Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia
Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia
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DOI：
10.1007/s11239-020-02130-7
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发表时间：
2020-05-11
影响因子：
4
通讯作者：
Frigieri, Francesca Covani
中科院分区：
文献类型：
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作者：
Pavoni, Vittorio;Gianesello, Lara;Frigieri, Francesca Covani
患有COVID-19肺炎的危重患者具有高血栓形成和出血风险。SARS-CoV-2对凝血和纤溶的影响尚不清楚。我们对因严重COVID-19肺炎而入住重症监护室（ICU）的危重患者进行了一项回顾性研究，并在入院当天（T0）以及入住ICU后5天（T5）和10天（T10）使用旋转血栓弹性测定法（ROTEM）评估了凝血功能。还评价了凝血标准参数。40例患者入组研究。ICU病死率为10%，住院病死率为12.5%。在ICU入院时，凝血酶原时间略有降低，在T10时显著升高（T0 = 65.1 +/- 9.8 vs T10 = 85.7 +/- 1.5，p = 0.002），而活化部分凝血活酶时间和纤维蛋白原值在T0时高于T10（分别为32.2 +/- 2.9 vs 27.2 +/- 2.1，p = 0.017和895.1 +/- 110 vs 332.5 +/- 50，p = 0.002）;此外，全血血栓弹性测定特征与以血凝块形成的传播阶段加速为特征的高凝状态一致[即，INTEM 16/40例患者（40%）和EXTEM 20/40例患者（50%）的CFT低于下限]和血凝块强度显著较高[INTEM 20/40例患者（50%）、EXTEM 28/40例患者（70%）和FIBTEM 29/40例患者的MCF高于上限（72.5%）];然而，这种高凝状态在前5天持续，但在10天后降低，没有恢复到正常值。在研究期间未发现继发性纤溶亢进或脓毒症诱导的凝血病（SIC）的体征。发现6例患者（15%）发生深静脉血栓形成，2例患者（5%）发生血栓栓塞事件; 12例患者（30%）发生导管相关血栓形成。ROTEM分析证实，患有严重COVID-19肺炎的患者具有随时间持续的高凝状态。
Critically ill patients with COVID-19 pneumonia suffered both high thrombotic and bleeding risk. The effect of SARS-CoV-2 on coagulation and fibrinolysis is not well known. We conducted a retrospective study of critically ill patients admitted to an intensive care unit (ICU) a cause of severe COVID-19 pneumonia and we evaluated coagulation function using rotational thromboelastometry (ROTEM) on day of admission (T0) and 5 (T5) and 10 (T10) days after admission to ICU. Coagulation standard parameters were also evaluated. Forty patients were enrolled into the study. The ICU and the hospital mortality were 10% and 12.5%, respectively. On ICU admission, prothrombin time was slightly reduced and it increased significantly at T10 (T0 = 65.1 +/- 9.8 vs T10 = 85.7 +/- 1.5, p = 0.002), while activated partial thromboplastin time and fibrinogen values were higher at T0 than T10 (32.2 +/- 2.9 vs 27.2 +/- 2.1, p = 0.017 and 895.1 +/- 110 vs 332.5 +/- 50, p = 0.002, respectively); moreover, whole blood thromboelastometry profiles were consistent with hypercoagulability characterized by an acceleration of the propagation phase of blood clot formation [i.e., CFT below the lower limit in INTEM 16/40 patients (40%) and EXTEM 20/40 patients (50%)] and significant higher clot strength [MCF above the upper limit in INTEM 20/40 patients (50%), in EXTEM 28/40 patients (70%) and in FIBTEM 29/40 patients (72.5%)]; however, this hypercoagulable state persists in the first five days, but it decreases ten day after, without returning to normal values. No sign of secondary hyperfibrinolysis or sepsis induced coagulopathy (SIC) were found during the study period. In six patients (15%) a deep vein thrombosis and in 2 patients (5%) a thromboembolic event, were found; 12 patients (30%) had a catheter-related thrombosis. ROTEM analysis confirms that patients with severe COVID-19 pneumonia had a hypercoagulation state that persisted over time.