Profile of natural anticoagulant, coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients
Profile of natural anticoagulant, coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients
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DOI：
10.1007/s11239-020-02182-9
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发表时间：
2020-07-09
影响因子：
4
通讯作者：
Zhu, Tienan
中科院分区：
文献类型：
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作者：
Zhang, Yan;Cao, Wei;Zhu, Tienan
2019 年新型冠状病毒病（COVID-19）的爆发现已成为全球大流行病。据报道，重症 COVID-19 患者出现凝血功能障碍，且与高死亡率相关。然而，尚未对全面的凝血功能进行检查，并且 COVID-19 患者凝血病的潜在机制尚不清楚。研究危重病 COVID-19 患者的常规止血试验、天然抗凝剂、凝血因子和抗磷脂抗体的凝血特征。这项单中心横断面研究纳入了 2020 年 2 月 23 日至 3 月 3 日入住中国武汉同济医院重症监护室 (ICU) 的 19 名 COVID-19 患者。收集并分析了患者的人口统计数据、实验室参数、治疗和临床结果。最终随访日期为2020年3月31日。本研究中，9例患者发生12例血栓事件，其中脑梗死4例、肢端缺血7例、颈内静脉血栓1例。常规凝血检测常见异常包括D-二聚体水平升高（100%）、凝血酶原时间延长（73.7%）和高纤维蛋白原血症（73.7%）。蛋白C、蛋白S和抗凝血酶等天然抗凝剂的中位活性均低于正常范围。所有患者的因子 VIII 活性均显着高于正常范围（中位值 307%，IQR 198-441）。近终末期患者的因子 V 和因子 VII 活性显着降低。 10 名患者体内存在抗磷脂抗体。引人注目的是，4 例脑梗塞事件的患者具有多种同种型的抗磷脂抗体。持续高凝状态和血栓事件在 COVID-19 危重患者中很常见。天然抗凝剂活性低、因子 VIII 水平升高和抗磷脂抗体的存在共同可能导致了 COVID-19 患者凝血病的病因病理。
The outbreak of novel coronavirus disease 2019 (COVID-19) has now become a global pandemic. Coagulopathy has been reported widely in critically ill COVID-19 patients and was related to high mortality. However, the comprehensive coagulation profiles have not been examined and the underlying mechanism of the coagulopathy in COVID-19 patients is unclear. To study the coagulation profiles of routine hemostasis tests, natural anticoagulants, coagulant factors and antiphospholipid antibodies in critically ill COVID-19 patients. This single-center and cross-section study included 19 patients with COVID-19, who were admitted to intensive care unit (ICU) at Tongji hospital in Wuhan, China, from Feb 23 to Mar 3, 2020. Demographic data, laboratory parameters, treatments and clinical outcomes of the patients were collected and analyzed. The final date of follow-up was Mar 31, 2020. In this study, 12 thrombotic events occurred in 9 patients, including 4 cerebral infarctions, 7 acro-ischemia and 1 internal jugular vein thrombosis. The common abnormalities of routine coagulation tests included evelated D-Dimer level (100%), prolonged prothrombin time (73.7%) and hyperfibrinogenemia (73.7%). The median activities of natural anticoagulants including protein C, protein S and antithrombin were all below the normal range. Factor VIII activities were significantly above normal range (median value 307%, IQR 198-441) in all patients. Factor V and factor VII activities were significantly lower in near-terminal stage patients. Anti-phospholipid antibodies were present in 10 patients. Strikingly, 4 cerebral infarction events were in patients had anti-phospholipid antibodies of multiple isotypes. Sustained hypercoagulable status and thrombotic events were common in critically ill patients with COVID-19. The low activities of natural anticoagulants, elevated factor VIII level and the presence of antiphospholipid antibodies, together, may contribute to the etiopathology of coagulopathy in COVID-19 patients.