PDF(Pubmed)
Abstract：
Coronavirus disease 2019 (COVID-19) features a hypercoagulable state, but therapeutic anticoagulation effectiveness varies with disease severity. We aimed to evaluate the dynamics of the coagulation profile and its association with COVID-19 severity, outcomes, and biomarker trajectories.
This multicenter, prospective, observational study included patients with COVID-19 requiring respiratory support. Rotational thromboelastometry findings were evaluated for coagulation and fibrinolysis status. Hypercoagulable status was defined as supranormal range of maximum clot elasticity in an external pathway. Longitudinal laboratory parameters were collected to characterize the coagulation phenotype.
Of 166 patients, 90 (54%) were severely ill at inclusion (invasive mechanical ventilation, 84; extracorporeal membrane oxygenation, 6). Higher maximum elasticity (P=0.02) and lower maximum lysis in the external pathway (P=0.03) were observed in severely ill patients compared with the corresponding values in patients on non-invasive oxygen supplementation. Hypercoagulability components correlated with platelet and fibrinogen levels. Hypercoagulable phenotype was associated with favorable outcomes in severely ill patients, while normocoagulable phenotype was not (median time to recovery, 15 days vs. 27 days, P=0.002), but no significant association was observed in moderately ill patients. In patients with severe COVID-19, lower initial C3, minimum C3, CH50, and greater changes in CH50 were associated with the normocoagulable phenotype. Changes in complement components correlated with dynamics of coagulation markers, hematocrit, and alveolar injury markers.
While hypercoagulable states become more evident with increasing severity of respiratory disease in patients with COVID-19, normocoagulable phenotype is associated with triggered by alternative pathway activation and poor outcomes.
This multicenter, prospective, observational study included patients with COVID-19 requiring respiratory support. Rotational thromboelastometry findings were evaluated for coagulation and fibrinolysis status. Hypercoagulable status was defined as supranormal range of maximum clot elasticity in an external pathway. Longitudinal laboratory parameters were collected to characterize the coagulation phenotype.
Of 166 patients, 90 (54%) were severely ill at inclusion (invasive mechanical ventilation, 84; extracorporeal membrane oxygenation, 6). Higher maximum elasticity (P=0.02) and lower maximum lysis in the external pathway (P=0.03) were observed in severely ill patients compared with the corresponding values in patients on non-invasive oxygen supplementation. Hypercoagulability components correlated with platelet and fibrinogen levels. Hypercoagulable phenotype was associated with favorable outcomes in severely ill patients, while normocoagulable phenotype was not (median time to recovery, 15 days vs. 27 days, P=0.002), but no significant association was observed in moderately ill patients. In patients with severe COVID-19, lower initial C3, minimum C3, CH50, and greater changes in CH50 were associated with the normocoagulable phenotype. Changes in complement components correlated with dynamics of coagulation markers, hematocrit, and alveolar injury markers.
While hypercoagulable states become more evident with increasing severity of respiratory disease in patients with COVID-19, normocoagulable phenotype is associated with triggered by alternative pathway activation and poor outcomes.
摘要：
■2019年冠状病毒病（COVID-19）以高凝状态为特征，但是抗凝治疗效果因疾病严重程度而异。我们旨在评估凝血谱的动力学及其与COVID-19严重程度的关系，结果，和生物标志物轨迹。
■这个多中心，prospective,观察性研究纳入了需要呼吸支持的COVID-19患者.对旋转血栓弹性测量结果的凝血和纤溶状态进行了评估。高凝状态定义为外部途径中最大凝块弹性的超常范围。收集纵向实验室参数以表征凝血表型。
■在166名患者中，90人(54%)在纳入时病情严重(有创机械通气，84；体外膜氧合，6).与接受非侵入性氧气补充的患者的相应值相比，在重症患者中观察到更高的最大弹性（P=0.02）和更低的外部途径最大溶解（P=0.03）。高凝成分与血小板和纤维蛋白原水平相关。高凝表型与重症患者的良好预后相关，而可正常凝固的表型则不是(恢复的中位时间，15天vs.27天,P=0.002),但在中度疾病患者中未观察到显著关联.在患有严重COVID-19的患者中，较低的初始C3，最低C3，CH50和更大的CH50变化与正常凝血表型相关。补体成分的变化与凝血标志物的动力学相关，血细胞比容,和肺泡损伤标记。
■虽然随着COVID-19患者呼吸系统疾病严重程度的增加，高凝状态变得更加明显，但正常凝血表型与替代途径激活和不良预后触发相关。
■这个多中心，prospective,观察性研究纳入了需要呼吸支持的COVID-19患者.对旋转血栓弹性测量结果的凝血和纤溶状态进行了评估。高凝状态定义为外部途径中最大凝块弹性的超常范围。收集纵向实验室参数以表征凝血表型。
■在166名患者中，90人(54%)在纳入时病情严重(有创机械通气，84；体外膜氧合，6).与接受非侵入性氧气补充的患者的相应值相比，在重症患者中观察到更高的最大弹性（P=0.02）和更低的外部途径最大溶解（P=0.03）。高凝成分与血小板和纤维蛋白原水平相关。高凝表型与重症患者的良好预后相关，而可正常凝固的表型则不是(恢复的中位时间，15天vs.27天,P=0.002),但在中度疾病患者中未观察到显著关联.在患有严重COVID-19的患者中，较低的初始C3，最低C3，CH50和更大的CH50变化与正常凝血表型相关。补体成分的变化与凝血标志物的动力学相关，血细胞比容,和肺泡损伤标记。
■虽然随着COVID-19患者呼吸系统疾病严重程度的增加，高凝状态变得更加明显，但正常凝血表型与替代途径激活和不良预后触发相关。
