Systemic Inflammatory Response Syndrome Is a Major Contributor to COVID-19–Associated Coagulopathy
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.163 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".