Background

COVID-19 predisposes patients to a prothrombotic state with demonstrated microvascular involvement. The degree of hypercoagulability appears to correlate with outcomes; however, optimal criteria to assess for the highest-risk patients for thrombotic events remain unclear; we hypothesized that deranged thromboelastography measurements of coagulation would correlate with thromboembolic events.

Study Design

Patients admitted to an ICU with COVID-19 diagnoses who had thromboelastography analyses performed were studied. Conventional coagulation assays, d-dimer levels, and viscoelastic measurements were analyzed using a receiver operating characteristic curve to predict thromboembolic outcomes and new-onset renal failure.

Results

Forty-four patients with COVID-19 were included in the analysis. Derangements in coagulation laboratory values, including elevated d-dimer, fibrinogen, prothrombin time, and partial thromboplastin time, were confirmed; viscoelastic measurements showed an elevated maximum amplitude and low lysis of clot at 30 minutes. A complete lack of lysis of clot at 30 minutes was seen in 57% of patients and predicted venous thromboembolic events with an area under the receiver operating characteristic curve of 0.742 (p = 0.021). A d-dimer cutoff of 2,600 ng/mL predicted need for dialysis with an area under the receiver operating characteristic curve of 0.779 (p = 0.005). Overall, patients with no lysis of clot at 30 minutes and a d-dimer > 2,600 ng/mL had a venous thromboembolic event rate of 50% compared with 0% for patients with neither risk factor (p = 0.008), and had a hemodialysis rate of 80% compared with 14% (p = 0.004).

Conclusions

Fibrinolysis shutdown, as evidenced by elevated d-dimer and complete failure of clot lysis at 30 minutes on thromboelastography predicts thromboembolic events and need for hemodialysis in critically ill patients with COVID-19. Additional clinical trials are required to ascertain the need for early therapeutic anticoagulation or fibrinolytic therapy to address this state of fibrinolysis shutdown.

中文翻译：

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严重COVID-19感染中纤维蛋白溶解的关闭与血栓栓塞事件的相关性。

背景

COVID-19使患者处于血栓形成前状态，并显示微血管受累。高凝程度似乎与预后相关。然而，评估高危患者血栓事件的最佳标准尚不清楚；我们假设血栓弹性成像的凝血测定失常会与血栓栓塞事件相关。

学习规划

研究入院诊断为COVID-19的ICU的患者进行了血栓弹性成像分析。使用接收器操作特征曲线分析常规凝血测定，d-二聚体水平和粘弹性测量，以预测血栓栓塞结局和新发肾功能衰竭。

结果

分析包括44名COVID-19患者。确认了凝血实验室值的变化，包括升高的d-二聚体，纤维蛋白原，凝血酶原时间和部分凝血活酶时间。粘弹性测量显示在30分钟时最大振幅升高且血凝块溶解降低。在57％的患者中观察到30分钟时血凝块完全缺乏，并预测了静脉血栓栓塞事件，接受者操作特征曲线下的面积为0.742（p = 0.021）。甲d -dimer截止的2600纳克/毫升的预测需要透析与接收机操作0.779（p值= 0.005）的特性曲线下的面积。总体而言，患者在30分钟和30 d内无凝块溶解-二聚体> 2600 ng / mL时，无危险因素的患者的静脉血栓栓塞事件发生率为50％，相比之下为0％（p = 0.008），血液透析发生率为80％，而没有血液透析患者为14％（p = 0.004）。

结论

纤维蛋白溶解关闭，如血栓弹力描记术中30分钟的d-二聚体升高和凝块溶解完全失败所证明，可预测血栓栓塞事件和重症COVID-19患者需要进行血液透析。需要其他临床试验以确定早期治疗性抗凝或纤溶治疗以解决这种纤溶关闭状态的必要性。