ABSTRACT
BACKGROUND Coagulopathy is a serious COVID-19 complication that requires rapid diagnosis and anticoagulation. This study aimed to determine the role of coagulation examination using thromboelastography (TEG) on the decision-making time of anticoagulant therapy in COVID-19 patients and its clinical outcomes. METHODS A prospective observational study was conducted in Cipto Mangunkusumo Hospital, Indonesia, from October 2020 to March 2021. We consecutively recruited moderate and severe COVID-19 patients in the high and intensive care units. Turnaround time, time to anticoagulant therapy decision, and clinical outcomes (length of stay and 30-day mortality) were compared between those who had a TEG examination in addition to the standard coagulation profile examination (thrombocyte count, PT, APTT, D-dimer, and fibrinogen) and those who had only a standard coagulation profile laboratory examination. RESULTS Among 100 moderate to severe COVID-19 patients recruited, 50 patients had a TEG examination. The turnaround time of TEG was 45 (15–102) min versus 82 (19– 164) min in the standard examination (p<0.001). The time to decision was significantly faster in the TEG group than the standard group (75 [42–133] min versus 184 [92–353] min, p<0.001). The turnaround time was positively correlated with time to decision (r = 0.760, p<0.001). However, TEG did not improve clinical outcomes such as length of stay (10.5 [3–20] versus 9 [2–39] days) and 30-day mortality (66% versus 64%). CONCLUSIONS The TEG method significantly enables quicker decision-making time for moderate to severe coagulation disorder in COVID-19 patients.
ABSTRACT
Background: Mortality predictors are often used for analyzing disease progression as a guide for disease management strategy. The sequential organ failure assessment (SOFA) score is a predictor tool used to analyze organ dysfunction in critically ill patients. This study aimed to validate the SOFA score in predicting 28-day mortality in critically ill Coronavirus disease 2019 (COVID-19) patients. Methods: Subjects included in this study were critically ill, confirmed COVID-19 cases admitted to the intensive care unit (ICU) between March and August 2020. Demographic data, clinical characteristics, and laboratory findings within the first 24 hours of ICU admission were obtained from medical records to compute the SOFA score. The 28-day outcome was recorded as alive or deceased. Validity was analyzed using the area under the curve (AUC), Hosmer-Leme-show goodness of fit, and bivariate logistic regression. The optimal cut-off point was determined statistically. Result: From the total of 88 subjects in this study, the mortality rate was 39.8%. AUC was 0.971 (confidence interval [CI] 95% 0.943-0.999), and the goodness of fit test by using Hosmer-Leme-show showed p=0.782. An optimal cut-off point of SOFA score was 6, with a sensitivity of 87% and specificity of 90%. Discussion: SOFA score demonstrated very strong discrimination and good calibration in predicting 28-day mortality on the critical case of COVID-19. Conclusion: The SOFA score is valid for predicting 28-day mortality in the critical case of COVID-19.