Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection.
Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection.
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DOI：
10.3389/fmed.2021.670694
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发表时间：
2021
影响因子：
3.9
通讯作者：
Le Cam Duchez V
中科院分区：
文献类型：
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作者：
Billoir P;Alexandre K;Duflot T;Roger M;Miranda S;Goria O;Joly LM;Demeyere M;Feugray G;Brunel V;Etienne M;Le Cam Duchez V
自2019年12月以来，一场由新型冠状病毒引起的大流行已蔓延至全球170多个国家。需要重症监护病房（ICU）的感染加重患者与30%的死亡率相关。部分恶化是由止血失调引起的。本研究的目的是研究凝血激活在COVID-19进展中的相关性。99名患者中有35名临床恶化。Logistic回归分析的最终模型显示，（RR = 7.27 [1.50-19.31]），单核细胞低于0.2G/L（RR = 2.88 [1.67-3.19]），纤维蛋白原水平（RR = 1.45 [1.17-1.82]/g/L增加），凝血酶原片段1+2高于290 pM（RR = 2.39 [1.20-3.30]）和凝血酶峰值（RR = 1.28 [1.03-1.59]/50 nM增加）与临床恶化风险增加相关。纤维蛋白原水平阈值为5.5 g/L，凝血酶峰值测量阈值为99 pM，O2需求量与我们队列中超过80%的临床结局相关。总之，我们确定了入院时纤维蛋白原和凝血酶峰值作为与ICU入院或死亡风险增加相关的凝血生物标志物。这一发现允许开始类固醇和分类恶化的患者。因此，我们的结果应被视为探索性的，值得确认。
Since December 2019, a pandemic caused by a new coronavirus has spread to more than 170 countries around the world. Worsening infected patients requiring intensive care unit (ICU) admission associated with 30% of mortality. A part of worsening is induced by hemostasis deregulation. The aim of this study was to investigate the association of coagulation activation in COVID-19 progression. Thirty-five of the 99 patients got clinically worse. The final model of the logistic regression analysis revealed that O2 requirement (RR = 7.27 [1.50–19.31]), monocytes below 0.2G/L (RR = 2.88 [1.67–3.19]), fibrinogen levels (RR = 1.45 [1.17–1.82] per g/L increase), prothrombin fragments 1+2 higher than 290 pM (RR = 2.39 [1.20–3.30]), and thrombin peak (RR = 1.28 [1.03–1.59] per 50 nM increase) were associated with an increased risk of clinical worsening. A fibrinogen level threshold of 5.5 g/L, a thrombin peak measurement threshold of 99 pM, and O2 requirement associated with clinical outcome in more than 80% of our cohort. In conclusion, we identified fibrinogen and thrombin peak at admission as coagulation biomarkers associated with an increased risk of ICU admission or death. This finding allows initiating steroids and triage for worsening patients. Our results should therefore be considered as exploratory and deserve confirmation.