Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate
Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate
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DOI：
10.1007/s11239-020-02275-5
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发表时间：
2020-09-12
影响因子：
4
通讯作者：
Moriya, Kyoji
中科院分区：
文献类型：
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作者：
Osawa, Itsuki;Okamoto, Koh;Moriya, Kyoji
与 2019 年冠状病毒病 (COVID-19) 相关的危重疾病可归因于高凝状态。关于使用甲磺酸萘莫司他（一种潜在的 COVID-19 治疗抗凝剂）的 COVID-19 患者中凝血因子的动态变化知之甚少。首先，我们根据入院时的临床特征进行回顾性聚类分析，以识别 2020 年 4 月 6 日至 5 月 31 日期间在日本东京大学医院接受甲磺酸萘莫司他治疗的 15 名 COVID-19 患者中的潜在亚组。接下来，我们描述了所有患者以及 COVID-19 患者亚组的特征，并比较了每个亚组之间凝血因子的动态变化。随后的纤维蛋白原和 D-二聚体水平的动态变化以图形方式呈现。所有 COVID-19 患者被分为三个亚组：A、B 和 C 组，分别代表不良结果的低、中和高风险。所有患者在症状出现后 30 天均存活。 A 组中没有患者需要机械通气；然而，C组的所有患者都需要机械通气，其中一半接受了静脉体外膜氧合治疗。 A组中的所有患者均维持较低的D-二聚体水平，但B组和C组中的一些危重患者的纤维蛋白原和D-二聚体水平出现动态变化。尽管甲磺酸萘莫司他的潜力需要在随机临床试验中进行评估，但 COVID-19 患者的入院特征可以预测随后的凝血病。
Critical illnesses associated with coronavirus disease 2019 (COVID-19) are attributable to a hypercoagulable status. There is limited knowledge regarding the dynamic changes in coagulation factors among COVID-19 patients on nafamostat mesylate, a potential therapeutic anticoagulant for COVID-19. First, we retrospectively conducted a cluster analysis based on clinical characteristics on admission to identify latent subgroups among fifteen patients with COVID-19 on nafamostat mesylate at the University of Tokyo Hospital, Japan, between April 6 and May 31, 2020. Next, we delineated the characteristics of all patients as well as COVID-19-patient subgroups and compared dynamic changes in coagulation factors among each subgroup. The subsequent dynamic changes in fibrinogen and D-dimer levels were presented graphically. All COVID-19 patients were classified into three subgroups: clusters A, B, and C, representing low, intermediate, and high risk of poor outcomes, respectively. All patients were alive 30 days from symptom onset. No patient in cluster A required mechanical ventilation; however, all patients in cluster C required mechanical ventilation, and half of them were treated with venovenous extracorporeal membrane oxygenation. All patients in cluster A maintained low D-dimer levels, but some critical patients in clusters B and C showed dynamic changes in fibrinogen and D-dimer levels. Although the potential of nafamostat mesylate needs to be evaluated in randomized clinical trials, admission characteristics of patients with COVID-19 could predict subsequent coagulopathy.