Background: High incidence of life-threatening thrombotic complications is observed in severely ill COVID-19 patients. D-dimer may help evaluate disease severity and predict outcomes at hospital admission. However, its non-specificity and long analysis times strongly constrain its clinical value. Viscoelastic tests (VET) are widely available rapid point-of-care devices that have been shown to detect a hypercoagulable state (increased clot stiffness and fibrinolysis shutdown) as major contributors of the thrombotic complication in COVID-19. Nevertheless, based on the data obtained so far, definitive conclusions have not been drawn. Objectives: We aim to evaluate the association between VET parameters, standard coagulation tests and inflammation markers assessed in COVID-19 patients at hospital admission with disease severity and outcomes. Patients/Methods: A total of 69 COVID-19 patients requiring hospitalization were included in the study. The pro-inflammatory and pro-thrombotic state was analyzed by a panel of inflammation markers (IL-6, CRP, LDH, ferritin), routine coagulation tests (PT, aPTT, platelet count, fibrinogen, D-dimer) and a SEER sonorheometry VET profile (Quantra System). Results: Inflammatory markers IL-6, CRP, LDH and ferritin were elevated in a high percentage of patients (73.6%, 89.2%, 57.1% and 52.4%), as were coagulation-related parameters such as fibrinogen (81.4%) and D-dimer levels (66.2%). Quantra analysis revealed increased clot stiffness (CS) in 34.8%, particularly due to increased fibrinogen contribution (FCS) in 63.7%. Increased clot stability to lysis (CSL) was observed in 32.4%. Age > 65 years, elevated values of fibrinogen, D-dimer, LDH, increased clot stiffness and resistance to clot lysis were significantly associated with worsening disease. The Quantra FCS parameter showed a particularly high prognostic value in distinguishing patients with severe symptomatology. Conclusion: The global study of hemostasis by the whole blood point-of-care Quantra VET system may be a powerful tool for identifying poor prognosis in COVID-19 patients at hospital admission. In particular, FCS measured by Quantra could be established as a plausible prognostic marker to aid the clinical management of COVID-19 patients.
A high risk of thrombotic complications has been observed among severely ill COVID-19 patients. Viscoelastic tests (VET) have shown a hypercoagulable profile in these patients, although so far there is no clear evidence on the use of these tools as predictors of risk in the clinical course of patients. In this study we aimed to evaluate the association between Quantra® sonorheometry VET parameters, standard coagulation tests and inflammatory markers in 69 patients with COVID-19 on hospital admission with disease severity and outcome. Inflammatory markers were elevated in a high percentage of patients, as were coagulation-related parameters such as fibrinogen and D-dimer levels. Quantra® sonorheometry analysis revealed increased clot stiffness (CS), especially due to increased fibrinogen contribution (FCS) in 63.7%. Analysis of clot stability to lysis (CSL) on the Quantra showed a value of 100%, suggesting hypofibrinolysis, in 32.4%. Age > 65 years, elevated values of fibrinogen, D-dimer, LDH, increased CS and CSL were significantly associated with worsening disease. The combination of elevated FCS and D-dimer values showed a particularly high prognostic value in distinguishing patients with severe symptomatology. In conclusion, FCS measured by Quantra® system and its combination with D-dimer could be established as a powerful tool to identify poor prognosis in COVID-19 patients on hospital admission.
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