Predictive value of coagulation variables and glycocalyx shedding in hospitalized COVID-19 patients – a prospective observational study

ABSTRACT

Objectives

Covid-19 disease causes an immense burden on the healthcare system. It has not yet been finally clarified which patients will suffer from a severe course and which will not. Coagulation disorders can be detected in many of these patients. The aim of the present study was therefore to identify variables of the coagulation system including standard and viscoelastometric tests as well as components of glycocalyx damage that predict admission to the intensive care unit.

Methods

Adult patients were included within 24 h of admission. Blood samples were analyzed at hospital admission and at ICU admission if applicable. We analyzed group differences and furthermore performed receiver operator characteristics (ROC).

Results

This study included 60 adult COVID-19 patients. During their hospital stay, 14 patients required ICU treatment. Comparing ICU and non-ICU patients at time of hospital admission, D-dimer (1450 µg/ml (675/2850) vs. 600 µg/ml (500/900); p = 0.0022; cut-off 1050 µg/ml, sensitivity 71%, specificity 89%) and IL-6 (47.6 pg/ml (24.9/85.4 l) vs. 16.1 pg/ml (5.5/34.4); p = 0.0003; cut-off 21.25 pg/ml, sensitivity 86%, specificity 65%) as well as c-reactive protein (92 mg/dl (66.8/131.5) vs. 43.5 mg/dl (26.8/83.3); p = 0.0029; cutoff 54.5 mg/dl, sensitivity 86%, specificity 65%) were higher in patients who required ICU admission. Thromboelastometric variables and markers of glycocalyx damage (heparan sulfate, hyaluronic acid, syndecan-1) at the time of hospital admission did not differ between groups.

Conclusion

General inflammatory variables continue to be the most robust predictors of a severe course of a COVID-19 infection. Viscoelastometric variables and markers of glycocalyx damage are significantly increased upon admission to the ICU without being predictors of ICU admission.

KEYWORDS:

• Covid-19
• coagulation
• viscoelastometry
• glycocalyx
• intensive care unit

Acknowledgments

We thank Prof. Chouker and his team for the support in the laboratories. Furthermore, we would like to thank all involved medical staff working on the wards for their organizational support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Author’s contribution

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by ST, STS, PG, DS, TN, FB, DJH, TK, and MM. The first draft of the manuscript was written by PG, ST, STS, and TK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Additional information

Funding

The study was financed by internal funds.