Bauer Wolfgang, Galtung Noa, Neuwinger Nick, Kaufner Lutz, Langer Elisabeth, Somasundaram Rajan, Tauber Rudolf, Kappert Kai
Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
TH Open. 2021 Feb 6;5(1):e43-e55. doi: 10.1055/s-0040-1722612. eCollection 2021 Jan.
COVID-19 (coronavirus disease 2019) patients often show excessive activation of coagulation, associated with increased risk of thrombosis. However, the diagnostic value of coagulation at initial clinical evaluation is not clear. We present an in-depth analysis of coagulation in patients presenting to the emergency department (ED) with suspected COVID-19. = 58 patients with clinically suspected COVID-19 in the ED were enrolled. = 17 subsequently tested positive using SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction (PCR) swabs, while in = 41 COVID-19 was ruled-out. We analyzed both standard and extended coagulation parameters, including thromboplastin time (INR), activated partial thromboplastin time (aPTT), antithrombin, plasminogen, plasminogen activator inhibitor-1 (PAI-1), D-dimers, and fibrinogen at admission, as well as α2-antiplasmin, activated protein C -resistance, factor V, lupus anticoagulant, protein C, protein S, and von Willebrand diagnostics. These data, as well as mortality and further laboratory parameters, were compared across groups based on COVID-19 diagnosis and severity of disease. In patients with COVID-19, we detected frequent clotting abnormalities, including D-dimers. The comparison cohort in the ED, however, showed similarly altered coagulation. Furthermore, parameters previously shown to distinguish between severe and moderate COVID-19 courses, such as platelets, plasminogen, fibrinogen, aPTT, INR, and antithrombin, as well as multiple nonroutine coagulation analytes showed no significant differences between patients with and without COVID-19 when presenting to the ED. At admission to the ED the prevalence of coagulopathy in patients with COVID-19 is high, yet comparable to the non-COVID-19 cohort presenting with respiratory symptoms. Nevertheless, coagulopathy might worsen during disease progression with the need of subsequent risk stratification.
2019冠状病毒病（COVID-19）患者常表现出凝血过度激活，这与血栓形成风险增加有关。然而，在初始临床评估时凝血的诊断价值尚不清楚。我们对急诊科疑似COVID-19患者的凝血情况进行了深入分析。纳入了急诊科58例临床疑似COVID-19患者。其中17例随后通过严重急性呼吸综合征冠状病毒2（SARS-CoV-2）聚合酶链反应（PCR）拭子检测呈阳性，而41例排除了COVID-19。我们分析了标准和扩展凝血参数，包括入院时的凝血酶原时间（INR）、活化部分凝血活酶时间（aPTT）、抗凝血酶、纤溶酶原、纤溶酶原激活物抑制剂-1（PAI-1）、D-二聚体和纤维蛋白原，以及α2-抗纤溶酶、活化蛋白C抵抗、因子V、狼疮抗凝物、蛋白C、蛋白S和血管性血友病因子诊断指标。这些数据以及死亡率和其他实验室参数，根据COVID-19诊断和疾病严重程度在各组之间进行了比较。在COVID-19患者中，我们检测到频繁的凝血异常，包括D-二聚体升高。然而，急诊科的对照队列显示凝血情况也有类似改变。此外，先前显示可区分重度和中度COVID-19病程的参数，如血小板、纤溶酶原、纤维蛋白原、aPTT、INR和抗凝血酶，以及多种非常规凝血分析物，在急诊科就诊的COVID-19患者和非COVID-19患者之间没有显著差异。在急诊科入院时，COVID-19患者中凝血病的患病率很高，但与出现呼吸道症状的非COVID-19队列相当。尽管如此，凝血病可能在疾病进展过程中恶化，需要进行后续风险分层。
