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

• 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
• Journal Title: PLoS ONE
• Volume: Volume 16, Number 3 March
• Publisher: PLOS | 2021-03-01, Pages e0248230-e0248230
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1371/journal.pone.0248230
• Subjects: Biology, Virology; Health Sciences, Health Care Management; Health Sciences, Pharmacology
• Keywords: Aged; Antithrombin III; Area Under Curve; COVID-19; Cohort Studies; Female; Fibrin Fibrinogen Degradation Products; Humans; Intensive Care Units; Male; Middle Aged; Odds Ratio; Patient Admission; Peptide Fragments; Peptide Hydrolases; Prothrombin; ROC Curve; Risk Factors; SARS-CoV-2; Survival Rate; Thrombosis

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.