Serial markers of coagulation and inflammation and the occurrence of clinical pulmonary thromboembolism in mechanically ventilated patients with SARS-CoV-2 infection; the prospective Maastricht intensive care COVID cohort.

Autor: Mulder MMG; Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands. mark.mulder@mumc.nl., Brandts L; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands., Brüggemann RAG; Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands., Koelmann M; Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands., Streng AS; Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, The Netherlands., Olie RH; Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Thrombosis Expert Centre Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands., Gietema HA; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands., Spronk HMH; Thrombosis Expert Centre Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands., van der Horst ICC; Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands., Sels JEM; Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands., Wildberger JE; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands., van Kuijk SMJ; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands., Schnabel RM; Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands., Ten Cate H; Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Thrombosis Expert Centre Maastricht and Department of Internal Medicine, Section Vascular Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands., Henskens YMC; Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands., van Bussel BCT; Department of Intensive Care Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.; Care and Public Health Research Institute, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: Thrombosis journal [Thromb J] 2021 May 31; Vol. 19 (1), pp. 35. Date of Electronic Publication: 2021 May 31.
DOI: 10.1186/s12959-021-00286-7
Abstrakt: Background: The incidence of pulmonary thromboembolism is high in SARS-CoV-2 patients admitted to the Intensive Care. Elevated biomarkers of coagulation (fibrinogen and D-dimer) and inflammation (c-reactive protein (CRP) and ferritin) are associated with poor outcome in SARS-CoV-2. Whether the time-course of fibrinogen, D-dimer, CRP and ferritin is associated with the occurrence of pulmonary thromboembolism in SARS-CoV-2 patients is unknown. We hypothesise that patients on mechanical ventilation with SARS-CoV-2 infection and clinical pulmonary thromboembolism have lower concentrations of fibrinogen and higher D-dimer, CRP, and ferritin concentrations over time compared to patients without a clinical pulmonary thromboembolism.
Methods: In a prospective study, fibrinogen, D-dimer, CRP and ferritin were measured daily. Clinical suspected pulmonary thromboembolism was either confirmed or excluded based on computed tomography pulmonary angiography (CTPA) or by transthoracic ultrasound (TTU) (i.e., right-sided cardiac thrombus). In addition, patients who received therapy with recombinant tissue plasminogen activator were included when clinical instability in suspected pulmonary thromboembolism did not allow CTPA. Serial data were analysed using a mixed-effects linear regression model, and models were adjusted for known risk factors (age, sex, APACHE-II score, body mass index), biomarkers of coagulation and inflammation, and anticoagulants.
Results: Thirty-one patients were considered to suffer from pulmonary thromboembolism ((positive CTPA (n = 27), TTU positive (n = 1), therapy with recombinant tissue plasminogen activator (n = 3)), and eight patients with negative CTPA were included. After adjustment for known risk factors and anticoagulants, patients with, compared to those without, clinical pulmonary thromboembolism had lower average fibrinogen concentration of - 0.9 g/L (95% CI: - 1.6 - - 0.1) and lower average ferritin concentration of - 1045 μg/L (95% CI: - 1983 - - 106) over time. D-dimer and CRP average concentration did not significantly differ, 561 μg/L (- 6212-7334) and 27 mg/L (- 32-86) respectively. Ferritin lost statistical significance, both in sensitivity analysis and after adjustment for fibrinogen and D-dimer.
Conclusion: Lower average concentrations of fibrinogen over time were associated with the presence of clinical pulmonary thromboembolism in patients at the Intensive Care, whereas D-dimer, CRP and ferritin were not. Lower concentrations over time may indicate the consumption of fibrinogen related to thrombus formation in the pulmonary vessels.
Databáze: MEDLINE
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