tetano
Editor, Senior Moderator
TH Open
. 2021 Dec 21;6(1):e50-e59.
doi: 10.1055/a-1725-9221. eCollection 2022 Jan.
Hypercoagulation Detected by Rotational Thromboelastometry Predicts Mortality in COVID-19: A Risk Model Based on a Prospective Observational Study
Lou M Almskog[SUP] 1 2 [/SUP], Agneta Wikman[SUP] 3 4 [/SUP], Jonas Svensson[SUP] 5 [/SUP], Matteo Bottai[SUP] 6 [/SUP], Mariann Kotormán[SUP] 1 [/SUP], Carl-Magnus Wahlgren[SUP] 2 7 [/SUP], Michael Wanecek[SUP] 1 8 [/SUP], Jan van der Linden[SUP] 2 9 [/SUP], Anna Ågren[SUP] 2 10 11 [/SUP]
Affiliations
Abstract
Background Severe disease due to the novel coronavirus disease 2019 (COVID-19) has been shown to be associated with hypercoagulation. The aim of this study was to assess the Rotational Thromboelastometry (ROTEM) as a marker of coagulopathy in hospitalized COVID-19 patients. Methods This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model, including variables ROTEM EXTEM-MCF (Maximum Clot Firmness) which in previous data has been suggested a suitable marker of hypercoagulation, age, and respiratory frequency, was developed using logistic regression to evaluate the probability of death. Results Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age, and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM-coagulation time (CT) was observed, supporting a severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) effect on prolonged initiation of coagulation. Conclusion Here, we show that hypercoagulation measured with ROTEM predicts 30-day mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.
Keywords: COVID-19; coagulopathy; mortality; thromboelastometry; thrombosis.
. 2021 Dec 21;6(1):e50-e59.
doi: 10.1055/a-1725-9221. eCollection 2022 Jan.
Hypercoagulation Detected by Rotational Thromboelastometry Predicts Mortality in COVID-19: A Risk Model Based on a Prospective Observational Study
Lou M Almskog[SUP] 1 2 [/SUP], Agneta Wikman[SUP] 3 4 [/SUP], Jonas Svensson[SUP] 5 [/SUP], Matteo Bottai[SUP] 6 [/SUP], Mariann Kotormán[SUP] 1 [/SUP], Carl-Magnus Wahlgren[SUP] 2 7 [/SUP], Michael Wanecek[SUP] 1 8 [/SUP], Jan van der Linden[SUP] 2 9 [/SUP], Anna Ågren[SUP] 2 10 11 [/SUP]
Affiliations
- PMID: 35265789
- PMCID: PMC8901374
- DOI: 10.1055/a-1725-9221
Abstract
Background Severe disease due to the novel coronavirus disease 2019 (COVID-19) has been shown to be associated with hypercoagulation. The aim of this study was to assess the Rotational Thromboelastometry (ROTEM) as a marker of coagulopathy in hospitalized COVID-19 patients. Methods This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model, including variables ROTEM EXTEM-MCF (Maximum Clot Firmness) which in previous data has been suggested a suitable marker of hypercoagulation, age, and respiratory frequency, was developed using logistic regression to evaluate the probability of death. Results Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age, and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM-coagulation time (CT) was observed, supporting a severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) effect on prolonged initiation of coagulation. Conclusion Here, we show that hypercoagulation measured with ROTEM predicts 30-day mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.
Keywords: COVID-19; coagulopathy; mortality; thromboelastometry; thrombosis.