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Coagulation Profile in COVID-19 Patients and its Relation to Disease Severity and Overall Survival: A Single-Center
Amal Ezzat Abd El-Lateef1,2, Saad Alghamdi2, Gamal Ebid3,4
1Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt.
Insights
This study reveals that elevated levels of Factor VIII and ristocetin cofactor (RiCoF) are key indicators of COVID-19 severity and mortality. Factor VIII, in particular, strongly predicts poor survival outcomes in patients with coronavirus disease.
Area of Science:
- Hematology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease (COVID-19) is associated with significant hemostatic alterations.
- Understanding these changes is crucial for predicting disease severity and patient outcomes.
- Previous studies have explored various coagulation markers, but specific predictors remain under investigation.
Purpose of the Study:
- To investigate hemostatic changes in COVID-19 patients.
- To determine the relationship between these hemostatic markers, disease severity, and survival.
- To identify novel predictors of COVID-19 severity and mortality.
Main Methods:
- Retrospective review of 284 COVID-19 patients' data.
- Assay of coagulation profile including platelet counts, INR, aPTT, fibrinogen, D-dimer, Factor VIII, RiCoF, and VWF-Ag.
- Analysis of demographic, radiological, and laboratory findings to correlate with disease severity and mortality.
Main Results:
- Factor VIII, RiCoF, and D-dimer were independent predictors of COVID-19 severity.
- Factor VIII and RiCoF demonstrated superior predictive capability for severity compared to D-dimer.
- Age, aPTT, and Factor VIII were associated with increased mortality risk; Factor VIII showed a high predictive accuracy (AUC 0.98).
- Elevated Factor VIII levels (>314 IU/dl) correlated with significantly shorter survival times and higher mortality rates.
Conclusions:
- RiCoF is identified as a novel predictor of COVID-19 disease severity.
- Factor VIII is confirmed as a significant predictor of both severity and mortality in COVID-19 patients.
- High Factor VIII levels are strongly associated with poorer overall survival and increased risk of death in COVID-19 patients.
Abstract:
Objectives: This study aims to investigate hemostatic changes in patients with coronavirus disease (COVID-19) and their relationship to disease severity and survival. Methods: This study included 284 patients with COVID-19 who attended the Security Forces Hospital, Makkah, Saudi Arabia between October 2020 and March 2021, and retrospectively reviewed their demographic, radiological, and laboratory findings. The coagulation profile was assayed at the time of diagnosis for platelet counts using an automated hematology analyzer; Sysmex XN2000 while international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, factor VIII, ristocetin cofactor (RiCoF), and von Willebrand factor antigen (VWF-Ag) were measured by Stago kits on a Stago automated coagulation analyzer (STA Compact Max®). Results: In this study, 32.3% of the cases had severe disease, while 8.8% of the cases died. D-dimer, factor VIII, and RiCoF were the only independent predictors of disease severity, with factor VIII and RiCoF having significantly higher areas under the curve (AUCs) than D-dimer (all p < 0.001). Furthermore, age, aPTT, and factor VIII were associated with an increased risk of mortality in multivariate Cox regression analysis, with factor VIII having a higher AUC of 0.98 than aPTT with an optimal cut-off value of >314 IU/dl in predicting mortality. Cases with factor VIII levels >314 IU/dl, compared to those with factor VIII levels <314 IU/dl, were associated with a significantly shorter mean overall survival time (20.08 vs. 31.35 days, p < 0.001), a lower survival rate (30.3% vs. 99.2%, p < 0.001), and a 16.62-fold increased mortality risk. Conclusion: RiCoF is a novel predictor of disease severity in COVID-19, while factor VIII is confirmed as a predictor of severity and mortality in COVID-19 patients and is associated with lower overall survival and increased mortality risk.
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