Thrombogenicity markers for early diagnosis and prognosis in COVID-19: a change from the current paradigm?

Abstract

Standard biomarkers have been widely used for COVID-19 diagnosis and prognosis. We hypothesize that thrombogenicity metrics measured by thromboelastography will provide better diagnostic and prognostic utility versus standard biomarkers in COVID-19 positive patients. In this observational prospective study, we included 119 hospitalized COVID-19 positive patients and 15 COVID-19 negative patients. On admission, we measured standard biomarkers and thrombogenicity using a novel thromboelastography assay (TEG-6s). In-hospital all-cause death and thrombotic occurrences (thromboembolism, myocardial infarction and stroke) were recorded. Most COVID-19 patients were African--Americans (68%). COVID-19 patients versus COVID-19 negative patients had higher platelet-fibrin clot strength (P-FCS), fibrin clot strength (FCS) and functional fibrinogen level (FLEV) (P ≤ 0.003 for all). The presence of high TEG-6 s metrics better discriminated COVID-19 positive from negative patients. COVID-19 positive patients with sequential organ failure assessment (SOFA) score at least 3 had higher P-FCS, FCS and FLEV than patients with scores less than 3 (P ≤ 0.001 for all comparisons). By multivariate analysis, the in-hospital composite endpoint occurrence of death and thrombotic events was independently associated with SOFA score more than 3 [odds ratio (OR) = 2.9, P = 0.03], diabetes (OR = 3.3, P = 0.02) and FCS > 40 mm (OR = 3.4, P = 0.02). This largest observational study suggested the early diagnostic and prognostic utility of thromboelastography to identify COVID-19 and should be considered hypothesis generating. Our results also support the recent FDA guidance regarding the importance of measurement of whole blood viscoelastic properties in COVID-19 patients. Our findings are consistent with the observation of higher hospitalization rates and poorer outcomes for African--Americans with COVID-19.

• Authors: Paul A Gurbel, Kevin P Bliden, Jerrold H Levy, Naval Walia, Nicole Rapista, Alastair Cho, Christophe Jerjian, Udaya S Tantry
• Journal: Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis (Blood Coagul Fibrinolysis) Vol. 32 Issue 8 Pg. 544-549 (Dec 01 2021) ISSN: 1473-5733 [Electronic] England
• PMID: 34369413 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Biomarkers
• Fibrin
• Fibrinogen
• L-Lactate Dehydrogenase

Topics

• Adult
• Black or African American (statistics & numerical data)
• Aged
• Aged, 80 and over
• Biomarkers
• COVID-19 (blood, complications, epidemiology)
• COVID-19 Testing
• Cardiovascular Diseases (epidemiology)
• Comorbidity
• Diabetes Mellitus (epidemiology)
• Early Diagnosis
• Female
• Fibrin (analysis)
• Fibrin Clot Lysis Time
• Fibrinogen (analysis)
• Hospitalization
• Humans
• Hyperlipidemias (epidemiology)
• L-Lactate Dehydrogenase (blood)
• Male
• Middle Aged
• Obesity (epidemiology)
• Organ Dysfunction Scores
• Prognosis
• Prospective Studies
• SARS-CoV-2
• Thrombelastography
• Thrombophilia (blood, diagnosis, drug therapy, etiology)
• Treatment Outcome
• White People (statistics & numerical data)