Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection
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 s...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-06-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.670694/full |
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| author | Paul Billoir Paul Billoir Kevin Alexandre Thomas Duflot Maxime Roger Sébastien Miranda Sébastien Miranda Odile Goria Luc Marie Joly Mathieu Demeyere Guillaume Feugray Valery Brunel Manuel Etienne Véronique Le Cam Duchez |
| author_facet | Paul Billoir Paul Billoir Kevin Alexandre Thomas Duflot Maxime Roger Sébastien Miranda Sébastien Miranda Odile Goria Luc Marie Joly Mathieu Demeyere Guillaume Feugray Valery Brunel Manuel Etienne Véronique Le Cam Duchez |
| author_sort | Paul Billoir |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T20:20:58Z |
| format | Article |
| id | doaj.art-c73532c4b6e74eb0aa39672518bcef38 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-14T20:20:58Z |
| publishDate | 2021-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-c73532c4b6e74eb0aa39672518bcef382022-12-21T22:48:44ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-06-01810.3389/fmed.2021.670694670694Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 InfectionPaul Billoir0Paul Billoir1Kevin Alexandre2Thomas Duflot3Maxime Roger4Sébastien Miranda5Sébastien Miranda6Odile Goria7Luc Marie Joly8Mathieu Demeyere9Guillaume Feugray10Valery Brunel11Manuel Etienne12Véronique Le Cam Duchez13Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, FranceF-CRIN INNOVTE, St-Étienne, FranceNormandie Univ, UNIROUEN, EA2656, CHU Rouen, Department of Infectious Diseases, Rouen, FranceNormandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Department of Pharmacology, Rouen, FranceCHU Rouen, Department of Pneumology, Rouen, FranceF-CRIN INNOVTE, St-Étienne, FranceNormandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Department of Internal Medicine, Rouen, FranceCHU Rouen, Department of Gastroenterology and Hepatology, Rouen, FranceDepartment of Emergency Medicine, Normandie Univ, UNIROUEN, CHU Rouen, Rouen, FranceCHU Rouen, Department of Radiology, Rouen, FranceNormandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, France0Department of General Biochemistry, CHU Rouen, Rouen, FranceNormandie Univ, UNIROUEN, EA2656, CHU Rouen, Department of Infectious Diseases, Rouen, FranceNormandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, FranceSince 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.https://www.frontiersin.org/articles/10.3389/fmed.2021.670694/fullCOVID-19intensive carehypercoagulabilityfibrinogenthrombin generation |
| spellingShingle | Paul Billoir Paul Billoir Kevin Alexandre Thomas Duflot Maxime Roger Sébastien Miranda Sébastien Miranda Odile Goria Luc Marie Joly Mathieu Demeyere Guillaume Feugray Valery Brunel Manuel Etienne Véronique Le Cam Duchez Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection Frontiers in Medicine COVID-19 intensive care hypercoagulability fibrinogen thrombin generation |
| title | Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection |
| title_full | Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection |
| title_fullStr | Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection |
| title_full_unstemmed | Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection |
| title_short | Investigation of Coagulation Biomarkers to Assess Clinical Deterioration in SARS-CoV-2 Infection |
| title_sort | investigation of coagulation biomarkers to assess clinical deterioration in sars cov 2 infection |
| topic | COVID-19 intensive care hypercoagulability fibrinogen thrombin generation |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.670694/full |
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