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Temporal changes of hemostatic activity in patients hospitalized for COVID-19: a prospective observational study
Kamil Polok1, Teresa Iwaniec2, Tomasz Stachura3
1Department of Pulmonology, Second Division of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland. kamil.polok@uj.edu.pl
Insights
COVID-19 causes hemostatic abnormalities, but these significantly improve within a month of hospital admission. Endothelial dysfunction markers, however, remain elevated in severe cases.
Area of Science:
- Internal Medicine
- Pathophysiology
- Hematology
Background:
- Hemostatic abnormalities are crucial in COVID-19 pathogenesis and patient outcomes.
- Short-term dynamics of these hemostatic changes in COVID-19 patients require further investigation.
Purpose of the Study:
- To assess markers of hemostatic activity in hospitalized COVID-19 patients.
- To correlate hemostatic markers with the severity of respiratory failure.
- To evaluate short-term changes in hemostasis within 28 days of admission.
Main Methods:
- Prospective observational study of 245 hospitalized COVID-19 patients in Poland (Jan-May 2021).
- Blood samples analyzed on admission and at 28-day follow-up for coagulation, fibrinolysis, and endothelial dysfunction markers.
- Patients stratified by respiratory support needs.
Main Results:
- On admission, hypercoagulability, hypofibrinolysis, and endothelial dysfunction correlated with respiratory support severity.
- Significant differences observed between admission and 28-day follow-up for most markers, excluding plasminogen activity.
- Endothelial dysfunction markers remained highest in the severe respiratory support group at 28 days; other markers showed diminished differences.
Conclusions:
- Hemostatic abnormalities in COVID-19 patients significantly decrease within one month post-hospitalization.
- The link between disease severity and hemostatic derangements persists primarily for endothelial dysfunction markers.
Introduction:
Hemostatic abnormalities play an important role in the pathogenesis of COVID‑19 and are considered determinants of the patients' outcomes. Less is known about the dynamics of these abnormalities in a short‑term observation.
Objectives:
The aim of the study was to evaluate hemostatic activity markers in patients hospitalized for COVID‑19 depending on the severity of respiratory failure.
Patients And Methods:
This was a prospective observational study enrolling adult patients hospitalized for COVID‑19 in a tertiary center in Poland, from January to May 2021. Blood samples were drawn upon admission and 28 days after the admission to measure the markers of coagulation, fibrinolysis, and endothelial dysfunction, and to evaluate whether there are significant differences between these 2 time points. All analyses were performed in the entire cohort and after stratification into 3 groups depending on the degree of respiratory support.
Results:
We recruited 245 patients at the median age of 63 years (interquartile range, 52-69), among whom 158 (64.5%) were men. The analysis of hemostatic markers on admission revealed that hypercoagulability, hypofibrinolysis, and endothelial dysfunction are related to the degree of respiratory support. We found significant differences between the admission and 28‑day follow‑up in all markers except for plasminogen activity. Interestingly, the markers of endothelial dysfunction remained the highest in the advanced respiratory support group after 28 days, while differences in the other markers diminished.
Conclusion:
Hemostatic abnormalities are significantly attenuated within a month after a hospital admission due to COVID‑19. The initially observed association between severity of the disease and hemostatic derangements persists only for the markers of endotheliopathy.
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