PB0086 - Haemostatic differences between SARS-CoV-2 PCR-positive and -negative patients at the time of hospital admission

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

JR

Jasper A. Remijn, PhD

Clinical Chemist - Hematologist
Department of Clinical Chemistry. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands

Co-Author(s)

MT

Marissa Traets

PhD student
Department of Internal Medicine. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands
Romy De Laat-Kremers, PhD

Post-doctoral Research Project Leader
Department of Data Analysis and Artificial Intelligence, Synapse Research Institute, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
SV

Stephan Verweij

MD
Department of Internal Medicine. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands
Marisa Ninivaggi, PhD

Research Project Leader
Department of Functional Coagulation, Synapse Research Institute, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
EJ

Eefje Jong

MD
Department of Internal Medicine. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands
Dana Huskens, PhD

PhD, Research Project Leader
Synapse research insitute
MAASTRICHT, Limburg, Netherlands
BB

Bas Blok

MD
Department of Internal Medicine. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands
GR

Gabrielle Remme

PhD student
Department of Internal Medicine. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands
AM

Adam Miszta

PhD
Synapse Research Institute
Maastricht, Limburg, Netherlands
RN

Roel Nijhuis

PhD
Department of Medical Microbiology and Medical Immunology. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands
JH

Judith Herder

MD
Department of Pulmonology. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands
RF

Rob Fijnheer

MD
Department of Internal Medicine. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands
Mark Roest, PhD

Clinical Director
Department of Platelet pathophysiology, Synapse Research Institute, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands
AF

Aernout Fiolet

MD
Department of Internal Medicine. Meander Medical Center, Amersfoort
Amersfoort, Utrecht, Netherlands
Bd

Bas de Laat, MD, PhD

General Director
Department of Functional Coagulation, Synapse Research Institute, Maastricht, the Netherlands
Maastricht, Limburg, Netherlands

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a prothrombotic phenotype with an increased risk for thrombosis.

Aims: To investigate whether COVID-19 is associated with changes in coagulation parameters upon presentation at the emergency department and whether these changes are associated with the development of thrombotic complications in patients with SARS-CoV-2 infection.

Methods: A single centre, cross-sectional cohort study: the MArkers in COVID-19 And Relations to Outcomes in the Netherlands (MACARON) study was conducted. All patients suspected of SARS-CoV-2 infection referred to the emergency department of the Meander Medical Center between March-May 2020 were included. 519 patients (26% PCR positive, median age 66 (range 19-97 years), 52.2% male) were included from whom an oro- and nasopharyngeal swab was obtained for detection of SARS-CoV-2 by polymerase chain reaction (PCR). Blood samples for laboratory analysis were obtained from all patients. Thrombosis was defined as a clinical diagnosis of venous thromboembolism or atherothrombotic event based upon radiology and laboratory results.

Results: SARS-CoV-2 PCR positive patients had increased fibrinogen levels (5.41 g/L vs. 4.21 g/L, p< 0.001) and decreased levels of protein C (85.1% vs. 96.1%, P< 0.001) and α2-macroglobulin (4.41 µM vs. 5.11 µM, P< 0.001) compared to the PCR negative patients. In addition, we found more acquired activated protein C resistance in PCR positive patients. Furthermore, we found that elevated levels of factor VIII (208% vs 162%, p=0.028) and von Willebrand Factor (208% vs 186%, p=0.038) and decreased ADAMTS-13 levels (597 ng/mL vs. 691 ng/mL, p< 0.001) were associated with increased occurrence of thrombosis in PCR positive patients (thrombosis vs non-thrombosis).

Conclusion(s): We found that PCR positive patients had a more pronounced prothrombotic phenotype with endothelial activation upon hospital admission showing that coagulation tests may be considered useful to discriminate severe cases of COVID-19 at risk for thrombosis.