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Klenk C, Erber J, Fresacher D, Röhrl S, Lengl M, Heim D, Irl H, Schlegel M, Haller B, Lahmer T, Diepold K, Rasch S, Hayden O. Platelet aggregates detected using quantitative phase imaging associate with COVID-19 severity. COMMUNICATIONS MEDICINE 2023; 3:161. [PMID: 37935793 PMCID: PMC10630365 DOI: 10.1038/s43856-023-00395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The clinical spectrum of acute SARS-CoV-2 infection ranges from an asymptomatic to life-threatening disease. Considering the broad spectrum of severity, reliable biomarkers are required for early risk stratification and prediction of clinical outcomes. Despite numerous efforts, no COVID-19-specific biomarker has been established to guide further diagnostic or even therapeutic approaches, most likely due to insufficient validation, methodical complexity, or economic factors. COVID-19-associated coagulopathy is a hallmark of the disease and is mainly attributed to dysregulated immunothrombosis. This process describes an intricate interplay of platelets, innate immune cells, the coagulation cascade, and the vascular endothelium leading to both micro- and macrothrombotic complications. In this context, increased levels of immunothrombotic components, including platelet and platelet-leukocyte aggregates, have been described and linked to COVID-19 severity. METHODS Here, we describe a label-free quantitative phase imaging approach, allowing the identification of cell-aggregates and their components at single-cell resolution within 30 min, which prospectively qualifies the method as point-of-care (POC) testing. RESULTS We find a significant association between the severity of COVID-19 and the amount of platelet and platelet-leukocyte aggregates. Additionally, we observe a linkage between severity, aggregate composition, and size distribution of platelets in aggregates. CONCLUSIONS This study presents a POC-compatible method for rapid quantitative analysis of blood cell aggregates in patients with COVID-19.
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Affiliation(s)
- Christian Klenk
- Heinz-Nixdorf-Chair of Biomedical Electronics, School of Computation, Information and Technology, Technical University of Munich, TranslaTUM, 81675, Munich, Germany
| | - Johanna Erber
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department for Internal Medicine II, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - David Fresacher
- Heinz-Nixdorf-Chair of Biomedical Electronics, School of Computation, Information and Technology, Technical University of Munich, TranslaTUM, 81675, Munich, Germany
- Chair for Data Processing, School of Computation, Information and Technology, Technical University of Munich, 80333, Munich, Germany
| | - Stefan Röhrl
- Chair for Data Processing, School of Computation, Information and Technology, Technical University of Munich, 80333, Munich, Germany
| | - Manuel Lengl
- Chair for Data Processing, School of Computation, Information and Technology, Technical University of Munich, 80333, Munich, Germany
| | - Dominik Heim
- Heinz-Nixdorf-Chair of Biomedical Electronics, School of Computation, Information and Technology, Technical University of Munich, TranslaTUM, 81675, Munich, Germany
| | - Hedwig Irl
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Martin Schlegel
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Bernhard Haller
- TUM School of Medicine and Health, Department of Clinical Medicine - Institute of AI and Informatics in Medicine, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Tobias Lahmer
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department for Internal Medicine II, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Klaus Diepold
- Chair for Data Processing, School of Computation, Information and Technology, Technical University of Munich, 80333, Munich, Germany
| | - Sebastian Rasch
- TUM School of Medicine and Health, Department of Clinical Medicine - Clinical Department for Internal Medicine II, University Medical Centre, Technical University of Munich, 81675, Munich, Germany
| | - Oliver Hayden
- Heinz-Nixdorf-Chair of Biomedical Electronics, School of Computation, Information and Technology, Technical University of Munich, TranslaTUM, 81675, Munich, Germany.
