More on COVID‐19 coagulopathy in Caucasian patients

Fogarty, Helen; Townsend, Liam; Cheallaigh, Clíona Ní; Bergin, Colm; Martín‐Loeches, Ignacio; Browne, Paul; Bacon, Christopher L.; Gaule, Richard; Gillett, Alexander; Byrne, Mary; Ryan, Kevin M.; O’Connell, Niamh M; O’Sullivan, Jamie M.; Conlon, Niall; O’Donnell, James S.

doi:10.1111/bjh.16791

Cited by 137 publications

(190 citation statements)

References 18 publications

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“…Several studies have described DIC in some Covid-19 patients. In the study of Fogarty et al (38), DIC was rare and appeared in the late stage disease. In two others studies (8, 39) DIC was signi cantly more frequent in non survivors than in survivors.…”

Section: Discussionmentioning

confidence: 91%

Haematological factors of SARS-CoV-2 infection aggravation: a COVID'HEMOS study

Billoir

Alexandre

Duflot

et al. 2020

Preprint

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Since December 2019, a pandemic caused by a new coronavirus has spread to more than 170 countries around the world. Worsening infected patients requiring intensive care unit (ICU) admission, associated with 30% of mortality. A part of worsening is mediated by haemostasis deregulation. The primary aim of this study was to determine if haematological biomarkers, in addition to clinical risk factors on hospital admission, predict worsening (defined by ICU admission and/or death) in Covid-19 infected patients, and secondary, if they could predict the occurrence of thrombotic events. Thirty-five of the 99 patients got clinically worse and 8 developed pulmonary embolism (PE). Final model of the logistic regression analysis revealed that oxygenodependence (RR=7.27[1.50-19.31]), fibrinogen levels (RR=1.45[1.17-1.82]), thrombin peak (RR=1.28[1.03-1.59]), monocytes counts below 0.2 G/L (RR=2.88[1.67-3.19]) and prothrombin fragment 1+2 (F1+2) higher than 290 pM (RR=2.39[1.20-3.30]) were associated with clinical worsening. Fibrinogen level threshold of 5.5 g/L, thrombin peak measurement threshold of 99 pM and oxygenodepence allowed prediction of clinical outcome in near than 80% of our cohort. Moreover, using ROC curves, thrombin peak and F1+2 on admission with a threshold of 204 nM and 393 pM were sensitive and specific to predict PE (AUC: 85.7% Se: 70.8% Sp: 100% and AUC: 81.5% Se: 75.0% Sp: 86.8% respectively). In conclusion, we described a rapid decision tree to predict outcome of SARS-CoV-2 infected patients based on fibrinogen, TGA peak and oxygen dependence. Furthermore, thrombin peak and F1+2 seem to be specific haematological marker to predict PE, even in patients with thromboprophylaxis.

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Section: Discussionmentioning

confidence: 91%

Haematological factors of SARS-CoV-2 infection aggravation: a COVID'HEMOS study

Billoir

Alexandre

Duflot

et al. 2020

Preprint

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“…COVID patients with persistent or enlarged thymus were younger than patients with normal thymic fatty atrophy, and displayed, on average, more severe pulmonary involvement: 4 [3][4][5] vs. 2 [1.5-4], p=0.01, Figure 3. They were also less frequently hypertensive, developed less frequently renal failure and had a lower mortality rate (8.6% versus 41.2%, p<0.001, Figure 4).…”

Section: Descriptive Analysismentioning

confidence: 99%

“…Although a large proportion of infected people remains asymptomatic or develops a more or less severe u-like syndrome, some patients requires hospitalization [1,2]. A fraction of them can develop severe forms, the severe acute respiratory syndrome (SARS) being the most frequent, associated or not with acute myocardial injury, sepsis, coagulopathy and other organs injury [3][4][5]. In France, the infection fatality ratio is on average 0.53%, ranging from 0.001% in individuals under 20y to 8.3% in patients >80y [6].…”

Section: Introductionmentioning

confidence: 99%

Protective Reactive Thymus Hyperplasia in the COVID-19 Acute Respiratory Distress Syndrome

