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. 2020 Nov;18(11):2942-2953.
doi: 10.1111/jth.15067. Epub 2020 Sep 18.

Coagulation biomarkers are independent predictors of increased oxygen requirements in COVID-19

Antoine Rauch  1 , Julien Labreuche  2 , Fanny Lassalle  1 , Julien Goutay  3 , Morgan Caplan  3 , Leslie Charbonnier  4 , Aurelien Rohn  4 , Emmanuelle Jeanpierre  1 , Annabelle Dupont  1 , Alain Duhamel  2 , Karine Faure  5 , Marc Lambert  6 , Eric Kipnis  7 , Delphine Garrigue  4 , Peter J Lenting  8 , Julien Poissy  9 , Sophie Susen  1
Affiliations

Coagulation biomarkers are independent predictors of increased oxygen requirements in COVID-19

Antoine Rauch et al. J Thromb Haemost. 2020 Nov.

Abstract

Background: Hypercoagulability seems to contribute to SARS-CoV-2 pneumonia pathogenesis. However, age and metabolic syndrome are potential confounders when assessing the value of coagulation biomarkers' prediction of COVID-19 outcomes. We assessed whether coagulation biomarkers, including factor VIII (FVIII) and von Willebrand factor (VWF) levels, measured at time of admission, were predictive of COVID-19 adverse outcomes irrespective of age and major comorbidities associated with metabolic syndrome.

Methods: Blood was sampled at admission in 243 adult COVID-19 patients for analysis of coagulation biomarkers including FVIII and VWF on platelet-poor plasma. The association between baseline C-reactive protein (CRP), activated partial thromboplastin time ratio, prothrombin time ratio, D-dimers, fibrinogen, FVIII, VWF antigen (VWF:Ag), and FVIII/VWF:Ag ratio levels and adverse outcomes (increased oxygen requirements, thrombosis, and death at day 30) was assessed by regression analysis after adjustment on age, sex, body mass index (BMI), diabetes, and hypertension.

Results: In univariable regression analysis increased CRP (subdistribution hazard ratio [SHR], 1.68; 95% confidence interval [CI], 1.26-2.23), increased fibrinogen (SHR, 1.32; 95% CI, 1.04-1.68), and decreased FVIII/VWF:Ag ratio (SHR, 0.70; 95% CI, 0.52-0.96) levels at admission were significantly associated with the risk of increased oxygen requirement during follow-up. Leucocytes (SHR, 1.36; 95% CI, 1.04-1.76), platelets (SHR,1.71; 95% CI, 1.11-2.62), D-dimers (SHR, 2.48; 95% CI, 1.66-3.78), and FVIII (SHR, 1.78; 95% CI, 1.17-2.68) were associated with early onset of thrombosis after admission. After adjustment for age, sex, BMI, hypertension, and diabetes, these associations were not modified.

Conclusion: Coagulation biomarkers are early and independent predictors of increased oxygen requirement in COVID-19 patients.

Keywords: SARS-CoV2; body mass index; factor VIII; oxygen; von Willebrand factor.

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Figures

FIGURE 1
FIGURE 1
Baseline values of main biomarkers according to admission type. Scatter plots of (A) PaO2/FiO2 ratio, (B) C‐reactive protein, (C) fibrinogen, (D) D‐dimers, (E) factor VIII (FVIII), (F) von Willebrand factor antigen (VWF:Ag), and (G) FVIII/VWF:Ag ratio. Bars indicate median and interquartile range or means ± standard deviation as appropriate. ICU = intensive care unit. *P < .05.
FIGURE 2
FIGURE 2
Baseline values of main biomarkers according to oxygen requirements at admission to the emergency department. Scatter plots of (A) C‐reactive protein, (B) fibrinogen, (C) D‐dimers, (D) factor VIII (FVIII), (E) von Willebrand factor antigen (VWF:Ag) and (F) FVIII/VWF:Ag ratio. Bars indicate median and interquartile range or means ± standard deviation as appropriate. *P < .05
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