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Bailey M, Linden D, Guo-Parke H, Earley O, Peto T, McAuley DF, Taggart C, Kidney J. Vascular risk factors for COVID-19 ARDS: endothelium, contact-kinin system. Front Med (Lausanne) 2023; 10:1208866. [PMID: 37448794 PMCID: PMC10336249 DOI: 10.3389/fmed.2023.1208866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023] Open
Abstract
SARS-CoV-2 binds to ACE2 receptors, expressed within the lungs. Risk factors for hospitalization include hypertension, diabetes, ischaemic heart disease and obesity-conditions linked by the presence of endothelial pathology. Viral infection in this setting causes increased conversion of circulating Factor XII to its active form (FXIIa). This is the first step in the contact-kinin pathway, leading to synchronous activation of the intrinsic coagulation cascade and the plasma Kallikrein-Kinin system, resulting in clotting and inflammatory lung disease. Temporal trends are evident from blood results of hospitalized patients. In the first week of symptoms the activated partial thromboplastin time (APTT) is prolonged. This can occur when clotting factors are consumed as part of the contact (intrinsic) pathway. Platelet counts initially fall, reflecting their consumption in coagulation. Lymphopenia occurs after approximately 1 week, reflecting the emergence of a lymphocytic pneumonitis [COVID-19 acute respiratory distress syndrome (ARDS)]. Intrinsic coagulation also induces the contact-kinin pathway of inflammation. A major product of this pathway, bradykinin causes oedema with ground glass opacities (GGO) on imaging in early COVID-19. Bradykinin also causes release of the pleiotrophic cytokine IL-6, which causes lymphocyte recruitment. Thromobosis and lymphocytic pneumonitis are hallmark features of COVID-19 ARDS. In this review we examine the literature with particular reference to the contact-kinin pathway. Measurements of platelets, lymphocytes and APTT should be undertaken in severe infections to stratify for risk of developing ARDS.
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Affiliation(s)
- Melanie Bailey
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Dermot Linden
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Hong Guo-Parke
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Olivia Earley
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Tunde Peto
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Danny F. McAuley
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Clifford Taggart
- Wellcome - Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Joseph Kidney
- Mater Infirmorum Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
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Smadja DM, Gendron N, Philippe A, Diehl JL, Ochat N, Bory O, Beauvais A, Mareau A, Jannot AS, Chocron R. Fibrin monomers evaluation during hospitalization for COVID-19 is a predictive marker of in-hospital mortality. Front Cardiovasc Med 2023; 10:1001530. [PMID: 37063947 PMCID: PMC10098364 DOI: 10.3389/fcvm.2023.1001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 02/28/2023] [Indexed: 04/01/2023] Open
Abstract
BackgroundCoagulopathy is one of the main triggers of severity and worsening of Coronavirus disease 2019 (COVID-19) particularly in critically ill patients. D-dimer has been widely used to detect COVID-19 coagulation disorders and has been correlated with outcomes such as disease severity and in-hospital mortality. Involvement of other fibrin degradation products, particularly fibrin monomers (FM), remains an ongoing question.MethodsWe performed a monocentric study of adult patients with COVID-19, who were admitted either in the medical ward (MW) or in the intensive care unit (ICU) and who had FM measurements performed on them during the first wave of COVID-19 outbreak. We analyzed the positivity of FM levels (FM > 7 µg/mL) to assess the ability of FM monitoring during the first days of hospitalization to predict COVID-19 outcomes.ResultsIn our cohort, 935 FM measurements were performed in 246 patients during their first 9 days of hospitalization. During patient follow-up, the FM levels were higher in patients admitted directly to the ICU than in those admitted to the MW. Moreover, we observed significantly increased levels of FM in patients when the data were stratified for in-hospital mortality. At hospital admission, only 27 (11%) patients displayed a positive value for FM; this subgroup did not differ from other patients in terms of severity (indicated by ICU referral at admission) or in-hospital mortality. When analyzing FM positivity in the first 9 days of hospitalization, we found that 37% of patients had positive FM at least once during hospitalization and these patients had increased in-hospital mortality (p = 0.001). Thus, we used non-adjusted Kaplan–Meier curves for in-hospital mortality according to FM positivity during hospitalization and we observed a statistically significant difference for in-hospital mortality (hazard ratio = 1.48, 95% CI: 1.25–1.76, p < 0.001). However, we compared the AUC of FM positivity associated with a ratio of D-dimer >70% and found that this combined receiver operating characteristic (ROC) curve was superior to the FM positivity ROC curve alone.ConclusionMonitoring of FM positivity in hospitalized patients with COVID-19 could be a reliable and helpful tool to predict the worsening condition and mortality of COVID-19.
