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Validation of an admission coagulation panel for risk stratification of COVID-19 patients.
Alabyad, Darwish; Rangaraju, Srikant; Liu, Michael; Imran, Rajeel; Kempton, Christine L; Sharifpour, Milad; Auld, Sara C; Gaddh, Manila; Sniecinski, Roman; Maier, Cheryl L; Guarner, Jeannette; Duncan, Alexander; Nahab, Fadi.
  • Alabyad D; Morehouse School of Medicine, Atlanta, Georgia, United States of America.
  • Rangaraju S; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Liu M; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Imran R; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Kempton CL; Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Sharifpour M; Division of Critical Care Medicine, Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Auld SC; Emory Critical Care Center, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Gaddh M; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.
  • Sniecinski R; Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Maier CL; Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Guarner J; Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Duncan A; Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
  • Nahab F; Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
PLoS One ; 16(3): e0248230, 2021.
Article in English | MEDLINE | ID: covidwho-1143293
ABSTRACT

BACKGROUND:

There is limited data on the markers of coagulation and hemostatic activation (MOCHA) profile in Coronavirus disease 2019 (COVID-19) and its ability to identify COVID-19 patients at risk for thrombotic events and other complications.

METHODS:

Hospitalized patients with confirmed SARS-COV-2 from four Atlanta hospitals were included in this observational cohort study and underwent admission testing of MOCHA parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer). Clinical outcomes included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, access line thrombosis, ICU admission, intubation and mortality. MAIN

RESULTS:

Of 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American), 45 (16%) had a thrombotic endpoint. Each MOCHA parameter was independently associated with a thrombotic event (p<0.05) and ≥ 2 abnormalities was associated with thrombotic endpoints (OR 3.3, 95% CI 1.2-8.8) as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5-6.6) and ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6-7.9). However, only ≥ 2 MOCHA abnormalities were associated with ICU admission (OR 3.0, 95% CI 1.7-5.2) and intubation (OR 3.2, 95% CI 1.6-6.4). MOCHA and D-dimer cutoffs were not associated with mortality. MOCHA with <2 abnormalities (26% of the cohort) had 89% sensitivity and 93% negative predictive value for a thrombotic endpoint.

CONCLUSIONS:

An admission MOCHA profile is useful to risk-stratify COVID-19 patients for thrombotic complications and more effective than isolated d-dimer for predicting risk of ICU admission and intubation.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Peptide Fragments / Peptide Hydrolases / Thrombosis / Fibrin Fibrinogen Degradation Products / Prothrombin / Antithrombin III / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0248230

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Peptide Fragments / Peptide Hydrolases / Thrombosis / Fibrin Fibrinogen Degradation Products / Prothrombin / Antithrombin III / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0248230