Shirai Kunihiro, Ishikawa Michiko, Kobayashi Tomoyuki, Sato Kiyoko, Murakami Hiromoto, Kohama Keisuke, Manbo Naomi, Hasegawa Kana, Hirata Junichi
Department of Emergency, Disaster and Critical Care Medicine, Hyogo Medical University, Nishinomiya 663-8501, Japan.
Department of Pediatrics, Hyogo Medical University, Nishinomiya 663-8501, Japan.
J Clin Med. 2023 Mar 3;12(5):2019. doi: 10.3390/jcm12052019.
Severe novel coronavirus disease 2019 (COVID-19) patients have a high incidence of thrombotic complications and mortality. The pathophysiology of coagulopathy involves fibrinolytic system impairment and vascular endothelial damage. This study examined coagulation and fibrinolytic markers as outcome predictors. In an observational study of 164 COVID-19 patients admitted to our emergency intensive care unit, hematological parameters on days 1, 3, 5, and 7 were retrospectively compared between survivors and nonsurvivors. Nonsurvivors had a higher APACHE II score, SOFA score, and age than survivors. Nonsurvivors also had a significantly lower platelet count and significantly higher plasmin/α2plasmin inhibitor complex (PIC), tissue plasminogen activator/plasminogen activator inhibitor-1 complex (tPAPAI-1C), D-dimer, and fibrin/fibrinogen degradation product (FDP) levels than survivors throughout the measurement period. The 7-day maximum or minimum values of the tPAPAI-1C, FDP, and D-dimer levels were significantly higher in nonsurvivors. A multivariate logistic regression analysis showed that the maximum tPAPAI-1C (OR = 1.034; 95% CI,1.014-1.061; = 0.0041) was an independent factor affecting mortality, with an area under the curve (AUC) of 0.713 (optimum cut-off of 51 ng/mL; sensitivity, 69.2%; and specificity, 68.4%). COVID-19 patients with poor outcomes exhibit exacerbated coagulopathy with fibrinolysis inhibition and endothelial damage. Consequently, plasma tPAPAI-1C might be a useful predictor of the prognosis in patients with severe or critical COVID-19.
2019年新型冠状病毒病（COVID-19）重症患者血栓形成并发症和死亡率的发生率较高。凝血病的病理生理学涉及纤维蛋白溶解系统损害和血管内皮损伤。本研究将凝血和纤维蛋白溶解标志物作为预后预测指标。在一项对入住我院急诊重症监护病房的164例COVID-19患者的观察性研究中，对存活者和非存活者在第1、3、5和7天的血液学参数进行了回顾性比较。非存活者的急性生理与慢性健康状况评分系统（APACHE II）评分、序贯器官衰竭评估（SOFA）评分和年龄均高于存活者。在整个测量期间，非存活者的血小板计数也显著低于存活者，而纤溶酶/α2纤溶酶抑制物复合物（PIC）、组织纤溶酶原激活物/纤溶酶原激活物抑制物-1复合物（tPAPAI-1C）、D-二聚体和纤维蛋白/纤维蛋白原降解产物（FDP）水平则显著高于存活者。非存活者的tPAPAI-1C、FDP和D-二聚体水平的7天最大值或最小值显著更高。多因素logistic回归分析显示，tPAPAI-1C最大值（比值比[OR]=1.034；95%置信区间[CI]，1.014-1.061；P=0.0041）是影响死亡率的独立因素，曲线下面积（AUC）为0.713（最佳截断值为51 ng/mL；敏感性为69.2%；特异性为68.4%）。预后不良的COVID-19患者表现出凝血病加重，伴有纤维蛋白溶解抑制和内皮损伤。因此，血浆tPAPAI-1C可能是重症或危重症COVID-19患者预后的有用预测指标。
