Predictive role of haematological determinants on outcomes of critically Ill COVID-19 patients admitted to intensive care unit
Predictive role of haematological determinants on outcomes of critically Ill COVID-19 patients admitted to intensive care unit
Background: the mortality of patients admitted to the intensive care unit (ICU) with COVID-19 remains significantly high. Severe COVID-19 pneumonia is characterised by refractory hypoxemia with significant shunting due to a combination of alveolar damage, vascular vasoconstriction, and occlusion due to microthrombi. Similar pathological features are seen in extra-pulmonary organs. However, the influence of thrombotic markers on the risk of mechanical ventilation (MV) and the development of acute kidney injury (AKI) is not fully defined.
Methods: this was a cross-sectional evaluation of haemostatic and thrombotic markers of COVID-19 patients admitted to the ICU to determine their predictability for the development of thromboembolism and the need for non-invasive or invasive MV, development of AKI, and mortality.
Results: an extended coagulation profile was obtained in 71 SARS-CoV-2 positive patients admitted to the ICU. All patients had acute severe hypoxic respiratory failure and required non-invasive or invasive MV. There were increases in peak D-dimer (3.0 mg/L), factor VIII levels (255 IU/dL) vWF antigen (471 IU/dL) with low ADAMTS13 activity (54.7 IU/dL) compared to the reference ranges. Peak D-dimer was consistently raised in patients who developed AKI and required invasive MV. ADAMTS13/vWF/platelet axis was associated with disease severity, multi-organ dysfunction, and mortality.
Conclusions: haematological abnormalities are a common feature of severe COVID-19 pneumonia. We found peak D-dimer and vWF-ADAMTS13-platelet axis are associated with increased ICU severity and outcome in severe COVID-19 patients admitted to ICU. Larger studies are needed to evaluate this more comprehensively.
acquired von willebrand, acute kidney injury care, adamts13, covid 19, d dimer, factor viii, intensive respiratory care
e16764
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
Abdul, Nabil
ee389e67-6b48-4885-b731-384651c8ded5
Dmochowski, Josh
326e598c-048c-4967-92e4-446532749f1b
James, Izabela
390a1d27-14dc-4c0d-a964-a1cf50f87af6
Heesom, Lesley
f51a5e71-b727-4b15-b376-6dc124b6fbbd
Westwood, Jennifer
5ceeb350-70f2-4ab7-b2f1-6e943d0fe781
Effney, Judith
3907f6ef-2de8-4173-9d29-f3ce3faac137
Bruty, Sarah
f2a45cb7-7448-4e01-9f3b-60c7fbd5c346
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Rangarajan, Savita
9a5e4c7e-55ba-4a3a-b5f6-f1e269d927c3
Kazmi, Rashid
8b8d1641-1cc8-48e3-aa41-c134650cec3b
30 July 2021
Dushianthan, Ahilanandan
013692a2-cf26-4278-80bd-9d8fcdb17751
Abdul, Nabil
ee389e67-6b48-4885-b731-384651c8ded5
Dmochowski, Josh
326e598c-048c-4967-92e4-446532749f1b
James, Izabela
390a1d27-14dc-4c0d-a964-a1cf50f87af6
Heesom, Lesley
f51a5e71-b727-4b15-b376-6dc124b6fbbd
Westwood, Jennifer
5ceeb350-70f2-4ab7-b2f1-6e943d0fe781
Effney, Judith
3907f6ef-2de8-4173-9d29-f3ce3faac137
Bruty, Sarah
f2a45cb7-7448-4e01-9f3b-60c7fbd5c346
Saeed, Kordo
87cb67e5-71e8-4759-bf23-2ea00ebd8b39
Rangarajan, Savita
9a5e4c7e-55ba-4a3a-b5f6-f1e269d927c3
Kazmi, Rashid
8b8d1641-1cc8-48e3-aa41-c134650cec3b
Dushianthan, Ahilanandan, Abdul, Nabil, Dmochowski, Josh, James, Izabela, Heesom, Lesley, Westwood, Jennifer, Effney, Judith, Bruty, Sarah, Saeed, Kordo, Rangarajan, Savita and Kazmi, Rashid
(2021)
Predictive role of haematological determinants on outcomes of critically Ill COVID-19 patients admitted to intensive care unit.
Cureus, 13 (7), .
(doi:10.7759/cureus.16764).
Abstract
Background: the mortality of patients admitted to the intensive care unit (ICU) with COVID-19 remains significantly high. Severe COVID-19 pneumonia is characterised by refractory hypoxemia with significant shunting due to a combination of alveolar damage, vascular vasoconstriction, and occlusion due to microthrombi. Similar pathological features are seen in extra-pulmonary organs. However, the influence of thrombotic markers on the risk of mechanical ventilation (MV) and the development of acute kidney injury (AKI) is not fully defined.
Methods: this was a cross-sectional evaluation of haemostatic and thrombotic markers of COVID-19 patients admitted to the ICU to determine their predictability for the development of thromboembolism and the need for non-invasive or invasive MV, development of AKI, and mortality.
Results: an extended coagulation profile was obtained in 71 SARS-CoV-2 positive patients admitted to the ICU. All patients had acute severe hypoxic respiratory failure and required non-invasive or invasive MV. There were increases in peak D-dimer (3.0 mg/L), factor VIII levels (255 IU/dL) vWF antigen (471 IU/dL) with low ADAMTS13 activity (54.7 IU/dL) compared to the reference ranges. Peak D-dimer was consistently raised in patients who developed AKI and required invasive MV. ADAMTS13/vWF/platelet axis was associated with disease severity, multi-organ dysfunction, and mortality.
Conclusions: haematological abnormalities are a common feature of severe COVID-19 pneumonia. We found peak D-dimer and vWF-ADAMTS13-platelet axis are associated with increased ICU severity and outcome in severe COVID-19 patients admitted to ICU. Larger studies are needed to evaluate this more comprehensively.
Text
20210829-27345-1x7ar8e
- Version of Record
More information
e-pub ahead of print date: 30 July 2021
Published date: 30 July 2021
Keywords:
acquired von willebrand, acute kidney injury care, adamts13, covid 19, d dimer, factor viii, intensive respiratory care
Identifiers
Local EPrints ID: 452055
URI: http://eprints.soton.ac.uk/id/eprint/452055
ISSN: 2168-8184
PURE UUID: ec936239-aafe-4731-855a-bd132ad988fb
Catalogue record
Date deposited: 10 Nov 2021 17:31
Last modified: 17 Mar 2024 04:02
Export record
Altmetrics
Contributors
Author:
Ahilanandan Dushianthan
Author:
Nabil Abdul
Author:
Josh Dmochowski
Author:
Izabela James
Author:
Lesley Heesom
Author:
Jennifer Westwood
Author:
Judith Effney
Author:
Sarah Bruty
Author:
Kordo Saeed
Author:
Rashid Kazmi
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics