Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
Haemophilia and Thrombosis Laboratory (Health Services Laboratories), Royal Free Hospital, London, UK.
Hemodial Int. 2023 Jan;27(1):38-44. doi: 10.1111/hdi.13046. Epub 2022 Sep 8.
Severe COVID-19 infections increase the risk of thrombotic events and Intensive Care Units reported increased extracorporeal circuit clotting (ECC) in COVID-19 patients with acute kidney injury. We wished to determine whether hemodialysis (HD) patients with COVID-19 also have increased risk of circuit clotting.
We reviewed coagulation studies and HD records, 4 weeks before and after COVID-19 polymerase chain reaction detection in HD patients between April 2020 and June 2021.
Sixty-eight (33.5%) of 203 HD patients with COVID-19, 65% male, mean age 64.9 ± 15.3 years, experienced some circuit clotting, and no clotting recorded prior to positive test results. In those who experienced ECC, prothrombin, activated partial thromboplastin or thrombin times were not different, whereas median factor VIII (273 [168-419] vs. 166 [139-225] IU/dl, p < 0.001), D-dimers (2654 [1381-6019] vs. 1351 [786-2334] ng/ml, p < 0.05), and fibrinogen (5.6 ± 1.4 vs. 4.9 ± 1.4 g/L, p < 0.05) were greater. Antithrombin (94 [83-112] vs. 89 [84-103] IU/dl), protein C (102 [80-130] vs. 86 [76-106] IU/dl), protein S (65 [61-75] vs. 65 [52-79] IU/dl) and platelet counts (193 [138-243] vs. 174 [138-229] × 10 /L) did not differ. On multivariable logistic analysis, circuit clotting was associated with log factor VIII (odds ratio [OR] 14.8 (95% confidence limits [95% CL] 1.12-19.6), p = 0.041), fibrinogen (OR 1.57 [95% CL 1.14-21.7], p = 0.006) and log D dimer (OR 4.8 [95% CL 1.16-12.5], p = 0.028).
Extracorporeal circuit clotting was increased within 4 weeks of testing positive for COVID-19. Clotting was associated with increased factor VIII, fibrinogen and D-dimer, suggesting that the risk of circuit clotting was related to the inflammatory response to COVID-19.
严重的 COVID-19 感染会增加血栓事件的风险，重症监护病房报告 COVID-19 合并急性肾损伤患者的体外循环凝血（ECC）增加。我们希望确定 COVID-19 血液透析（HD）患者是否也有更高的回路凝血风险。
我们回顾了 2020 年 4 月至 2021 年 6 月期间 COVID-19 聚合酶链反应检测前后 4 周内的凝血研究和 HD 记录。
68 例（33.5%）COVID-19 血液透析患者（65%为男性，平均年龄 64.9±15.3 岁）经历了某种程度的回路凝血，在阳性检测结果之前没有记录到凝血。在经历 ECC 的患者中，凝血酶原、活化部分凝血活酶或凝血酶时间没有差异，而中位因子 VIII（273[168-419] vs. 166[139-225]IU/dl，p<0.001）、D-二聚体（2654[1381-6019] vs. 1351[786-2334]ng/ml，p<0.05）和纤维蛋白原（5.6±1.4 vs. 4.9±1.4g/L，p<0.05）更高。抗凝血酶（94[83-112] vs. 89[84-103]IU/dl）、蛋白 C（102[80-130] vs. 86[76-106]IU/dl）、蛋白 S（65[61-75] vs. 65[52-79]IU/dl）和血小板计数（193[138-243] vs. 174[138-229]×10 /L）没有差异。多变量逻辑分析表明，回路凝血与 log 因子 VIII（优势比[OR]14.8（95%置信区间[95%CL]1.12-19.6），p=0.041）、纤维蛋白原（OR 1.57（95%CL 1.14-21.7），p=0.006）和 logD 二聚体（OR 4.8（95%CL 1.16-12.5），p=0.028）有关。
在 COVID-19 检测呈阳性后 4 周内，体外循环凝血增加。凝血与因子 VIII、纤维蛋白原和 D-二聚体的增加有关，这表明回路凝血的风险与 COVID-19 的炎症反应有关。
