tetano
Editor, Senior Moderator
PLoS One
. 2021 Mar 19;16(3):e0248230.
doi: 10.1371/journal.pone.0248230. eCollection 2021.
Validation of an admission coagulation panel for risk stratification of COVID-19 patients
Darwish Alabyad[SUP] 1 [/SUP], Srikant Rangaraju[SUP] 2 [/SUP], Michael Liu[SUP] 2 [/SUP], Rajeel Imran[SUP] 2 [/SUP], Christine L Kempton[SUP] 3 [/SUP], Milad Sharifpour[SUP] 4 [/SUP], Sara C Auld[SUP] 5 6 [/SUP], Manila Gaddh[SUP] 3 [/SUP], Roman Sniecinski[SUP] 7 [/SUP], Cheryl L Maier[SUP] 8 [/SUP], Jeannette Guarner[SUP] 8 [/SUP], Alexander Duncan[SUP] 8 [/SUP], Fadi Nahab[SUP] 9 [/SUP]
Affiliations
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.
. 2021 Mar 19;16(3):e0248230.
doi: 10.1371/journal.pone.0248230. eCollection 2021.
Validation of an admission coagulation panel for risk stratification of COVID-19 patients
Darwish Alabyad[SUP] 1 [/SUP], Srikant Rangaraju[SUP] 2 [/SUP], Michael Liu[SUP] 2 [/SUP], Rajeel Imran[SUP] 2 [/SUP], Christine L Kempton[SUP] 3 [/SUP], Milad Sharifpour[SUP] 4 [/SUP], Sara C Auld[SUP] 5 6 [/SUP], Manila Gaddh[SUP] 3 [/SUP], Roman Sniecinski[SUP] 7 [/SUP], Cheryl L Maier[SUP] 8 [/SUP], Jeannette Guarner[SUP] 8 [/SUP], Alexander Duncan[SUP] 8 [/SUP], Fadi Nahab[SUP] 9 [/SUP]
Affiliations
- PMID: 33740793
- DOI: 10.1371/journal.pone.0248230
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.