Prognostic value of an automated thrombin generation assay in COVID-19 patients entering hospital: A multicentric, prospective observational study.

Autor: Gris JC; Department of Haematology, CHU Nîmes, Univ. Montpellier, Nîmes, France; Faculty of Pharmaceutical and Biological Sciences, Montpellier University, France; UMR UA11 INSERM IDESP - Montpellier University, France; Department of Obstetrics and Gynaecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation. Electronic address: jean.christophe.gris@chu-nimes.fr., Guillotin F; Department of Haematology, CHU Nîmes, Univ. Montpellier, Nîmes, France., Dos Santos TP; BESPIM, CHU Nîmes, Univ. Montpellier, Nîmes, France., Chéa M; Department of Haematology, CHU Nîmes, Univ. Montpellier, Nîmes, France., Loubet P; Department of Infectious and Tropical Diseases, CHU Nîmes, Univ Montpellier, Nîmes, France., Laureillard D; Department of Infectious and Tropical Diseases, CHU Nîmes, Univ Montpellier, Nîmes, France., Sotto A; Department of Infectious and Tropical Diseases, CHU Nîmes, Univ Montpellier, Nîmes, France., Muller L; Department of Anaesthesiology, Critical Care and Emergency Medicine, CHU Nîmes, Univ Montpellier, Nîmes, France., Barbar SD; Department of Anaesthesiology, Critical Care and Emergency Medicine, CHU Nîmes, Univ Montpellier, Nîmes, France., Roger C; Department of Anaesthesiology, Critical Care and Emergency Medicine, CHU Nîmes, Univ Montpellier, Nîmes, France., Lefrant JY; Department of Anaesthesiology, Critical Care and Emergency Medicine, CHU Nîmes, Univ Montpellier, Nîmes, France., Jung B; Department of Intensive Care Medicine, Lapeyronie Hospital, CHU Montpellier, Univ. Montpellier, Nîmes, France; Department of Vascular Medicine, CHU Montpellier, Univ. Montpellier, Nîmes, France., Klouche K; Department of Intensive Care Medicine, Lapeyronie Hospital, CHU Montpellier, Univ. Montpellier, Nîmes, France; Department of Vascular Medicine, CHU Montpellier, Univ. Montpellier, Nîmes, France., Mura T; BESPIM, CHU Nîmes, Univ. Montpellier, Nîmes, France., Quéré I; Department of Intensive Care Medicine, Lapeyronie Hospital, CHU Montpellier, Univ. Montpellier, Nîmes, France; Department of Vascular Medicine, CHU Montpellier, Univ. Montpellier, Nîmes, France., Perez-Martin A; Department of Vascular Medicine, CHU Nîmes, Univ. Montpellier, Nîmes, France.
Jazyk: angličtina
Zdroj: Thrombosis research [Thromb Res] 2023 Feb; Vol. 222, pp. 85-95. Date of Electronic Publication: 2023 Jan 02.
DOI: 10.1016/j.thromres.2022.12.019
Abstrakt: Introduction: The prognostic significance of the thrombin generation assay (TGA) with a thrombomodulin (TM) challenge in patients entering hospital with severe COVID-19 is uncertain.
Methods: We prospectively evaluated an automated TGA (aTGA) using the ST-ThromboScreen® assay and ST-Genesia® analyser in 179 patients with severe COVID-19 during their admission to 2 university hospitals. The primary outcome was early survival at Day 28 (D28). Secondary outcomes were late survival at Day 90 (D90), later transfer to an intensive care unit (ICU), and occurrence of any thrombotic complications during hospitalisation.
Results: Among the 174 patients, 50 were initially admitted to ICUs. Forty-two were transferred to ICUs before D28. Fourteen patients, all in ICUs, died before D28, and 20 before D90, all but 1 in ICUs. None of the aTGA-derived results were associated with vital status either at D28 or D90. Nine patients had a thrombotic event with no association with the aTGA results. Later transfer to the ICU was associated with higher velocity index, thrombin peak height and endogenous thrombin potential (ETP) values of the aTGA performed with TM, and mainly with a lower TM-induced decrease in ETP (odds ratio 15.5 (2.15-132), p = 0.009).
Conclusions: aTGA, a global assay supposed to evidence coagulopathy, could predict neither early or late survival, nor thrombotic events, in hospitalised COVID-19 patients. Its clinical justification in that setting is thus unlikely. A relative resistance of the ETP to TM was associated with later transfer to the ICU and deserves further investigation.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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