Almskog Lou M, Wikman Agneta, Svensson Jonas, Bottai Matteo, Kotormán Mariann, Wahlgren Carl-Magnus, Wanecek Michael, van der Linden Jan, Ågren Anna
Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
TH Open. 2021 Dec 21;6(1):e50-e59. doi: 10.1055/a-1725-9221. eCollection 2022 Jan.
Severe disease due to the novel coronavirus disease 2019 (COVID-19) has been shown to be associated with hypercoagulation. The aim of this study was to assess the Rotational Thromboelastometry (ROTEM) as a marker of coagulopathy in hospitalized COVID-19 patients. This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model, including variables ROTEM EXTEM-MCF (Maximum Clot Firmness) which in previous data has been suggested a suitable marker of hypercoagulation, age, and respiratory frequency, was developed using logistic regression to evaluate the probability of death. Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age, and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM-coagulation time (CT) was observed, supporting a severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) effect on prolonged initiation of coagulation. Here, we show that hypercoagulation measured with ROTEM predicts 30-day mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.
新型冠状病毒肺炎（COVID-19）所致的重症已被证明与高凝状态有关。本研究的目的是评估旋转血栓弹力图（ROTEM）作为住院COVID-19患者凝血病的标志物。
这是一项前瞻性观察性研究，因COVID-19感染住院的患者符合纳入条件。入院后进行常规凝血试验和ROTEM检测，并对患者进行30天的随访。使用逻辑回归建立了一个预测模型，该模型包括变量ROTEM EXTEM-MCF（最大血凝块硬度），在先前的数据中它被认为是高凝状态的合适标志物、年龄和呼吸频率，以评估死亡概率。
在纳入的141例患者中，18例（13%）在30天内死亡。在最终的预测模型中，因COVID-19住院患者30天内的死亡风险随着EXTEM-MCF、年龄和呼吸频率的增加而增加。重症亚组的纵向ROTEM数据显示高凝状态增强。在一项体外分析中，未观察到肝素对EXTEM凝血时间（CT）的影响，这支持了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）对凝血启动延长的影响。
在此，我们表明，用ROTEM测量的高凝状态可预测COVID-19患者的30天死亡率。纵向ROTEM数据强化了高凝状态是COVID-19重症驱动因素的假说。因此，ROTEM可能是评估COVID-19疾病严重程度的有用工具，并可能指导抗凝治疗。
