Hypercoagulation by rotational thromboelastometry (ROTEM) predicts mortality in COVID-19: A prospectiveobservational study

ABSTRACT

Background: Severe disease due to COVID-19 has been shown to be associated with coagulopathy with a high rate of micro-and macrothrombosis, and early identification of prothrombotic patients may guide treatment. Rotational Thromboelastometry (ROTEM) is an established point-of-care (POC) blood test, used for detecting and monitoring hypo-and hypercoagulation. Aims: The primary aim of this study was to assess whether analysis by ROTEM alone or in combination with other risk markers can be a predictor of mortality in COVID-19. Methods: This was a single center, prospective, observational study where COVID-19 positive patients over 18 years in need of hospitalization were eligible for inclusion. Conventional coagulation tests and ROTEM were taken day 1-3 after hospital admission and patients were followed for 30 days. A logistic regression approach was applied to the ROTEM data and possible important covariates. Results: 141 patients were included, 62 % men, median age 63 years. 18 patients (13%) died within 30 days. Comorbidities were common, and most patients had laboratory markers indicating hypercoagulation (e.g. d-dimer, P-fibrinogen and ROTEM). The logistic model presented that the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased age, respiratory frequency and the ROTEM variable EXTEM-MCF (all predictors P < 0.05). When the model is applied to the data, the ROC curve AUC is 0.91. FIGURE 1 Predicted probability of death vs risk score Figure 1. Prediction model using logistic regression. Distribution of patients across range of risk scores, with the three predictor variables at inclusion (EXTEM-MCF, age and respiratory frequency). In lower part of figure, a histogram showing the distribution of risk scores for the present data. Conclusions: The results support that hypercoagulation in COVID-19, as measured using ROTEM, is associated with an increased risk of death. In our prediction model, increased EXTEM-MCF, age and respiratory frequency on admission were associated with increased mortality within 30 days.