Contributions
Abstract: EP1324
Type: E-Poster Presentation
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
COVID-19 is a severe respiratory disease caused by the SARS-CoV-2 that manifests severely in a high number of patients, leading to hospitalization of many of them and in the worst case to death. Recent studies have shown a high incidence of thrombotic complications in these patients, especially in those with poor prognosis, and confer special interest to D-dimer as an indicator of poor prognosis. However, the diagnostic value of D-dimer is limited by the long analysis times and that it only reflects the final part of the physiological process of hemostasis. Therefore, the identification of other parameters is needed to allow a rapid and reliable characterization of the hemostatic status of the patient. Viscoelastic testing allows a global analysis of coagulation and have already proven their usefulness in the study of other infectious diseases. The application of viscoelastic tests in COVID-19 patients would therefore be very useful to quickly determine the hemostatic status of patients and thus identify predictors of poor prognosis.
Aims
To characterize the hemostatic status of COVID-19 patients with standard and viscoelastic testings, and identification of poor prognosis variables.
Methods
Prospective, observational, single-centre study. A total of 50 patients requiring hospitalization were included in the study. The next-generation viscoelastic testing “Quantra Hemostasis Analyzer” (HemoSonics) was used to determine the coagulation profile of patients. Blood samples at the time of hospitalization were taken to determine the parameters reported by Quantra (QStat and QPlus cartridges). Correlation study using a heat map of our Spearman partial correlation matrix with a confidence interval of 95%.
Results
As described, a high percentage of COVID-19 patients admitted to hospital showed increased levels of fibrinogen (81.6%), D-dimer (61.9%), IL-6 (70.3%) and increased clot stiffness measured by CS, FCS and PCS parameters (63.6%), while clotting times were normal in almost 100% of patients. Age (>65 years), together with elevated levels of D-dimer, LDH and clot firmness were associated with the presence of an adverse event during admission, including the need for mechanical ventilation, ICU admission or death (p=0.007/0.030/0.010/0.002). Increased D-dimer levels were significantly recurrent in patients >65 years (p=0.031). A significant difference was observed between the median of these parameters between patients who experienced an adverse event and those who did not: fibrinogen (750 vs 532, p=0.010), D-dimer (779 vs 560, p=0.005), LDH (309 vs 227, p=0.027), CTH (131.5 vs 123, p=0.042), CS (38.15 vs 25, p=0.042), PCS (30.85 vs 20.7, p=0.042) and FCS (7.45 vs 3.9, p=0.027). Multiple correlation study using HeatMap representation revealed independence between clot firmness, age, LDH and D-dimer levels.
Conclusion
The study of global hemostatic status using Quantra can be a powerful tool for the analysis of COVID-19 patients at admission and thereby predict risk by identifying markers of poor prognosis. Increased levels of parameters measuring clot stiffness are associated with the presence of an adverse event in patients and can be considered as new independent prognostic markers.
Keyword(s): Coagulation, COVID-19, Thrombosis
Abstract: EP1324
Type: E-Poster Presentation
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
COVID-19 is a severe respiratory disease caused by the SARS-CoV-2 that manifests severely in a high number of patients, leading to hospitalization of many of them and in the worst case to death. Recent studies have shown a high incidence of thrombotic complications in these patients, especially in those with poor prognosis, and confer special interest to D-dimer as an indicator of poor prognosis. However, the diagnostic value of D-dimer is limited by the long analysis times and that it only reflects the final part of the physiological process of hemostasis. Therefore, the identification of other parameters is needed to allow a rapid and reliable characterization of the hemostatic status of the patient. Viscoelastic testing allows a global analysis of coagulation and have already proven their usefulness in the study of other infectious diseases. The application of viscoelastic tests in COVID-19 patients would therefore be very useful to quickly determine the hemostatic status of patients and thus identify predictors of poor prognosis.
Aims
To characterize the hemostatic status of COVID-19 patients with standard and viscoelastic testings, and identification of poor prognosis variables.
Methods
Prospective, observational, single-centre study. A total of 50 patients requiring hospitalization were included in the study. The next-generation viscoelastic testing “Quantra Hemostasis Analyzer” (HemoSonics) was used to determine the coagulation profile of patients. Blood samples at the time of hospitalization were taken to determine the parameters reported by Quantra (QStat and QPlus cartridges). Correlation study using a heat map of our Spearman partial correlation matrix with a confidence interval of 95%.
Results
As described, a high percentage of COVID-19 patients admitted to hospital showed increased levels of fibrinogen (81.6%), D-dimer (61.9%), IL-6 (70.3%) and increased clot stiffness measured by CS, FCS and PCS parameters (63.6%), while clotting times were normal in almost 100% of patients. Age (>65 years), together with elevated levels of D-dimer, LDH and clot firmness were associated with the presence of an adverse event during admission, including the need for mechanical ventilation, ICU admission or death (p=0.007/0.030/0.010/0.002). Increased D-dimer levels were significantly recurrent in patients >65 years (p=0.031). A significant difference was observed between the median of these parameters between patients who experienced an adverse event and those who did not: fibrinogen (750 vs 532, p=0.010), D-dimer (779 vs 560, p=0.005), LDH (309 vs 227, p=0.027), CTH (131.5 vs 123, p=0.042), CS (38.15 vs 25, p=0.042), PCS (30.85 vs 20.7, p=0.042) and FCS (7.45 vs 3.9, p=0.027). Multiple correlation study using HeatMap representation revealed independence between clot firmness, age, LDH and D-dimer levels.
Conclusion
The study of global hemostatic status using Quantra can be a powerful tool for the analysis of COVID-19 patients at admission and thereby predict risk by identifying markers of poor prognosis. Increased levels of parameters measuring clot stiffness are associated with the presence of an adverse event in patients and can be considered as new independent prognostic markers.
Keyword(s): Coagulation, COVID-19, Thrombosis