J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 5, May 2022, pages 188-195

Analysis of Risk Factors of Soft Tissue Bleeding in COVID-19 Patients: A Point of View After Two Years of Pandemic

Figure 1. Bleeding in the context of the left uterine broad ligament. The CT images in (a) and (b) show the spots of active bleeding (arrows) with progressive spread of contrast medium. The angiographic image in (c) shows the active bleeding spot adjacent to the left uterine artery. The angiographic image in (d) shows the complete embolization, by means of metallic micro-spirals, of the arterial afferents at the bleeding point. CT images in (e) and (f) show complete reabsorption of hematomas after 3 months. CT: computed tomography.

Figure 2. Bleeding in the context of the left rectus abdominis muscle. The CT images in (a) and (b) show the spots of active bleeding (arrows) with progressive spread of contrast medium. The angiographic image in (c) shows the active bleeding spot (arrow) adjacent to the left inferior epigastric artery. The angiographic image in (d) shows the complete embolization, by means of glue and metallic micro-spirals, of the arterial afferents at the bleeding point. CT images in (e) and (f) show complete reabsorption of hematomas after 3 months. CT: computed tomography.

Figure 3. Measurement of adipose tissue areas in cm² obtained by analyzing axial CT images at the level of the third lumbar vertebra with an image processing application (OsiriX, Pixmeo, Bernex, Switzerland): TAT (a) and SAT (b). VAT is calculated by difference between TAT and SAT. CT: computed tomography; TAT: total adipose tissue; SAT: subcutaneous adipose tissue; VAT: visceral adipose tissue.

**Table 1.** Soft Tissue Bleeding Features and Embolization Techniques
Soft tissue bleeding features	No. of patients
Bleeding site
Iliopsoas muscle	16
Rectus abdominis muscle	12
Quadriceps femoris muscle	4
Adductor magnus muscle	4
Soleus muscle	2
Triceps brachii muscle	5
Biceps brachii muscle	3
Upper abdomen	8
Pelvic floor	6
Serratus anterior muscle	4
Pectoralis minor muscle	2
Masseter muscle	2
Scalene muscles	2
Embolization techniques
Coils	4
Glue	2
Gelfoam	2
Coils + gelfoam	2
Coils + glue	2
Coils + microparticles	4

Table 1. Soft Tissue Bleeding Features and Embolization Techniques

Soft tissue bleeding features

No. of patients

Bleeding site

Iliopsoas muscle

Rectus abdominis muscle

Quadriceps femoris muscle

Adductor magnus muscle

Soleus muscle

Triceps brachii muscle

Biceps brachii muscle

Upper abdomen

Pelvic floor

Serratus anterior muscle

Pectoralis minor muscle

Masseter muscle

Scalene muscles

Embolization techniques

Coils

Glue

Gelfoam

Coils + gelfoam

Coils + glue

Coils + microparticles

**Table 2.** Variables for Bleeding Group and Control Group
Variables	Bleeding group	Control group	P
COVID-19: coronavirus disease 2019; SS: severity score; BMI: body mass index; PLT: platelet; INR: international rationalized ratio; SAT: subcutaneous adipose tissue; VAT: visceral adipose tissue.
No. of patients	70	62
Sex (male/female)	50/20	46/16	> 0.05
Age (mean ± SD) (years)	70.9 ± 11,6	65 ± 11.2	< 0.05
COVID-19 SS	12.5 ± 4.7	14.6 ± 4.5	> 0.05
BMI (kg/m²)	26.6 ± 3.7	29.6 ± 4.9	< 0.05
PLT count (× 10⁹/L)	235.3 ± 91.2	254 ± 75.6	> 0.05
INR	1.3 ± 0.3	1.2 ± 0.2	> 0.05
SAT area (cm²)	136 ± 78	159 ± 82.2	> 0.05
VAT area (cm²)	168 ± 84.6	196 ± 101.9	> 0.05
VAT/SAT	1.5 ± 0.8	1.5 ± 0.9	> 0.05

Table 2. Variables for Bleeding Group and Control Group

Variables

Bleeding group

Control group

COVID-19: coronavirus disease 2019; SS: severity score; BMI: body mass index; PLT: platelet; INR: international rationalized ratio; SAT: subcutaneous adipose tissue; VAT: visceral adipose tissue.

