Hypercoagulability in critically ill patients with COVID 19, an observational prospective study.

oleh: Laure Calvet, François Thouy, Olivier Mascle, Anne-Françoise Sapin, Kévin Grapin, Jean Mathias Liteaudon, Bertrand Evrard, Benjamin Bonnet, Mireille Adda, Bertrand Souweine, Claire Dupuis

Format: Article
Diterbitkan: Public Library of Science (PLoS) 2022-01-01

Deskripsi

<h4>Objective</h4>COVID 19 is often associated with hypercoagulability and thromboembolic (TE) events. The aim of this study was to assess the characteristics of hypercoagulability and its relationship with new-onset TE events and the composite outcome of need for intubation and/or death in intensive care unit (ICU) patients admitted for COVID.<h4>Design</h4>Prospective observational study.<h4>Setting</h4>Monocentric, intensive care, University Hospital of Clermont Ferrand, France.<h4>Patients</h4>Patients admitted to intensive care from January 2020 to May 2021 for COVID-19 pneumonia.<h4>Interventions</h4>Standard hemostatic tests and rotational thromboelastometry (ROTEM) were performed on admission and on day 4. Hypercoagulability was defined by at least one of the following criteria: D-dimers > 3000 μg/dL, fibrinogen > 8 g/L, EXTEM CFT below the normal range, EXTEM A5, MCF, Li 60 above the normal range, and EXTEM G-score ((5000 x MCF) / (100-MCF)) ≥ 11 dyne/cm2.<h4>Measurements and main results</h4>Of the 133 patients included, 17 (12.7%) developed new-onset TE events, and 59 (44.3%) required intubation and/or died in the ICU. ROTEM was performed in 133 patients on day 1 and in 67 on day 4. Hypercoagulability was present on day 1 in 115 (86.4%) patients. None of the hypercoagulability indices were associated with subsequent new-onset TE events on days 1 and 4 nor with the need for intubation and/or ICU death. Hyperfibrinogenemia > 8g/dL, higher D-dimers and higher EXTEM Li 60 on day 4 were predictive of need for intubation and/or of ICU death.<h4>Conclusions</h4>Our study confirmed that most COVID-19 ICU patients have hypercoagulability on admission and almost all on day 4. Hyperfibrinogenemia or fibrinolysis shutdown on day 4 were associated with unfavorable outcome.