Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2021-12-22 eCollection Date: 2021-01-01 DOI:10.1155/2021/3935098

Sarah Alexandra van Blydenstein, Colin Nigel Menezes, Nicole Miller, Naomi Johnson, Bavinash Pillay, Barry F Jacobson, Shahed Omar

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引用次数: 2

Abstract

Introduction: The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood and is an indicator of the overall real-time coagulopathic state of the patient.

Methods: A single-centre, prospective, observational cohort study was conducted in South Africa, analysing the coagulation patterns of 41 patients with hypoxia related to SARS-CoV-2 using serial thromboelastography (TEG) on admission, after 48 hours, and at resolution of hypoxia/day 10. Results: Two-thirds (n = 26) were women. The median age was 61 (IQR 50-67), and the majority (88%) were Black patients. Almost half (22) of the patients were critically ill and ventilated, with median SOFA and SAPS2 scores of 3 and 22 (IQR2-4 and 18-30), respectively. The prevalence of hypercoagulability was 0.54 (95% CI 0.46-0.62), whilst 29/41 (0.71, CI 0.64-0.78)) met the definition of hypofibrinolysis. Differences between the hypercoagulable (HC) and non-hypercoagulable groups remained apparent at 48 hours after anticoagulation. At this time point, the K time was significantly lower (p ˂ 0,01), and the α-angle (p ˂ 0,01) and maximum amplitude (MA) (p ˂ 0,01) were significantly higher in the HC cohort. At resolution of hypoxia, or day 10, only MA was significantly higher in the hypercoagulable group compared to the non-hypercoagulable group (p = 0.01). The initial impairment in fibrinolysis (Ly30), α angle, and MA were significantly associated with mortality, with p values of 0.006, 0.031, and 0.04, respectively.

Conclusions: In this South African population, hypercoagulability was a highly prevalent phenomenon in COVID-19 disease. It was typified by hypofibrinolysis and a persistently elevated MA, despite anticoagulation therapy.

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使用连续血栓弹性成像分析南非人群中covid -19相关高凝血症的患病率和发展轨迹

由严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)引起的凝血功能异常已被归因于炎症和随后的细胞因子风暴。血栓弹性成像(TEG)是一种用于评估全血凝块形成和降解的即时测试，是患者整体实时凝血状态的指标。方法:在南非进行了一项单中心、前瞻性、观察性队列研究，使用系列血栓弹性成像(TEG)分析41例与SARS-CoV-2相关的缺氧患者入院时、48小时后和缺氧/第10天的凝血模式。结果:三分之二(n = 26)为女性。中位年龄为61岁(IQR 50-67)，多数(88%)为黑人患者。近一半(22例)患者危重，需通气，SOFA和SAPS2中位评分分别为3分和22分(IQR2-4和18-30)。高凝性的患病率为0.54 (95% CI 0.46-0.62)，而29/41 (0.71,CI 0.64-0.78)符合低纤溶的定义。抗凝后48小时，高凝组和非高凝组之间的差异仍然很明显。在这个时间点，HC队列的K时间显著低于p小于0,01，α-角(p小于0,01)和最大振幅(MA) (p小于0,01)显著高于p小于0,01。在缺氧消退或第10天，高凝组只有MA显著高于非高凝组(p = 0.01)。纤维蛋白溶解(Ly30)、α角和MA初始损伤与死亡率显著相关，p值分别为0.006、0.031和0.04。结论:在南非人群中，高凝是COVID-19疾病中非常普遍的现象。它的典型特征是低纤溶和持续升高的MA，尽管抗凝治疗。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.