Sujets)
COVID-19/anatomopathologie , Produits de dégradation de la fibrine et du fibrinogène/métabolisme , Facteur de von Willebrand/métabolisme , Adulte , Sujet âgé , COVID-19/complications , COVID-19/virologie , Études cas-témoins , Facteur VIII/métabolisme , Femelle , Humains , Mâle , Adulte d'âge moyen , Sortie du patient , Inhibiteur-1 d'activateur du plasminogène/métabolisme , SARS-CoV-2/isolement et purification , Indice de gravité de la maladie , Thrombose/diagnostic , Thrombose/étiologie , Facteurs tempsRésumé
BACKGROUND: Abnormal coagulation parameters have been reported in COVID-19-infected patients. Although the underlying mechanism of COVID-19 coagulopathy remains unknown, it has been suggested to be a form of disseminated intravascular coagulation (DIC). OBJECTIVES: The aim of our study was to analyze the coagulation parameters of patients with COVID-19, determine whether coagulation factors consumption occurs and identify potential prognostic biomarkers of the disease. PATIENTS/METHODS: Blood samples from hospitalized patients with COVID-19 pneumonia were collected. We performed basic coagulation tests and quantification of coagulation factors and physiological inhibitor proteins. Laboratory data were compared with clinical data and outcomes. RESULTS: The study involved 206 patients (63.6% male). D-dimer was particularly elevated (median 450 ng/mL; IQR 222.5-957.3). Free protein S levels were below the normal range (median 56.6%; IQR: 43.6-68.9), and factor VIII showed an increasing trend (median 173.4%; IQR: 144.1-214.9). However, all coagulation factors were within normal limits. We found no correlation between abnormal coagulation parameters and thrombosis, except for higher D-dimer (HR 1.99; 95% CI 1.3-3.1; P = .002). CONCLUSIONS: COVID-19 is associated with coagulopathy that correlates with poor prognosis. However, we did not demonstrate a consumption of coagulation factors, as seen in DIC.
Sujets)
Betacoronavirus/pathogénicité , Infections à coronavirus/complications , Syndrome de libération de cytokines/complications , Coagulation intravasculaire disséminée/complications , Facteur VIII/métabolisme , Pneumopathie virale/complications , Thrombose veineuse/complications , Sujet âgé , Sujet âgé de 80 ans ou plus , Marqueurs biologiques/sang , Tests de coagulation sanguine , Plaquettes/anatomopathologie , Plaquettes/virologie , COVID-19 , Infections à coronavirus/diagnostic , Infections à coronavirus/mortalité , Infections à coronavirus/virologie , Syndrome de libération de cytokines/diagnostic , Syndrome de libération de cytokines/mortalité , Syndrome de libération de cytokines/virologie , Coagulation intravasculaire disséminée/diagnostic , Coagulation intravasculaire disséminée/mortalité , Coagulation intravasculaire disséminée/virologie , Femelle , Produits de dégradation de la fibrine et du fibrinogène/métabolisme , Humains , Poumon/vascularisation , Poumon/effets des médicaments et des substances chimiques , Poumon/anatomopathologie , Poumon/virologie , Mâle , Adulte d'âge moyen , Pandémies , Pneumopathie virale/diagnostic , Pneumopathie virale/mortalité , Pneumopathie virale/virologie , Pronostic , Protéine S/métabolisme , Études rétrospectives , SARS-CoV-2 , Indice de gravité de la maladie , Analyse de survie , Thrombose veineuse/diagnostic , Thrombose veineuse/mortalité , Thrombose veineuse/virologieRésumé
Critically ill patients with coronavirus disease 2019 (COVID-19) have been observed to be hypercoagulable, but the mechanisms for this remain poorly described. Factor VIII is a procoagulant factor that increases during inflammation and is cleaved by activated protein C. To our knowledge, there is only 1 prior study of factor VIII and functional protein C activity in critically ill patients with COVID-19. Here, we present a case series of 10 critically ill patients with COVID-19 who had severe elevations in factor VIII activity and low normal functional protein C activity, which may have contributed to hypercoagulability.