ABSTRACT
Background : Synergy between coagulation and inflammation is clear in SARS-CoV-2 infection making patients susceptible to thrombosis. Numerous articles describe the prognostic value of individual or combined laboratory biomarkers. However, there is no single test that can be used to provide a composite assessment to easily identify and track emerging hypercoagulability. We present two methods via which a single assessment could be used as a global measure of inflammation (NETs) and coagulation (ROTEM). Aims : Investigate whether patients with COVID-19 demonstrate ROTEM parameters and or elevated NETs markers (H3.1-nucleosomes), indicating hypercoagulability, early in admission. (ii) Whether patients admitted to ITU have a significantly higher Maximum Clot Firmness (MCF) and H3.1-nucleosomes compared to those on the ward. Methods : Consenting patients were tested for ROTEM on admission and daily for 10 days and weekly thereafter until discharge from hospital. H3.1-nucleosomes were measured at all time points in 3 patients (1 admitted directly to ITU, 1 to ITU during their hospital stay and 1 remaining on the ward) using Nu.Q™ H3.1-nucleosome ELISA (Belgian Volition SRL, Isnes, Belgium) according to the manufacturer's instruction. Results : ROTEM demonstrated a hypercoagulable state compared to controls on admission for FIBTEM CT ( P < 0.001) and MCF ( P < 0.001), EXTEM CT, CFT, MCF and ML ( P < 0.002) and INTEM CT ( P < 0.028), MCF ( P < 0.004) and ML ( P < 0.001). In our cohort MCF ( P = 0.849) was not significantly higher in those admitted to ITU compared to those on the ward however moderate significance was observed in the EXTEM CFT ( P = 0.051) and EXTEM ML ( P = 0.056). In the 3 assessed with serial H3.1, the values closely track their clinical course (Fig 1). Conclusions : ROTEM measures a hypercoagulable state compared to controls with increased MCF and hypofibrinolysis. Although this is a small, exploratory study, the H3.1 nucleosome findings suggest that it may be able to risk stratify on admission and track clinical course.