Thrombin generation and all-cause mortality in The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

INTRODUCTION: Thrombin generation assay (TGA) is a laboratory method that provides the global evaluation of hemostasis. The association between thrombin generation and all-cause mortality is poorly investigated and results are contradictory. This study evaluated whether TGA parameters are associated with all-cause mortality in a prospective cohort. METHODS: This study was conducted in 2,588 participants enrolled at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TGA was performed using the Calibrated Automated Thrombogram (CAT) method, and its parameters lagtime, time-to-peak, peak, Endogenous Thrombin Potential (ETP) and normalized ETP (nETP) were evaluated according to the reference interval (RI). The association between TGA parameters and all-cause mortality was estimated by Cox regression and adjusted for confounders. RESULTS: The mean follow-up time was 6.6 ± 2.7 years and 85 deaths occurred. After adjustment, time-to-peak values above the RI at low and high tissue factor (TF) concentrations were associated with higher risk of death [HR = 2.45 (95 % CI: 1.17-5.13) and HR = 2.24 (95 % CI: 1.02-4.93), respectively] and nETP and peak values below RI at high TF concentration were associated with higher risk of death [HR = 3.85 (95 % CI: 1.39-10.68) and HR = 2.56 (95 % CI: 1.17-5.61), respectively]. CONCLUSIONS: Delayed thrombin generation was associated with higher risk of all-cause mortality.

COVID-19: Review and hematologic impact.

In the last decades, coronaviruses have been a major threat to public health worldwide. SARS-CoV-2 is the third known coronavirus that causes fatal respiratory diseases in humans. The initial clinical features of SARS-CoV-2 infection are quite nonspecific and not all suspected patients can be tested to exclude or confirm the diagnosis. Increasing scientific evidence has shown that abnormalities in routine laboratory tests, particularly hematological tests, have the potential to indicate, in a quick, practical and economical way, the need for specific laboratory tests for the diagnosis of SARS-CoV-2 infection, besides assisting in the prognosis of the disease and in the optimization of its clinical monitoring. In order to address in a simple and practical way the various aspects related to SARS-CoV-2 infection, this review reports the history of the virus, the epidemiology and pathophysiology of COVID-19, with emphasis on its laboratory diagnosis, particularly in hematological changes found during the course of the disease.