Background A new clinical syndrome has been recognized following the COVID-19 vaccine, termed thrombosis with thrombocytopenia syndrome (TTS). The following systematic review focuses on extrapolating thrombotic risk factors, clinical manifestations, and outcomes of patients diagnosed with TTS following the COVID-19 vaccine. Methods We utilized the World Health Organization's criteria for a confirmed and probable case of TTS following COVID-19 vaccination and conducted a systematic review and posthoc analysis using the PRISMA 2020 statement. Data analysis was conducted using SPSS V25 for factors associated with mortality, including age, gender, anti-PF4/heparin antibodies, platelet nadir, D-dimer peak, time to event diagnosis, arterial or venous thrombi. Results Of the 175 studies identified, a total of 25 studies with 69 patients were included in this systematic review and post hoc analysis. Platelet nadir ( P < .001), arterial or venous thrombi ( χ2 = 41.911, P = .05), and chronic medical conditions ( χ2 = 25.507, P = .041) were statistically associated with death. The ROC curve analysis yielded D-dimer (AUC = .646) and platelet nadir (AUC = .604) as excellent models for death prediction. Conclusion Adenoviral COVID-19 vaccines have been shown to trigger TTS, however, reports of patients having received mRNA COVID-19 vaccines are also present. Healthcare providers are recommended to maintain a high degree of suspicion among individuals who have received the COVID-19 vaccine within the last 4 weeks.

Objectives: Determine the incidence and predisposing factors of acquired-hypernatraemia in the intensive care units (ICU) and its impact on the outcome. Design: Observational cross-sectional study with prospective analysis. Setting: Surgical, medical and trauma intensive care units of National Hospital of Sri Lanka. Study Population: 174 consecutive patients were included in this study. Definition: Hypernatraemia was defined as serum sodium concentration > 145 mmol/l. Results: 74 patients (42.5%) developed hypernatraemia after admission to the intensive care units. Incidence in medical, surgical and trauma ICUs were 47%, 48% and 31% respectively. Significantly lower incidence was reported in patients with trauma compared to the patients from the other two ICUs. High APACHE II (Acute Physiology and Chronic Health Evaluation) score, low GCS (Glasgow Coma Scale), organ dysfunction, transfusion of blood and blood products were associated with an increased incidence of hypernatraemia. Hypernatraemic patients had received significantly greater volume of intravenous fluids exceeding their daily fluid requirement. Compared to normonatraemic patients, hypernatraemic patients demonstrated a longer length of stay (LOS) in the ICU (mean 4.8 days versus 11 days, p< 0.001) and a higher ICU-mortality rate (15% versus 43%, p<0.001). Conclusions: Severity of the illness, inappropriate intravenous fluid therapy and blood transfusions contribute to the incidence of hypernatraemia in intensive care units. It is associated with increased risk of ICU-mortality and longer length of stay in the ICU.