Systemic Inflammatory Response Syndrome Is a Major Contributor to COVID-19–Associated Coagulopathy
Notice bibliographique
Résumé
Coronavirus disease 2019 (COVID-19) is associated with a systemic coagulopathy 1 favoring thromboembolic complications, which occur in 15% to 30% of critically ill patients with COVID-19. 2,3This coagulopathy remains poorly documented and data on thrombin generation and fibrinolysis are lacking.We characterized the coagulation and fibrinolysis profiles of patients with CO-VID-19 with acute respiratory distress syndrome (ARDS).From October 2019 to April 2020, 28 consecutive patients with severe ARDS were referred to our tertiary intensive care unit and included in this prospective single-center cohort study.The protocol was approved by a research ethics committee (CPP Ouest III, 2019-A01160-57), and the study was conducted in accordance with the Declaration of Helsinki.Informed consent was obtained from patients or their relatives.Blood samples were collected on admission for a comprehensive coagulation/fibrinolytic pathways analysis.To better assess the in vivo dynamics of clot formation, stabilization, and lysis, we used a global coagulation assay assessing changes in viscoelastic properties of whole blood.We compared 11 patients with ARDS included before the COVID-19 pandemic (influenza pneumonia, n=4; bacterial pneumonia, n=2; other causes of ARDS, n=5) with 17 patients with COVID-19.Baseline characteristics of the patients with and without COVID-19 did not differ and are presented in the Table .Briefly, the median age was 45 years; most patients were men (68%), overweight (32.1%), or obese (57.1%); and a few of them had additional comorbidities.On admission, all patients were receiving thromboprophylaxis according to current guidelines.Pulmonary embolism was incidentally diagnosed in 3 out of 17 patients with CO-VID-19.Coagulation and fibrinolysis profiles are presented in the Table.In addition, von Willebrand factor antigen and activity did not differ between groups and were 3-to 4-fold higher than the upper limit of normal range (median, 4.44 and 2.86 IU/mL, respectively, in the overall population).Compared with patients without COVID-19, patients with COVID-19 exhibited significantly higher levels of procoagulant factors, mainly fibrinogen (median, 810 mg/dL versus 710; P=0.03), factor V (median, 1.53 IU/mL versus 0.73; P<0.0001), factor VIII (median, 2.97 IU/mL versus 1.61; P=0.03), and acute phase reactants including C-reactive protein (P=0.05) and α1-acid glycoprotein (P=0.02).All of these measures were strongly correlated with each other (P<0.05 for all correlations).In contrast, antithrombin, protein C, and protein S levels were within the normal range and did not differ between groups.Prothrombin fragment 1 and 2 levels did not differ between patients with and without COVID-19 and were 2-to 3-fold higher than the upper limit of normal range.Thrombin-antithrombin complex levels were increased in both groups but significantly lower in patients with COVID-19 (median, 7.69 µg/L versus 22.63; P=0.03).Fibrinolysis profiles showed factor XIII, plasminogen, and
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,163 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».