目标:在COVID-19大流行期间,作者机构对2例青少年患者的室房(VA)分流并发症进行了管理,这些患者与有症状的COVID-19感染非常接近.系统性血栓形成事件是COVID-19感染的一种既定并发症,原因是血液高凝状态。血栓并发症,尤其是中心静脉压升高,会导致VA分流失败。目前尚不清楚COVID-19对血管内装置患者的真正影响。在这项研究中,作者旨在确定COVID-19感染与VA分流失败之间是否存在关联.
方法:TriNetX,一个聚合的电子健康记录平台,用于分析超过1300万美国儿科患者的数据。定义了两组年龄<18岁的VA分流患者。从2020年3月1日至2022年3月31日,第1组(n=311)的COVID-19实验室检测呈阳性。第2组(n=311),一个对照组,从2020年3月1日至2022年3月31日进行了任何医疗预约,并且从未对COVID-19进行过阳性实验室检查。作者分析了第1组的COVID-19检测呈阳性后1年的结果,以及第2组的医疗预约后的结果。结果包括分流并发症,分流修订或替换,和血栓栓塞并发症。为了保护患者隐私,TriNetX中未指定少于10名患者的个体结果.
结果:第1组发生机械分流并发症的几率大于第2组(20%vs4%,OR5.71,95%CI3.07-10.62)。第1组分流再手术的几率高于第2组(11%vs<3%,或>3.7,95%CI1.72-7.62)。第1组中有1-10例患者(≤第1组的3%)由于分流而出现血栓栓塞,与第2组中没有因分流而发生血栓栓塞的患者相比。
结论:这项分析证明了分流并发症的相关性,重新操作,和COVID-19感染后VA分流患者的血栓栓塞事件。
OBJECTIVE: During the COVID-19 pandemic, the authors\' institution managed ventriculoatrial (VA) shunt complications in 2 teenage patients in close proximity to a symptomatic COVID-19 infection. Systemic thrombotic events are an established complication of COVID-19 infection due to a hypercoagulable state. Thrombotic complications, particularly elevated central venous pressure, can cause VA shunt failure. The true effect of COVID-19 on patients with intravascular devices is currently unknown. In this study, the authors aimed to determine if there was an association between COVID-19 infection and VA shunt failure.
METHODS: TriNetX, an aggregated electronic health record platform, was used to analyze data of more than 13 million US pediatric patients. Two matched cohorts of patients < 18 years of age with a VA shunt were defined. Group 1 (n = 311) had a positive laboratory test for COVID-19 from March 1, 2020, to March 31, 2022. Group 2 (n = 311), a control group, had any medical appointment from March 1, 2020, to March 31, 2022, and never had a positive laboratory test for COVID-19. The authors analyzed outcomes 1 year after testing positive for COVID-19 in group 1, and after the medical appointment in group 2. Outcomes included shunt complications, shunt revisions or replacements, and thromboembolic complications. To protect patient privacy, individual results of fewer than 10 patients are not specified in TriNetX.
RESULTS: Group 1 had a greater odds of mechanical shunt complication than group 2 (20% vs 4%, OR 5.71, 95% CI 3.07-10.62). Group 1 had a greater odds of shunt reoperation than group 2 (11% vs < 3%, OR > 3.7, 95% CI 1.72-7.62). There were 1-10 patients in group 1 (≤ 3% of group 1) who experienced a thromboembolism due to the shunt, compared with no patients in group 2 who had a thromboembolism due to the shunt.
CONCLUSIONS: This analysis demonstrates an association of shunt complications, reoperations, and thromboembolic events in patients with VA shunts following COVID-19 infection.