Cuvelier

Roux

Couëdel-Courteille

et al. 2020

Preprint

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Background. COVID-19 (COVID) patients can develop acute respiratory distress syndrome associated or not with sepsis, coagulopathy and visceral injuries. While thoracic CT-scans are routinely performed in the initial evaluation of patients with severe pulmonary forms, thymus involvement and reactivation have not been investigated so far.Methods. In this observational study, we systematically scored the thymus enlargement and the lung involvement, using CT-scans, in all adult patients admitted in ICU for COVID or any other cause (control group) in one center between March and April 2020. Initial biological investigations included nasal detection of SARS-CoV-2 ribonucleic acid detection by positive polymerase chain reaction (PCR). In a subgroup of 24 patients with different degrees of pulmonary involvement and thymus hypertrophy, plasma cytokines concentrations were measured and mature T-cell export from the thymus was estimated simultaneously by PCR quantification of T-cell receptor excision circles (TRECs).Results. Eighty-seven patients were studied: 50 COVID patients and 37 controls. Non-atrophic or enlarged thymus was more frequent in COVID patients than in controls (66% vs. 24%, p<0.0001). Thymus enlargement in COVID patients was associated with more extensive pulmonary involvement score on CT-scans 4 [3-5] vs. 2 [1.5-4], p=0.01, but lower mortality (8.6% versus 41.2%, p<0.001). Other factors associated with mortality were age, lymphopenia, high CRP and co-morbidities. COVID patients had higher concentrations of IL-7: 6.00 [3.72-9.25] vs. 2.17 [1.76-4.4] pg/mL; p=0.04, and higher thymic production of new lymphocytes: TRECS ratio = 2.88 [1.98-4.51] vs. 0.23 [0.15-0.60]; p=0.004. This thymic production was also correlated to the CT-scan thymic score (r = 0.38, p=0.03) and inversely correlated to the lymphocyte count (r=0.56, p=0.007).Conclusions. In COVID patients, thymus enlargement was frequent and associated with increased T-lymphocytes production that appears a beneficial adaptation to virus-induced lymphopenia. The loss of thymic reactivation might contribute to worse prognosis.Trial registration: NA

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“…Among them, seven articles ful lled the inclusion criteria, and one article was assessed after reviewing the references of another study. Thus, eight studies were analyzed in the scoping review [8][9][10][11][12][13][14][15]. The results of the literature search strategy are described in Table 2.…”

Section: Selection Of Sources Of Evidencementioning

confidence: 99%

“…Regarding the status of the studies, seven studies have been published and two clinical studies are ongoing. The rst study was published in March 2020 [8], followed by studies in April (n = 4) [9][10][11][12] and May (n = 1) [13]. The ongoing studies were registered in March [14] and April [15].…”

Section: Status Publication or Registration Data And Locationmentioning

confidence: 99%

Treatment of Coagulopathy in COVID-19 Patients: A scoping review

Mori

Ohkawara

Togawa

et al. 2020

Preprint

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Background: Coagulopathy, including disseminated intravascular coagulation, is frequently noted in patients with coronavirus infection disease 2019 (COVID-19). Recently, a number of articles on this topic have been reported.Objective: The aim of this study is to identify existing gaps where further research on anticoagulants in COVID-19 patients with coagulopathy needs to be done.Methods: We used the PRISMA Extension for Scoping Reviews. The protocol was registered on May 21, 2020, before conducting this review. MEDLINE, CENTRAL, WHO-ICTRP, ClinicalTrial.gov and PROSPERO were used.Result: Eight studies were included; six studies were already published and two are ongoing. The reported results for three publications were from case series, three were from retrospective cohorts and two were from randomized controlled trials. Eight studies examined the effectiveness of low molecular weight heparin (LMWH), of which seven studies used a prophylactic dose and four studies used a therapeutic dose of LMWH. A prophylactic or therapeutic dose of unfractionated heparin was investigated in four and three studies, respectively. No recombinant human soluble thrombomodulin was investigated. Conclusion: The anticoagulants are limited to heparinoids, and the study designs were of low quality. Further studies with an improved design are needed to compare other available anticoagulants.

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More on COVID‐19 coagulopathy in Caucasian patients

Cited by 137 publications

References 18 publications

Haematological factors of SARS-CoV-2 infection aggravation: a COVID'HEMOS study

Haematological factors of SARS-CoV-2 infection aggravation: a COVID'HEMOS study

Protective Reactive Thymus Hyperplasia in the COVID-19 Acute Respiratory Distress Syndrome

Treatment of Coagulopathy in COVID-19 Patients: A scoping review

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