Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection

Frontiers in Medicine

Odile Goria¹  Maxime Roger²  Mathieu Demeyere³  Luc Marie Joly⁴  Valery Brunel⁵  Sébastien Miranda⁶  Manuel Etienne⁷  Kevin Alexandre⁷  Thomas Duflot⁸  Guillaume Feugray⁹  Véronique Le Cam Duchez⁹  Paul Billoir^1,10 

[1] CHU Rouen, Department of Gastroenterology and Hepatology, Rouen, France;CHU Rouen, Department of Pneumology, Rouen, France;CHU Rouen, Department of Radiology, Rouen, France;Department of Emergency Medicine, Normandie Univ, UNIROUEN, CHU Rouen, Rouen, France;Department of General Biochemistry, CHU Rouen, Rouen, France;F-CRIN INNOVTE, St-Étienne, France;Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Department of Internal Medicine, Rouen, France;Normandie Univ, UNIROUEN, EA2656, CHU Rouen, Department of Infectious Diseases, Rouen, France;Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Department of Pharmacology, Rouen, France;Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, France;Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, France;F-CRIN INNOVTE, St-Étienne, France;

关键词: COVID-19;    intensive care;    hypercoagulability;    fibrinogen;    thrombin generation;   

DOI  :  10.3389/fmed.2021.670694

来源: Frontiers

【 摘 要 】

Since December 2019, a pandemic caused by a new coronavirus has spread to more than 170 countries around the world. Worsening infected patients requiring intensive care unit (ICU) admission associated with 30% of mortality. A part of worsening is induced by hemostasis deregulation. The aim of this study was to investigate the association of coagulation activation in COVID-19 progression. Thirty-five of the 99 patients got clinically worse. The final model of the logistic regression analysis revealed that O2 requirement (RR = 7.27 [1.50–19.31]), monocytes below 0.2G/L (RR = 2.88 [1.67–3.19]), fibrinogen levels (RR = 1.45 [1.17–1.82] per g/L increase), prothrombin fragments 1+2 higher than 290 pM (RR = 2.39 [1.20–3.30]), and thrombin peak (RR = 1.28 [1.03–1.59] per 50 nM increase) were associated with an increased risk of clinical worsening. A fibrinogen level threshold of 5.5 g/L, a thrombin peak measurement threshold of 99 pM, and O2 requirement associated with clinical outcome in more than 80% of our cohort. In conclusion, we identified fibrinogen and thrombin peak at admission as coagulation biomarkers associated with an increased risk of ICU admission or death. This finding allows initiating steroids and triage for worsening patients. Our results should therefore be considered as exploratory and deserve confirmation.

【 授权许可】

CC BY