Hemostastatic alterations with disease severity in the early symptomatic phase of COVID-19

ABSTRACT

Background: The main factors associated with disease severity in COVID-19 are age, sex, body weight, hypertension, and diabetes. Biomarkers of hemostatic activation have been shown to be independent predictors of disease severity in different populations of inpatients. Aims: To evaluate whether biomarkers of hemostatic activation were associated with clinical outcomes in patients admitted to a field hospital, set up to provide initial care to patients in the early symptomatic phase of COVID-19. Methods: Data and samples were obtained from June to September 2020. Laboratory evaluation included complete blood counts, PT, aPTT, fibrinogen, D-dimer, factor VIII activity, Von Willebrand Factor (VWF) (activity and antigen), C reactive protein (CRP) and Pselectin (ELISA). Patients were segregated by outcome, with clinical deterioration defined as need for ICU, mechanical ventilation, pulmonary embolism, deep vein thrombosis or death. Results: In total 209 were enrolled in the study, of which 24 presented clinical deterioration (11.5%). Clinical data are described in Table 1. No differences could be observed between patient subgroups regarding the presence of fever (63.2% vs . 62.5%), dry cough (75.1% vs . 87.5%) and dyspnea (65.9% vs . 54.2%) at admission. As main comorbidities, the groups presented chronic obstructive pulmonary disease (2.2% vs 8.3%), asthma (3.2% vs 4.2%), chronic heart failure (1.1% vs 8.3%), arterial hypertension (46% vs 41.7%) and diabetes (28.1% vs 33.3%) in comparing improved with clinical deterioration patients. Laboratory markers of hemostatic activation are shown in Table 2. In general, it was verified a significant decrease in platelet number, and an increase in the parameters of aPTT, CRP, vWF antigen and ristocetin cofactor. Conclusions: Our results demonstrate that hemostasis activation is associated with clinical deterioration even at the early phases of COVID-19.