PB0071 - Associations between hemostatic markers and mortality in COVID-19 – compounding effects of amplified coagulation and decreased fibrinolytic activity

Background: Several studies have reported on associations between laboratory parameters of hemostasis and the clinical outcomes of hospitalized patients with COVID-19.

Aims: We applied an extensive panel of laboratory markers on a cohort of patients that were hospitalized for symptoms consistent with COVID-19 to find predictive markers and increase understanding of the disease.

Methods: 217 patients were included in the study after being admitted to our hospital with a clinical suspicion of COVID-19 during the spring 2020. 96 patients were diagnosed with COVID-19. The clinical outcomes were monitored until September 2020.

Results: In the 96 patients that tested positive for SARS-CoV-2 (COVID-19+), the cumulative incidences of death and venous thromboembolism were 24.0 % and 19.8 % as compared to 12.4 % (p=0.031) and 11.6 % (p=0.13) in the 121 patients that tested negative (COVID-19-). In COVID-19+ patients, we found pronounced increases in plasma levels of von Willebrand factor (vWF) and fibrinogen. Among COVID-19+ patients, excess mortality was observed in patients with laboratory signs of either coagulopathy or low fibrinolytic activity, with Odds Ratios (OR) for death of 4.7 (95% confidence interval (CI95) 1.7-12.9; p=0.003) for D-dimer >0.5 mg/L, 5.9 (CI 95 1.8–19.7; p =0.004) for antithrombin (AT) ˂0.85 kIU/l and 4.9 (CI 95 1.3–18.3; p=0.019) for plasmin-antiplasmin complex (PAP) < 1000 μg/L. Compounding increases in mortality was observed in COVID-19+ patients with combined defects in both fibrinolysis and coagulation, with ORs for the death of 15.7 (CI95 4.3–57; p< 0.001) for patients with PAP < 1000 μg/L and D-dimer >0.5 mg/L and an OR of 15.5 (CI95 2.8–87, p=0.002) for patients with PAP < 1000 μg/L and AT ˂0.85 kIU/L.

Conclusion(s): In COVID-19+ patients with high D-dimer, low PAP was correlated to high mortality and associated with low levels of small fibrin fragments, indicating impaired fibrinolytic breakdown of fibrin.