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

Niklas Boknäs1, Cia Laine2, Andreas Hillarp3

  • 1Department of Biomedical and Clinical Sciences and Department of Hematology, Linköping University, Linköping, Sweden.

Thrombosis Research
|March 22, 2022
PubMed

Insights

COVID-19 patients exhibit significantly higher mortality and venous thromboembolism rates. Specific hemostatic marker abnormalities, including high D-dimer and low antithrombin, strongly predict excess mortality in these patients.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • COVID-19 is associated with a prothrombotic state.
  • Understanding hemostatic alterations is crucial for managing COVID-19 complications.

Purpose of the Study:

  • To characterize hemostatic function in COVID-19 patients.
  • To identify laboratory markers predicting mortality in COVID-19.

Main Methods:

  • Single-center cohort study of 217 patients admitted to Linköping University Hospital.
  • Laboratory markers of hemostasis were analyzed in SARS-CoV-2 positive (COVID-19+) and negative (COVID-19-) patients.
  • Cumulative incidences of death and venous thromboembolism were compared.

Main Results:

  • COVID-19+ patients (n=96) had higher mortality (24.0% vs 12.4%) and VTE rates (19.8% vs 11.6%) than COVID-19- patients (n=121).
  • Elevated plasma levels of von Willebrand factor and fibrinogen were observed in COVID-19+ patients.
  • High D-dimer, low antithrombin (AT), and low plasmin-antiplasmin complex (PAP) formation were associated with significantly increased mortality (ORs 4.7-5.9).
  • Combined defects in fibrinolysis and coagulation markers (e.g., low PAP and high D-dimer) showed compounded increases in mortality (ORs 15.5-15.7).
  • Low PAP in COVID-19+ patients correlated with incompletely degraded D-dimer fragments, indicating impaired fibrinolysis.

Conclusions:

  • Hemostatic dysfunction is prevalent in COVID-19 and linked to adverse outcomes.
  • Specific laboratory markers like D-dimer, antithrombin, and PAP can predict mortality risk in COVID-19 patients.
  • Impaired fibrinolysis contributes to the thrombotic complications observed in severe COVID-19.

Keywords:
AntithrombinCOVID-19FibrinolysisPlasmin-antiplasmin complex

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