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. 2024 Apr 26;8(4):102427.
doi: 10.1016/j.rpth.2024.102427. eCollection 2024 May.

Hypocoagulability in severe yellow fever infection is associated with bleeding: results from a cohort study

Leticia Lemos Jardim  1   2 , Mariana Brandão Franco  3 , Neimy Ramos de Oliveira  4 , Beatriz Nogueira de Carvalho  5 , Fernando Basques  5 , Daniel Dias Ribeiro  6 , Ton Lisman  7 , Leonardo Soares Pereira  4 , Suely Meireles Rezende  3
Affiliations

Hypocoagulability in severe yellow fever infection is associated with bleeding: results from a cohort study

Leticia Lemos Jardim et al. Res Pract Thromb Haemost. .

Abstract

Background: Severe yellow fever infection (YFI) may be complicated by a hemorrhagic diathesis. However, the hemostasis profile of YFI has rarely been reported.

Objectives: The aim of this study was to characterize the hemostatic features of YFI by using a rotational thromboelastometry (ROTEM).

Methods: We evaluated clinical, laboratory, and ROTEM parameters in adults with severe YFI and their correlation with hemostatic variables according to bleeding and death.

Results: A total of 35 patients were included (median age, 49 years). ROTEM was performed in 22 patients, of whom 21 (96%) presented bleeding and 4 (18%) died. All patients who died had major bleeding. Patients who died presented prolonged clotting time (CT; median, 2326 seconds; IQR, 1898-2986 seconds) and reduced alpha angle (median, 12°; IQR, 12°-15°) in comparison with patients who had minor (median CT, 644 seconds; IQR, 552-845 seconds and alpha angle, 47°; IQR, 28°-65°) and major (median CT, 719 seconds; IQR, 368-1114 seconds and alpha angle, 43°; IQR, 32°-64°) bleeding who survived. In patients who had bleeding, CT showed a strong negative correlation with factor (F)V (r = -.68), FIX (r = -.84), and FX (r = -.63) as well as alpha angle showed a strong negative correlation with FIX (r = -.92). In patients who died, the correlations were even stronger. A total of 19/21 (90%) patients presented hypocoagulability assessed by ROTEM.

Conclusion: Hypocoagulabitity is the hallmark of the bleeding diathesis of severe YFI. Abnormal CT and alpha angle associated with death and could be used as potential predictors of adverse outcome in severe YFI.

Keywords: bleeding; blood coagulation; blood coagulation factor; thromboelastography; yellow fever.

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Flow chart of patients enrolled in the study.
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