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Affiliation(s)
- David M. Smadja
- Innovative Therapies in Hemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
- Correspondence: David M. Smadja
| | - Nicolas Gendron
- Innovative Therapies in Hemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Aurélien Philippe
- Innovative Therapies in Hemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Jean-Luc Diehl
- Innovative Therapies in Hemostasis, INSERM, University Paris Cité, Paris, France
- Intensive Care Unit, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Nadège Ochat
- Hematology Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Olivier Bory
- Emergency Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Agathe Beauvais
- Emergency Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
| | - Alexis Mareau
- Centre de Recherche des Cordeliers, AP-HP.CUP, Georges Pompidou European Hospital, Medical Informatics, Biostatistics and Public Health Department, European Georges Pompidou Hospital, AP-HP.CUP, University Paris Cité, Paris, France
| | - Anne-Sophie Jannot
- Centre de Recherche des Cordeliers, AP-HP.CUP, Georges Pompidou European Hospital, Medical Informatics, Biostatistics and Public Health Department, European Georges Pompidou Hospital, AP-HP.CUP, University Paris Cité, Paris, France
| | - Richard Chocron
- Emergency Department, AP-HP.CUP, Georges Pompidou European Hospital, Paris, France
- PARCC, INSERM, University Paris Cité, Paris, France
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Beauvais A, Gendron N, Philippe A, Vedie B, Loriot MA, Juvin P, Khider L, Sanchez O, Diehl JL, Smadja DM, Chocron R. Clinical usefulness of admission versus monitoring troponin in patients with coronavirus disease 2019. Arch Cardiovasc Dis 2023; 116:170-172. [PMID: 36710144 PMCID: PMC9851912 DOI: 10.1016/j.acvd.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Agathe Beauvais
- Innovative Therapies in Haemostasis, Inserm, Université Paris Cité, 75006 Paris, France; Emergency Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Nicolas Gendron
- Innovative Therapies in Haemostasis, Inserm, Université Paris Cité, 75006 Paris, France; Haematology Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Aurélien Philippe
- Innovative Therapies in Haemostasis, Inserm, Université Paris Cité, 75006 Paris, France; Haematology Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Benoit Vedie
- Biochemistry Department, Georges Pompidou European Hospital, AP-HP, Université de Paris, 75015 Paris, France
| | - Marie-Anne Loriot
- Biochemistry Department, Georges Pompidou European Hospital, AP-HP, Université de Paris, 75015 Paris, France
| | - Philippe Juvin
- Emergency Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Lina Khider
- Vascular Medicine Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Olivier Sanchez
- Innovative Therapies in Haemostasis, Inserm, Université Paris Cité, 75006 Paris, France; Respiratory Medicine Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Jean-Luc Diehl
- Innovative Therapies in Haemostasis, Inserm, Université Paris Cité, 75006 Paris, France; Medical Intensive Care Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - David M Smadja
- Innovative Therapies in Haemostasis, Inserm, Université Paris Cité, 75006 Paris, France; Haematology Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Richard Chocron
- Emergency Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France; Paris Cardiovascular Research Centre (PARCC), Inserm, UMR-S970, Université de Paris, 75015 Paris, France.
