Validation of an admission coagulation panel for risk stratification of covid-19 patients

• Type of Material: Article
• Authors: Darwish Alabyad, Morehouse School of Medicine; Srikant Rangaraju, Emory University; Michael Liu, Emory University; Rajeel Imran, Emory University; Milad Sharifpour, Emory University; Christine Kempton, Emory University; Sara C. Auld, Emory Healthcare; Manila Gaddh, Emory University; Roman Sniecinski, Emory University; Cheryl L. Maier, Emory University; Jeannette Guarner, Emory University; Alexander Duncan, Emory University; Fadi Nahab, Emory University
• Language: English
• Date: 2021-03-01
• Publisher: PLOS
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Alabyad et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0248230
• Title of Journal or Parent Work: PLoS ONE
• Volume: 16
• Issue: 3 March
• Start Page: e0248230
• End Page: e0248230
• Grant/Funding Information: The authors received no specific funding for this work.
• Keywords: Middle Aged; Risk Factors; Humans; Fibrin Fibrinogen Degradation Products; Cohort Studies; Prothrombin; Aged; Peptide Hydrolases; Thrombosis; Survival Rate; Area Under Curve; Male; Antithrombin III; Odds Ratio; Intensive Care Units; COVID-19; Peptide Fragments; Female; ROC Curve; SARS-CoV-2; Patient Admission
• Research Categories: Health Sciences, Health Care Management; Biology, Virology; Health Sciences, Pharmacology

Abstract

Background: There is limited data on the markers of coagulation and hemostatic activation (MOCHA) profile in Coronavirus disease 2019 (COVID-19) and its ability to identify COVID-19 patients at risk for thrombotic events and other complications. Methods: Hospitalized patients with confirmed SARS-COV-2 from four Atlanta hospitals were included in this observational cohort study and underwent admission testing of MOCHA parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer). Clinical outcomes included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, access line thrombosis, ICU admission, intubation and mortality. Main results: Of 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American), 45 (16%) had a thrombotic endpoint. Each MOCHA parameter was independently associated with a thrombotic event (p<0.05) and ? 2 abnormalities was associated with thrombotic endpoints (OR 3.3, 95% CI 1.2-8.8) as were admission D-dimer ? 2000 ng/mL (OR 3.1, 95% CI 1.5-6.6) and ? 3000 ng/mL (OR 3.6, 95% CI 1.6-7.9). However, only ? 2 MOCHA abnormalities were associated with ICU admission (OR 3.0, 95% CI 1.7-5.2) and intubation (OR 3.2, 95% CI 1.6-6.4). MOCHA and D-dimer cutoffs were not associated with mortality. MOCHA with <2 abnormalities (26% of the cohort) had 89% sensitivity and 93% negative predictive value for a thrombotic endpoint. Conclusions: An admission MOCHA profile is useful to risk-stratify COVID-19 patients for thrombotic complications and more effective than isolated d-dimer for predicting risk of ICU admission and intubation.