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

Area of Science:

• Medical Research
• Infectious Diseases
• Critical Care Medicine

Background:

• COVID-19 poses a significant healthcare burden, with patient outcomes varying widely.
• Identifying factors predicting severe disease progression is crucial for resource allocation and patient management.
• Coagulation disorders are frequently observed in COVID-19 patients, necessitating further investigation.

Purpose of the Study:

• To identify predictors of intensive care unit (ICU) admission in COVID-19 patients.
• To evaluate the predictive value of coagulation system variables, including standard and viscoelastometric tests.
• To assess the role of glycocalyx damage components in predicting severe COVID-19 outcomes.

Main Methods:

• Adult COVID-19 patients were enrolled within 24 hours of hospital admission.
• Blood samples were analyzed at hospital admission and, if applicable, at ICU admission.
• Group differences were analyzed, and receiver operating characteristic (ROC) curves were generated to determine predictive values.

Main Results:

• In patients requiring ICU admission, D-dimer, IL-6, and C-reactive protein levels were significantly higher at hospital admission compared to non-ICU patients.
• Specific cut-off values were identified for D-dimer (1050 µg/ml), IL-6 (21.25 pg/ml), and C-reactive protein (54.5 mg/dl) with varying sensitivity and specificity.
• Thromboelastometric variables and markers of glycocalyx damage (heparan sulfate, hyaluronic acid, syndecan-1) did not differ significantly between ICU and non-ICU groups at hospital admission.

Conclusions:

• General inflammatory markers remain the most reliable predictors of severe COVID-19 requiring ICU admission.
• Viscoelastometric variables and glycocalyx damage markers are elevated upon ICU admission but do not predict the need for ICU admission at the time of initial hospital presentation.