, Loyola Medicine - Macneal Hospital, Berwyn, IL, USA
Ebrahim Salimi Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
Mashallah Babashahi Department of Laboratory Sciences, School of Allied Medical Sciences, University of Medical Sciences, Ilam, Iran
Aliashraf Mozafari Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran

DOI: https://doi.org/10.18502/ijhoscr.v18i1.14740

Keywords: SARS-CoV-2; COVID-19; Acute kidney injuries; Thromboses; Thrombocytopenia; Thrombotic microangiopathy

Abstract

Background: COVID-19 usually complicates respiratory failure; microvascular, macrovascular, and renal complications are common. Both micro and macrovascular complications are associated with multi-organ dysfunction and in-hospital mortality. Thrombotic microangiopathy (TMA) causes microvascular thromboses associated with organ failure, including acute kidney injury (AKI).

Materials and Methods: This Retrospective Cohort study included 100 COVID-19 patients with thrombocytopenia, followed up in a university hospital’s intensive care unit (ICU). The primary endpoints were in-hospital mortality or discharge from the hospital and assessing the occurrence of TMA and AKI during the hospitalization. The effect of thrombotic microangiopathy and acute kidney injury on mortality was investigated using logistic regression models in Stata software version 12.1.

Results: The TMA and AKI were associated with in-hospital mortality in COVID-19 patients presenting with thrombocytopenia in multivariate regression analysis, adjusted for other variables. The effect of AKI on mortality was obtained (adjusted OR 4.09, 95% CI: 1.33–12.53, p = 0.01). Moreover, the odds of mortality due to TMA were ten-fold higher in the patients who had TMA than those who did not (adjusted OR 10.26, 95% CI: 1.26–83.76, p = 0.03).

Conclusion: We outlined TMA in COVID-19 patients, which could be responsible for kidney injury and mortality in critically COVID-19 patients.