Loutsidi Natasa-Eleni, Politou Marianna, Vlahakos Vassilios, Korakakis Dimitrios, Kassi Theodora, Nika Asimina, Pouliakis Abraham, Eleftheriou Konstantinos, Balis Evangelos, Pappas Apostolos G, Kalomenidis Ioannis
Haematology-Lymphomas Department and Bone Marrow Transplant Unit, "Evangelismos" General Hospital, 10676 Athens, Greece.
Hematology Laboratory-Blood Bank, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece.
Viruses. 2024 Dec 14;16(12):1916. doi: 10.3390/v16121916.
Hypercoagulation is central to the pathogenesis of acute and post-acute COVID-19. This prospective observational study explored whether rotational thromboelastometry (ROTEM), a method that unveils coagulation status, predicts outcomes of hospitalized patients with COVID-19 pneumonia. We investigated 62 patients using ROTEM that was conducted at enrollment, clinical deterioration, discharge and follow-up visits 1 and 3 months post-discharge. A hypercoagulable ROTEM was more common at clinical deterioration than at enrollment and the levels of hypercoagulable ROTEM indices correlated with the clinical severity score. Hypercoagulable ROTEM at enrollment was not associated with in-hospital death. Patients with hypercoagulable ROTEM at enrollment, discharge and 1 month post-discharge had an increased risk of persistent symptoms 1 and 3 months after discharge. Patients with hypercoagulable ROTEM at enrollment, discharge, and 1 month after discharge were more likely to have lung diffusion capacity (DLco) impairment 3 months after discharge. High levels of hypercoagulable ROTEM indices were associated with the increased risk of persistent symptoms at later stages of the disease. In a multivariate analysis, (i) hypercoagulable ROTEM at discharge and female gender were linked to the presence of symptoms at one month post-discharge, (ii) hypercoagulable ROTEM at one month after discharge was linked to the presence of symptoms at three months post-discharge, (iii) hypercoagulable ROTEM at enrollment and at discharge and female gender were linked to the presence of impaired DLco at three months post-discharge. Excessive coagulation may contribute to long-COVID pathogenesis and ROTEM findings during hospitalization may predict post-acute-COVID-19 sequelae in patients with COVID-19-related pneumonia.
高凝状态是急性和急性后 COVID-19 发病机制的核心。这项前瞻性观察性研究探讨了旋转血栓弹力图（ROTEM）这种揭示凝血状态的方法是否能预测 COVID-19 肺炎住院患者的预后。我们对 62 名患者进行了研究，在入组时、临床病情恶化时、出院时以及出院后 1 个月和 3 个月的随访时进行了 ROTEM 检测。临床病情恶化时出现高凝性 ROTEM 的情况比入组时更常见，且高凝性 ROTEM 指标水平与临床严重程度评分相关。入组时的高凝性 ROTEM 与院内死亡无关。入组时、出院时和出院后 1 个月出现高凝性 ROTEM 的患者在出院后 1 个月和 3 个月出现持续症状的风险增加。入组时、出院时和出院后 1 个月出现高凝性 ROTEM 的患者在出院后 3 个月更有可能出现肺弥散功能（DLco）受损。高凝性 ROTEM 指标水平升高与疾病后期持续症状的风险增加相关。在多变量分析中，（i）出院时的高凝性 ROTEM 和女性性别与出院后 1 个月出现症状有关，（ii）出院后 1 个月的高凝性 ROTEM 与出院后 3 个月出现症状有关，（iii）入组时和出院时的高凝性 ROTEM 以及女性性别与出院后 3 个月出现 DLco 受损有关。过度凝血可能导致新冠后综合征的发病机制，住院期间的 ROTEM 检测结果可能预测 COVID-19 相关肺炎患者的急性后 COVID-19 后遗症。
