Thromboelastometry Predicts Thromboembolic Events, Hospital Length of Stay, and Mortality in Patients with COVID-19 Infection and Mild Hypoxemia: A Prospective Observational Study

Abstract

Denis Snegovskikh,1 Mark C Kendall,1 Andrew Levinson,2 Ravi Sarpatwari,2 Dominic Pisano,1 Klaus Görlinger,3,4 Gildasio De Oliveira1 1Department of Anesthesiology, The Warren Alpert Medical School of Brown University, Providence, RI, USA; 2Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA; 3Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany; 4Medical Department, Tem Innovations, Munich, GermanyCorrespondence: Mark C Kendall, Department of Anesthesiology, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Davol #129, Providence, RI, 02903, USA, Tel [phone], Fax [phone], Email [email protected]: The aim of this study was to assess changes in hemostasis and associated outcome of hospitalized patients with COVID-19 infection and mild hypoxemia.Methods: Adult patients with COVID-19 infection and hypoxemia admitted to ICU were included in this prospective observational study. The primary outcome was defined as an unfavorable course of the disease if a patient: (1) developed a thromboembolic event while receiving anticoagulation prophylaxis, (2) had prolonged ICU stay, or (3) died. Demographic data, laboratory parameters and thromboelastometry (ROTEM) test results were collected.Results: Twenty-five patients were recruited into the study. There were 16 patients with an unfavorable course of the disease. Compared to the 9 patients in the favorable course group, patients with an unfavorable course had a lower platelet count, median difference of 154 (95% CI, 26 to 223 x109/L), P = 0.012, and lower clot firmness parameters in EXTEM assay: amplitude at 20 minutes (A20), median difference of 7 (95% CI, 2 to 11) P = 0.006, maximum clot firmness (MCF), median difference of 6 (95% CI, 3 to 10) P = 0.006 and area under the curve (AUC) with a median difference of 671 (95% CI, 244 to 1029) P = 0.005. They also demonstrated suppression of fibrinolysis: higher lysis index 60, median difference of − 3 (95% CI, − 6 to 0), P = 0.023. Results of functional fibrinogen (FIBTEM) assay were similar between the groups.Conclusion: The platelet count and the results of EXTEM assay, but not FIBTEM assay, were associated with the difference in clinical outcome among patients with COVID-19 infection and hypoxemia. The role of platelets in the outcome of COVID-19 infection calls for further investigation. Future studies on adjusting anticoagulant therapy based on the results of viscoelastic testing may be beneficial.Keywords: intensive care unit, thromboelastometry, coronavirus disease 2019, hypoxemia, hemostasis, thrombosis, recovery, mortality

Keywords

• intensive care unit
• thromboelastometry
• coronavirus disease 2019
• hypoxemia
• hemostasis
• thrombosis
• recovery
• mortality