Associations between hemostatic markers and mortality in COVID-19 – Compounding effects of D-dimer, antithrombin and PAP complex

• Published in: Thrombosis research 2022-05, Vol.213, p.97-104
• Main Authors: Boknäs, Niklas, Laine, Cia, Hillarp, Andreas, Macwan, Ankit S., Gustafsson, Kerstin M., Lindahl, Tomas L., Holmström, Margareta
• Format: Article
• Language: English
• Subjects: alpha-2-Antiplasmin; Anticoagulants; Antithrombin; Antithrombin III; Antithrombins; Biomarkers; Cohort Studies; COVID-19; COVID-19 Testing; Fibrin Fibrinogen Degradation Products - metabolism; Fibrinolysin - metabolism; Fibrinolysis; Full Length; Hemostatics; Humans; Plasmin-antiplasmin complex; SARS-CoV-2
• ISSN: 0049-3848; 1879-2472; 1879-2472
• DOI: 10.1016/j.thromres.2022.03.013

In this single-center cohort study, we applied a panel of laboratory markers to characterize hemostatic function in 217 consecutive patients that underwent testing for COVID-19 as they were admitted to Linköping University Hospital between April and June 2020. In the 96 patients that tested positive for SARS-CoV-2 (COVID-19+), the cumulative incidences of death and venous thromboembolism were 24.0% and 19.8% as compared to 12.4% (p = 0.031) and 11.6% (p = 0.13) in the 121 patients that tested negative (COVID-19−). In COVID-19+ patients, we found pronounced increases in plasma levels of von Willebrand factor (vWF) and fibrinogen. Excess mortality was observed in COVID-19+ patients with the following aberrations in hemostatic markers: high D-dimer, low antithrombin or low plasmin-antiplasmin complex (PAP) formation, with Odds Ratios (OR) for death of 4.7 (95% confidence interval (CI95) 1.7–12.9; p = 0.003) for D-dimer >0.5 mg/L, 5.9 (CI95 1.8–19.7; p = 0.004) for antithrombin (AT) ˂0.85 kIU/l and 4.9 (CI95 1.3–18.3; p = 0.019) for PAP