No. of patients

Sex (male/female)

50/20

46/16

> 0.05

Age (mean ± SD) (years)

70.9 ± 11,6

65 ± 11.2

< 0.05

COVID-19 SS

12.5 ± 4.7

14.6 ± 4.5

> 0.05

BMI (kg/m²)

26.6 ± 3.7

29.6 ± 4.9

< 0.05

PLT count (× 10⁹/L)

235.3 ± 91.2

254 ± 75.6

> 0.05

INR

1.3 ± 0.3

1.2 ± 0.2

> 0.05

SAT area (cm²)

136 ± 78

159 ± 82.2

> 0.05

VAT area (cm²)

168 ± 84.6

196 ± 101.9

> 0.05

VAT/SAT

1.5 ± 0.8

1.5 ± 0.9

> 0.05

**Table 3.** Variables for Embolization Group and Non-Embolization Group
Variables	Embolization group	Non-embolization group	P
COVID-19: coronavirus disease 2019; SS: severity score; BMI: body mass index; PLT: platelet; INR: international rationalized ratio; SAT: subcutaneous adipose tissue; VAT: visceral adipose tissue.
No. of patients	16	54
Sex (male/female)	6/10	44/10	< 0.05
Age (mean ± SD) (years)	72.6 ± 6.2	70.4 ± 12.8	> 0.05
COVID-19 SS	10.1 ± 4.6	13.2 ± 4.5	> 0.05
BMI (kg/m²)	25.3 ± 4	27.4 ± 3.6	< 0.05
PLT count (× 10⁹/L)	276.1 ± 65.7	222.7 ± 95.2	> 0.05
INR	1.4 ± 0.5	1.2 ± 0.2	> 0.05
SAT area (cm²)	105.6 ± 63.2	145 ± 80.7	> 0.05
VAT area (cm²)	118.5 ± 58.4	182.7 ± 86.4	< 0.05
VAT/SAT	1.4 ± 0.7	1.6 ± 0.8	> 0.05

Table 3. Variables for Embolization Group and Non-Embolization Group

Variables

Embolization group

Non-embolization group

COVID-19: coronavirus disease 2019; SS: severity score; BMI: body mass index; PLT: platelet; INR: international rationalized ratio; SAT: subcutaneous adipose tissue; VAT: visceral adipose tissue.

No. of patients

Sex (male/female)

6/10

44/10

< 0.05

Age (mean ± SD) (years)

72.6 ± 6.2

70.4 ± 12.8

> 0.05

COVID-19 SS

10.1 ± 4.6

13.2 ± 4.5

> 0.05

BMI (kg/m²)

25.3 ± 4

27.4 ± 3.6

< 0.05

PLT count (× 10⁹/L)

276.1 ± 65.7

222.7 ± 95.2

> 0.05

INR

1.4 ± 0.5

1.2 ± 0.2

> 0.05

SAT area (cm²)

105.6 ± 63.2

145 ± 80.7

> 0.05

VAT area (cm²)

118.5 ± 58.4

182.7 ± 86.4

< 0.05

VAT/SAT

1.4 ± 0.7

1.6 ± 0.8

> 0.05

**Table 4.** Multivariate Logistic Regression Analysis for Bleeding and Control Groups and for Embolization and Non-Embolization Groups
Variables	Score	df	Significance
*Significance was set at 0.05. BMI: body mass index; PLT: platelet; INR: international rationalized ratio; Hb: hemoglobin.
Bleeding and control groups
Age	0.646	1	0.421
Sex	15.086	1	< 0.001*
BMI	1.839	1	0.175
PLT	7.189	1	0.007*
INR	0.024	1	0.877
Hb	0.003	1	0.955
Overall status	18.505	6	0.005
Embolization and non-embolization groups
Age	0.063	1	0.802
Sex	2.182	1	0.140
BMI	13.603	1	< 0.001*
PLT	0.631	1	0.427
INR	2.064	1	0.151
Hb	3.823	1	0.051
Overall status	16.871	6	0.010

Table 4. Multivariate Logistic Regression Analysis for Bleeding and Control Groups and for Embolization and Non-Embolization Groups

Variables

Score

Significance

*Significance was set at 0.05. BMI: body mass index; PLT: platelet; INR: international rationalized ratio; Hb: hemoglobin.

Bleeding and control groups

Age

0.646

0.421

Sex

15.086

< 0.001*

BMI

1.839

0.175

PLT

7.189

0.007*

INR

0.024

0.877

0.003

0.955

Overall status

18.505

0.005

Embolization and non-embolization groups

Age

0.063

0.802

Sex

2.182

0.140

BMI

13.603

< 0.001*

PLT

0.631

0.427

INR

2.064

0.151

3.823

0.051

Overall status

16.871

0.010