Hypercoagulability in critically ill patients with COVID 19, an observational prospective study

COVID 19 is often associated with hypercoagulability and thromboembolic (TE) events. The aim of this study was to assess the characteristics of hypercoagulability and its relationship with new-onset TE events and the composite outcome of need for intubation and/or death in intensive care unit (ICU)...

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Published in:PloS one 2022-11, Vol.17 (11), p.e0277544-e0277544
Main Authors: Calvet, Laure, Thouy, François, Mascle, Olivier, Sapin, Anne-Françoise, Grapin, Kévin, Liteaudon, Jean Mathias, Evrard, Bertrand, Bonnet, Benjamin, Adda, Mireille, Souweine, Bertrand, Dupuis, Claire
Format: Article
Language:English
Subjects:
Biology and Life Sciences
Blood Coagulation Disorders
Blood platelets
Catheters
Coronaviruses
COVID-19
COVID-19 - complications
Critical Illness
Critically ill
Death
Dimers
Disease transmission
Fibrinogen
Fibrinolysis
Health aspects
Health risks
Hemostatics
Human health and pathology
Humans
Intensive care
Intubation
Laboratories
Life Sciences
Medical imaging
Medicine and Health Sciences
Missing data
Mortality
Patients
Prospective Studies
Proteins
Pulmonary embolisms
Shutdowns
Thrombelastography
Thromboembolism
Thrombophilia - complications
Thrombosis
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Summary:COVID 19 is often associated with hypercoagulability and thromboembolic (TE) events. The aim of this study was to assess the characteristics of hypercoagulability and its relationship with new-onset TE events and the composite outcome of need for intubation and/or death in intensive care unit (ICU) patients admitted for COVID. Prospective observational study. Monocentric, intensive care, University Hospital of Clermont Ferrand, France. Patients admitted to intensive care from January 2020 to May 2021 for COVID-19 pneumonia. Standard hemostatic tests and rotational thromboelastometry (ROTEM) were performed on admission and on day 4. Hypercoagulability was defined by at least one of the following criteria: D-dimers > 3000 μg/dL, fibrinogen > 8 g/L, EXTEM CFT below the normal range, EXTEM A5, MCF, Li 60 above the normal range, and EXTEM G-score ((5000 x MCF) / (100-MCF)) ≥ 11 dyne/cm2. Of the 133 patients included, 17 (12.7%) developed new-onset TE events, and 59 (44.3%) required intubation and/or died in the ICU. ROTEM was performed in 133 patients on day 1 and in 67 on day 4. Hypercoagulability was present on day 1 in 115 (86.4%) patients. None of the hypercoagulability indices were associated with subsequent new-onset TE events on days 1 and 4 nor with the need for intubation and/or ICU death. Hyperfibrinogenemia > 8g/dL, higher D-dimers and higher EXTEM Li 60 on day 4 were predictive of need for intubation and/or of ICU death. Our study confirmed that most COVID-19 ICU patients have hypercoagulability on admission and almost all on day 4. Hyperfibrinogenemia or fibrinolysis shutdown on day 4 were associated with unfavorable outcome.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0277544