Retrospective Analyses Associate Hemostasis Activation Biomarkers With Poor Outcomes in Patients With COVID-19

• Type of Material: Article
• Authors: Mitchell Moosavi, Emory University; Melanie Wooten, Emory University; Abigail Goodman, Emory University; Fadi Nahab, Emory University; Alexander Duncan, Emory University; Cheryl Maier, Emory University; Jeannette Guarner, Emory University
• Language: English
• Date: 2021-04-01
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Final Published Version
• Copyright Statement: © American Society for Clinical Pathology, 2020.
• Final Published Version (URL): http://dx.doi.org/10.1093/AJCP/AQAA266
• Title of Journal or Parent Work: AMERICAN JOURNAL OF CLINICAL PATHOLOGY
• Volume: 155
• Issue: 4
• Start Page: 498
• End Page: 505
• Keywords: Coagulation; SARS-CoV-2; Hemostasis; Pathology; Thrombophilia; COVID-19; Coagulopathy; Coronavirus; Thrombotic complications; Science & Technology; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Pathology; Biology, Neuroscience

Abstract

Objectives: Patients with coronavirus disease 2019 (COVID-19) have thromboembolic complications. Assessment of coagulation and other markers could be useful to understand their coagulopathy. Methods: We performed a retrospective study of inflammatory and coagulation parameters, including prothrombin fragment 1.2 (PF1.2), thrombin-antithrombin complexes (TATs), fibrin monomers, and D-dimer, in hospitalized patients with COVID-19. We compared the markers in patients with thrombosis, admission to the intensive care unit (ICU), and poor outcome. Results: Of the 81 patients, 9 (11%) experienced an acute thrombotic event (4 with pulmonary embolism, 3 with venous thrombosis, and 2 with stroke). PF1.2 was elevated in 32 (39%) patients, TATs in 54 (67%), fibrin monomers in 49 (60%), and D-dimer in 76 (94%). Statistically significant elevation in PF1.2 and TATs was seen in patients admitted to the ICU, while D-dimer and fibrin monomers were significantly elevated in patients with poor outcomes. The presence of multiple abnormal coagulation parameters was associated with ICU admission. Other parameters with statistically significant results included abnormal WBC counts and elevated C-reactive protein, which were associated with ICU admission and poor outcomes. Conclusions: Our data demonstrate that abnormalities of biomarkers of hemostasis activation and inflammatory markers are associated with poor outcomes in patients with COVID-19.