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Smadja DM, Fellous BA, Bonnet G, Hauw-Berlemont C, Sutter W, Beauvais A, Fauvel C, Philippe A, Weizman O, Mika D, Juvin P, Waldmann V, Diehl JL, Cohen A, Chocron R. D-dimer, BNP/NT-pro-BNP, and creatinine are reliable decision-making biomarkers in life-sustaining therapies withholding and withdrawing during COVID-19 outbreak. Front Cardiovasc Med 2022; 9:935333. [PMID: 36148049 PMCID: PMC9485619 DOI: 10.3389/fcvm.2022.935333] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background The decision for withholding and withdrawing of life-sustaining treatments (LSTs) in COVID-19 patients is currently based on a collegial and mainly clinical assessment. In the context of a global pandemic and overwhelmed health system, the question of LST decision support for COVID-19 patients using prognostic biomarkers arises. Methods In a multicenter study in 24 French hospitals, 2878 COVID-19 patients hospitalized in medical departments from 26 February to 20 April 2020 were included. In a propensity-matched population, we compared the clinical, biological, and management characteristics and survival of patients with and without LST decision using Student's t-test, the chi-square test, and the Cox model, respectively. Results An LST was decided for 591 COVID-19 patients (20.5%). These 591 patients with LST decision were secondarily matched (1:1) based on age, sex, body mass index, and cancer history with 591 COVID-19 patients with no LST decision. The patients with LST decision had significantly more cardiovascular diseases, such as high blood pressure (72.9 vs. 66.7%, p = 0.02), stroke (19.3 vs. 11.1%, p < 0.001), renal failure (30.4 vs. 17.4%, p < 0.001), and heart disease (22.5 vs. 14.9%, p < 0.001). Upon admission, LST patients were more severely attested by a qSOFA score ≥2 (66.5 vs. 58.8%, p = 0.03). Biologically, LST patients had significantly higher values of D-dimer, markers of heart failure (BNP and NT-pro-BNP), and renal damage (creatinine) (p < 0.001). Their evolutions were more often unfavorable (in-hospital mortality) than patients with no LST decision (41.5 vs. 10.3%, p < 0.001). By combining the three biomarkers (D-dimer, BNP and/or NT-proBNP, and creatinine), the proportion of LST increased significantly with the number of abnormally high biomarkers (24, 41.3, 48.3, and 60%, respectively, for none, one, two, and three high values of biomarkers, trend p < 0.01). Conclusion The concomitant increase in D-dimer, BNP/NT-proBNP, and creatinine during the admission of a COVID-19 patient could represent a reliable and helpful tool for LST decision. Circulating biomarker might potentially provide additional information for LST decision in COVID-19.
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Affiliation(s)
- David M. Smadja
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, AP-HP, Georges Pompidou European Hospital, Paris, France
- *Correspondence: David M. Smadja
| | - Benjamin A. Fellous
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - Guillaume Bonnet
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Unité Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Pessac, France
| | | | - Willy Sutter
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Vascular Surgery Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Agathe Beauvais
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | | | - Aurélien Philippe
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Hematology Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Orianne Weizman
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, Vandoeuvre les Nancy, France
| | - Delphine Mika
- Université Paris-Saclay, Inserm, UMR-S 1180, Chatenay-Malabry, France
| | - Philippe Juvin
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Victor Waldmann
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Cardiology Department, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Jean-Luc Diehl
- Université de Paris-Cité, Innovative Therapies in Haemostasis, INSERM, Paris, France
- Medical Intensive Care Department AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Ariel Cohen
- Cardiology Department, AP-HP, Saint Antoine Hospital, Paris, France
| | - Richard Chocron
- Université de Paris, Paris Cardiovascular Research Centre (PARCC), INSERM, UMR-S970, Paris, France
- Emergency Department, AP-HP, Georges Pompidou European Hospital, Paris, France
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Auditeau C, Khider L, Planquette B, Sanchez O, Smadja DM, Gendron N. D‐dimer testing in clinical practice in the era of COVID‐19. Res Pract Thromb Haemost 2022; 6:e12730. [PMID: 35664536 PMCID: PMC9133433 DOI: 10.1002/rth2.12730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/31/2022] [Accepted: 04/15/2022] [Indexed: 11/12/2022] Open
Abstract
D‐dimer is a fragment of crosslinked fibrin resulting from plasmin cleavage of fibrin clots and hence an indirect biomarker of the hemostatic system activation. Early in the coronavirus disease 2019 (COVID‐19) pandemic, several studies described coagulation disorders in affected patients, including high D‐dimer levels. Consequently, D‐dimer has been widely used in not‐yet‐approved indications. Ruling out pulmonary embolism and deep vein thrombosis in patients with low or intermediate clinical suspicion is the main application of D‐dimer. D‐dimer is also used to estimate the risk of venous thromboembolism recurrence and is included in the ISTH algorithm for the diagnosis of disseminated intravascular coagulation. Finally, numerous studies identified high D‐dimer levels as a biomarker of poor prognosis in hospitalized patients with COVID‐19. This report focuses on validated applications of D‐dimer testing in patients with and without COVID‐19.
