Maghrabi Khalid A, AlQahtany Fatmah S, AlOtair Hadeel, Maghrabi Mohannad K, AlSaleh Khalid, Owaidah Tarek
Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, KSA.
Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, KSA.
J Taibah Univ Med Sci. 2023 Oct;18(5):1089-1098. doi: 10.1016/j.jtumed.2023.02.013. Epub 2023 Mar 10.
Several hematological and immunological markers, particularly neutrophil count, predict the severity of COVID-19. This study aimed at assessing hematological and coagulation parameters at different time points, to predict the complications or outcomes of patients with COVID-19 admitted to the intensive care unit (ICU).
We conducted a prospective observational multicenter study in ICU departments. A total of 118 patients with COVID-19 admitted to the ICU were included. Clinical data and blood samples from routine hematology and coagulation tests were collected at admission, and on days 3, 7, and 14. The main outcome measures were high-flow-O requirement, thrombosis, and 30-day mortality.
The venous thromboembolism score increased from a mean of 5.10 ± 2 on day 0 to 6.40 ± 2.80 on day 14 ( = 0.0002). The disseminated intravascular coagulation (DIC) score significantly correlated with thrombosis ( = 0.031). A total of 41.20% of patients in the ICU had a DIC score ≥4, and 11.40% had a score <4. Mortality was negatively associated with patients on high-flow O, 9 patients (10.80%) ( = 0.040), and positively associated with patients receiving ventilation, 16 patients (27.50%) ( < 0.001). An increase in white blood cell count (subdistribution hazard ratio (SHR): 0.91; 95% CI: 0.80-1) and neutrophil count (SHR: 1; 95% CI: 1.01-1.05) was associated with greater disease severity and D-dimer level (SHR: 1.60; 95% CI: 1.10-2.5).
The venous thromboembolism score was significantly higher for patients who died than those who recovered. Furthermore, mechanical ventilation was associated with high mortality, whereas the risk of thrombosis and ICU admission correlated with high D-dimer values and DIC scores. Therefore, D-dimer levels and DIC scores are prognostic markers that may predict disease severity in patients with COVID-19.
多种血液学和免疫学指标，尤其是中性粒细胞计数，可预测新型冠状病毒肺炎（COVID-19）的严重程度。本研究旨在评估不同时间点的血液学和凝血参数，以预测入住重症监护病房（ICU）的COVID-19患者的并发症或预后。
我们在ICU科室开展了一项前瞻性观察性多中心研究。共纳入118例入住ICU的COVID-19患者。在入院时以及第3、7和14天收集临床资料以及常规血液学和凝血检查的血样。主要结局指标为高流量吸氧需求、血栓形成和30天死亡率。
静脉血栓栓塞评分从第0天的平均5.10±2增加至第14天的6.40±2.80（P = 0.0002）。弥散性血管内凝血（DIC）评分与血栓形成显著相关（P = 0.031）。ICU中共有41.20%的患者DIC评分≥4，11.40%的患者评分<4。死亡率与接受高流量吸氧的患者呈负相关，9例患者（10.80%）（P = 0.040），与接受机械通气的患者呈正相关，16例患者（27.50%）（P<0.001）。白细胞计数增加（亚组分布风险比（SHR）：0.91；95%置信区间：0.80 - 1）、中性粒细胞计数增加（SHR：1；95%置信区间：1.01 - 1.05）与疾病严重程度增加以及D-二聚体水平升高（SHR：1.60；95%置信区间：1.10 - 2.5）相关。
死亡患者的静脉血栓栓塞评分显著高于康复患者。此外，机械通气与高死亡率相关，而血栓形成风险和入住ICU与高D-二聚体值及DIC评分相关。因此，D-二聚体水平和DIC评分是可预测COVID-19患者疾病严重程度的预后指标。
