Di Micco Pierpaolo, Russo Vincenzo, Carannante Novella, Imparato Michele, Cardillo Giuseppe, Lodigiani Corrado
UOC Medicina, Fatebenefratelli Hospital of Naples, 80131 Naples, Italy.
Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Piazzale Ettore Ruggeri, 80131 Naples, Italy.
J Clin Med. 2020 Dec 21;9(12):4134. doi: 10.3390/jcm9124134.
A highly pathogenic human coronavirus able to induce severe acute respiratory syndrome (SARS) has been recently recognized as the cause of the coronavirus disease 2019 (COVID-19); the disease became pandemic after a few months. Little is still known about the laboratory prognostic markers in COVID-19 patients. The aim of our study was to describe the prognostic value of clotting parameters for the prediction of severe form of COVID-19 characterized by acute respiratory distress syndrome (ARDS) at hospital admission.
From a large cohort of 152 patients consecutively admitted from February to March 2020 for fever and dyspnea to the emergency departments (ED) of three Italian hospitals, we evaluated 85 patients with confirmed diagnosis of COVID-19 and 67 patients with acute illness. All patients underwent medical history checks, physical examination, and laboratory evaluation. Prothrombin time (PT), activated thromboplastin time (aPTT), fibrinogen and D-dimer tests were performed and compared, first, between COVID-19 and control groups, and then between COVID-19 patients with or without ARDS.
COVID-19 patients were more likely to show abnormal baseline levels of PT, aPTT, D-dimer, and fibrinogen at admission compared to the control group. COVID-19 patients with ARDS showed a statistically significant increase in levels of fibrinogen compared to those without ARDS (720 (621-833) vs. 490 (397.5-601.5); = 1.8653 × 10 (0.0765). A cut-off value of 617 mg/dL had a sensitivity of 76% and a specificity of 79% in identifying COVID-19 patients with ARDS.
A serum level of fibrinogen of 617 mg/dL in COVID-19 patients admitted to emergency department may help to identify early those with ARDS.
一种能够引发严重急性呼吸综合征（SARS）的高致病性人类冠状病毒最近被确认为2019冠状病毒病（COVID-19）的病因；该疾病在几个月后成为大流行病。关于COVID-19患者的实验室预后标志物仍知之甚少。我们研究的目的是描述凝血参数对预测以急性呼吸窘迫综合征（ARDS）为特征的COVID-19严重形式在入院时的预后价值。
从2020年2月至3月因发热和呼吸困难连续入住意大利三家医院急诊科的152例患者的大型队列中，我们评估了85例确诊为COVID-19的患者和67例急性疾病患者。所有患者均接受了病史检查、体格检查和实验室评估。进行了凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）、纤维蛋白原和D-二聚体检测，并首先在COVID-19组和对照组之间进行比较，然后在有或无ARDS的COVID-19患者之间进行比较。
与对照组相比，COVID-19患者入院时更有可能出现PT、aPTT、D-二聚体和纤维蛋白原的基线水平异常。与无ARDS的COVID-19患者相比，有ARDS的COVID-19患者纤维蛋白原水平有统计学显著升高（720（621-833）对490（397.5-601.5）； = 1.8653 × 10（0.0765）。617 mg/dL的临界值在识别有ARDS的COVID-19患者时灵敏度为76%，特异性为79%。
急诊科收治的COVID-19患者血清纤维蛋白原水平为617 mg/dL可能有助于早期识别患有ARDS的患者。
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