Plasma hemostatic system in patients with the novel coronavirus disease 2019 (COVID-19)

ABSTRACT

Aim. To investigate plasma hemostasis in patients with different levels of COVID-19 severity. Materials and methods. The study included 46 patients with confirmed COVID-19, who were stratified into four groups based on disease severity as mild (1), moderate (2), severe (3), and critically severe (4). Laboratory investigations included APTT, Quick's prothrombin time, concentration of D-dimer, fibrinogen, ATIII, and platelet count. Results. D-dimer concentration >450 ng/ml was found in 100% of patients increasing from 973 (545–1635) ng/ml in group 1 to 13513 (7627–22512) ng/ml in group 4 (p<0.05). Patients in group 2 had the highest fibrinogen level averaging 6.1(3.9–6.4) g/L. The highest and lowest platelet counts were in groups 1 (323x109) and 4 (155×109), respectively, (p <0.05). The ATIII levels in groups 1 and 2 were within the normal range, while in groups 3 and 4, they were decreased to 76% and 64%, respectively (p <0.05). All patients enrolled in the study had normal values of APTT and Quick's prothrombin time. Unfavorable outcomes were observed at a D-dimer concentration> 3633 ng/ml (specificity 92.3%, sensitivity 100%, AUC 0.94, p <0.001, positive predictive value 99.1%, and negative predictive value 100%) and ATIII <70.8% (specificity 70%, sensitivity 82.6%, AUC 0.85, p <0.001, positive predictive value 30.5%, and negative predictive value 96.1%). Conclusion. The levels of D-dimer, fibrinogen, and ATIII were found to be associated with the severity of COVID-19.