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Affiliation(s)
- Claire Auditeau
- Hematology Department Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
| | - Lina Khider
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Vascular Medicine Department Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
| | - Benjamin Planquette
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Respiratory Medicine Department Assistance Publique – Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- F‐CRIN INNOVTE Saint‐Étienne France
| | - Olivier Sanchez
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Respiratory Medicine Department Assistance Publique – Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- F‐CRIN INNOVTE Saint‐Étienne France
| | - David M. Smadja
- Hematology Department Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- F‐CRIN INNOVTE Saint‐Étienne France
| | - Nicolas Gendron
- Hematology Department Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
- Université Paris Cité Innovative Therapies in Haemostasis INSERM Paris France
- Biosurgical Research Lab (Carpentier Foundation) Assistance Publique Hôpitaux de Paris‐Centre Université de Paris (APHP‐CUP) Paris France
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Citu C, Burlea B, Gorun F, Motoc A, Gorun OM, Malita D, Ratiu A, Margan R, Grigoras ML, Bratosin F, Citu IM. Predictive Value of Blood Coagulation Parameters in Poor Outcomes in COVID-19 Patients: A Retrospective Observational Study in Romania. J Clin Med 2022; 11:jcm11102831. [PMID: 35628956 PMCID: PMC9146890 DOI: 10.3390/jcm11102831] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023] Open
Abstract
SARS-CoV-2 infection produces alterations in blood clotting, especially in severe cases of COVID-19. Abnormal coagulation parameters in patients with COVID-19 are important prognostic factors of disease severity. The objective of this study was to evaluate the predictive value of aPTT, D-dimer, INR and PT in the mortality of patients with COVID-19. A retrospective, single-center, observational study was conducted on COVID-19 patients admitted to the Municipal Emergency Clinical Hospital in Timisoara, Romania, between August and October 2021. Patients were confirmed as COVID-19 positive by reverse transcription-polymerase chain reaction (RT-PCR) assay. After applying the inclusion/exclusion criteria, a total of 82 patients were included in the analysis. Receiver operating characteristic (ROC) curves of D-Dimer, INR, PT and aPTT were generated to assess whether the baseline of each of these biomarkers was accurately predictive for mortality in patients with COVID-19. Mortality among patients enrolled in this study was 20.7%, associated with older age and presence of heart disease. The areas under the ROC curve (AUC-ROC) of D-Dimer, INR, PT, and aPTT were 0.751, 0.724, 0.706 and 0.753. Differences in survival for patients with coagulation biomarker levels above cut-off values compared to patients below these values were statistically significant. All evaluated parameters had significant differences and good performance in predicting mortality of COVID-19 patients, except fibrinogen, which had no significant difference. Moreover, aPTT and D-dimer were the best performing parameters in predicting mortality in patients with SARS-CoV-2 infection.
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Affiliation(s)
- Cosmin Citu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (C.C.); (A.R.)
| | - Bogdan Burlea
- Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, 1–3 Alexandru Odobescu Street, 300202 Timisoara, Romania; (B.B.); (O.M.G.)
| | - Florin Gorun
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (C.C.); (A.R.)
- Correspondence:
| | - Andrei Motoc
- Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (A.M.); (M.L.G.)
| | - Oana Maria Gorun
- Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, 1–3 Alexandru Odobescu Street, 300202 Timisoara, Romania; (B.B.); (O.M.G.)
| | - Daniel Malita
- Department of Radiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square nr. 2, 300041 Timisoara, Romania;
| | - Adrian Ratiu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (C.C.); (A.R.)
| | - Roxana Margan
- Department 14 Microbiology, Discipline of Hygiene, Center for Studies in Preventive Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Mirela Loredana Grigoras
- Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (A.M.); (M.L.G.)
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Ioana Mihaela Citu
- Department of Internal Medicine I, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
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