Disorders Of the Hemostatic System as A Predictor of Adverse Outcome In COVID-19

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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