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: Marcel Koelmann, Henri M. H. Spronk, LIoyd Brandts, Hugo ten Cate, Hester A. Gietema, Renée A G Brüggemann, Mark M.G. Mulder, Joachim E. Wildberger, Sander M. J. van Kuijk, Jan-Willem E M Sels, Yvonne M. C. Henskens, Alexander S. Streng, Iwan C. C. van der Horst, Ronny M. Schnabel, Bas C T van Bussel, Renske H. Olie
Přispěvatelé: RS: GROW - R1 - Prevention, Epidemiologie, MUMC+: MA Med Staf Artsass Interne Geneeskunde (9), MUMC+: DA CDL Algemeen (9), Interne Geneeskunde, MUMC+: HVC Pieken Trombose (9), RS: Carim - B04 Clinical thrombosis and Haemostasis, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, MUMC+: MA Intensive Care (3), Intensive Care, MUMC+: MA Medische Staf IC (9), RS: Carim - V04 Surgical intervention, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), MUMC+: Diagnostiek en Advies (3), MUMC+: DA Beeldvorming (5), RS: Carim - B06 Imaging, MUMC+: KIO Kemta (9), RS: CAPHRI - R2 - Creating Value-Based Health Care, MUMC+: HVC Trombosezorg (8), MUMC+: MA Alg Interne Geneeskunde (9), Faculteit FHML Centraal, RS: CAPHRI - R5 - Optimising Patient Care
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Thrombosis Journal, 19(1):35. BioMed Central Ltd
Thrombosis Journal, Vol 19, Iss 1, Pp 1-12 (2021)
Thrombosis Journal
ISSN: 1477-9560
DOI: 10.1186/s12959-021-00286-7
Popis: 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: OpenAIRE
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