avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2026-16-3-187-192GGDFQOavk-2279Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLEНарушения системы гемостаза как предиктор неблагоприятного исхода COVID-19Disorders Of the Hemostatic System as A Predictor of Adverse Outcome In COVID-19https://orcid.org/0000-0002-5466-2590АниськоЛ. А.AniskoL. A.

Анисько Людмила Александровна — к.м.н., доцент кафедры инфекционных болезней с курсом ПКиП учреждения образования «Белорусский государственный медицинский университет»; заведующий клинико-диагностической лабораторией учреждения здравоохранения «Городская клиническая инфекционная больница»  

Минск 

Luidmila A. Anisko — MD, Cand. Sci. (Medicine), Associate Professor of the Department of Infectious Diseases “Belarusian State Medical University”; Head of the Clinical Diagnostic Laboratory of the “City Clinical Infectious Diseases Hospital” 

Minsk 

lanisko@internet.ruhttps://orcid.org/0009-0004-5432-2133КарповИ. А.KarpovI. A.

Карпов Игорь Александрович — д.м.н., профессор, чл.-корр. НААН Республики Беларусь, заведующий кафедрой учреждения образования 

Минск 

Igor A. Karpov — MD, Dr. Sci. (Medicine), Professor; Corresponding Member of the National Academy of Sciences of Belarus, Head of the Department of Infectious Diseases 

Minsk 

vip.kia1957@gmail.comУЗ «Городская клиническая инфекционная больница»; УО «Белорусский государственный медицинский университет»БеларусьCity Clinical Hospital of Infectious Diseases; Belarusian State Medical UniversityBelarusУО «Белорусский государственный медицинский университет»БеларусьBelarusian State Medical UniversityBelarus202604062026163187192Copyright © Анисько Л.А., Карпов И.А., 20262026Анисько Л.А., Карпов И.А.Anisko L.A., Karpov I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/2279

Инфекция COVID-19 ассоциирована с высоким риском тромботических осложнений, определяющих тяжесть течения и исход заболевания. Выявление ключевых предикторов неблагоприятного исхода среди параметров системы гемостаза остается важной задачей. Цель. Оценить значимость показателей системы гемостаза в качестве предикторов неблагоприятного исхода у пациентов с COVID-19. Материалы и методы. Проведено одноцентровое ретроспективное когортное исследование, включившее 9256 пациентов с подтвержденным COVID-19. В зависимости от исхода (неблагоприятный/благоприятный) пациенты были разделены на группы. При поступлении оценивались показатели коагулограммы (активированное частичное тромбоплатиновое врермя, протромбиновый индекс, тромбиновое время, фибриноген, D-димер, антитромбин III). Статистический анализ выполнялся с использованием U-критерия Манна-Уитни. Для описания количественных показателей использовались медиана, 25-й и 75-й процентили. Результаты. У пациентов с неблагоприятным исходом зафиксированы статистически значимые различия по сравнению с выжившими: значительное повышение уровня D-димера (медиана 464,5 нг/мл [Q25–Q75: 245,0–1120,0] нг/мл против 198,0 [110,0–350,0] нг/мл; p<0,0001) и фибриногена (5,62 [4,70–6,80] г/л против 5,03 [4,30–5,90] г/л; p<0,0001), снижение активности антитромбина III (81,0 % [73,0–89,0] против 99,0 % [90,0–108,0]; p=0,0001) и протромбинового индекса (83,0 % [77,0–90,0] против 93,0 % [88,0–98,0]; p<0,0001), а также удлинение тромбинового времени (15,4 с [14,5–16,5] против 14,9 с [14,2–15,8]; p=0,0001). Показатель АЧТВ значимо не отличался между группами (p=0,95). Заключение. У пациентов с неблагоприятным исходом COVID-19 выявлена выраженная гиперкоагуляция с признаками коагулопатии потребления, характеризующаяся резким повышением D-димера и фибриногена на фоне снижения антитромбина III и протромбинового индекса. Мониторинг этих показателей, особенно D-димера и антитромбина III, обладает высокой прогностической ценностью для стратификации риска и своевременной коррекции терапии.

COVID-19 is associated with a high risk of thrombotic complications, which determine the severity and outcome of the disease. Identifying key predictors of adverse outcomes among hemostatic system parameters remains an important task. Aime. To assess the significance of hemostatic system parameters as predictors of adverse outcomes in patients with COVID-19. Materials and methods. A single-center retrospective cohort study was conducted, including 9256 patients with confirmed COVID-19. Depending on the outcome (adverse/favorable), patients were divided into groups. Upon admission, coagulogram parameters (APTT, prothrombin index, thrombin time, fibrinogen, D-dimer, antithrombin III) were assessed using an ACL TOP 750 analyzer. Statistical analysis was performed using the Mann-Whitney U test. For the description of quantitative indicators, the median, the 25th and 75th percentiles were used. Results. Statistically significant differences were recorded in patients with adverse outcome compared to survivors: a significant increase in D-dimer level (median 464.5 [Q25–Q75: 245.0–1120.0] ng/mL vs. 198.0 [110.0–350.0] ng/mL; p<0.0001) and fibrinogen (5.62 [4.70–6.80] g/L vs. 5.03 [4.30–5.90] g/L; p<0.0001), a decrease in antithrombin III activity (81.0 % [73.0–89.0] vs. 99.0 % [90.0– 108.0]; p=0.0001) and prothrombin index (83.0 % [77.0–90.0] vs. 93.0 % [88.0–98.0]; p<0.0001), as well as a prolongation of thrombin time (15.4 s [14.5–16.5] vs. 14.9 s [14.2–15.8]; p=0.0001). The APTT parameter did not differ significantly between the groups (p=0.95). Conclusion. Patients with adverse COVID-19 outcomes exhibited marked hypercoagulation with signs of consumption coagulopathy, characterized by a sharp increase in D-dimer and fibrinogen against a background of decreased antithrombin III and prothrombin index. Monitoring these parameters, especially D-dimer and antithrombin III, has high prognostic value for risk stratification and timely therapy adjustment.

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The authors declare that there are no conflicts of interest present.