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CC BY 4.0 · TH Open 2022; 06(01): e50-e59
DOI: 10.1055/a-1725-9221
Original Article

Hypercoagulation Detected by Rotational Thromboelastometry Predicts Mortality in COVID-19: A Risk Model Based on a Prospective Observational Study

Lou M. Almskog 
1   Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden
2   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
,
Agneta Wikman
3   Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
4   Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden
,
Jonas Svensson
5   Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden
,
Matteo Bottai
6   Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
,
Mariann Kotormán
1   Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden
,
Carl-Magnus Wahlgren
2   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
7   Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
,
Michael Wanecek
1   Department of Anaesthesiology and Intensive Care, Capio St. Göran's Hospital, Stockholm, Sweden
8   Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
,
Jan van der Linden
2   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
9   Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
,
Anna Ågren
2   Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
10   Coagulation Unit, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden
11   Department of Clinical Sciences, Danderyd Hospital and Karolinska Institutet, Stockholm, Sweden
› Author Affiliations Funding This work was supported by a grant from the Swedish Society of Thrombosis and Haemostasis (L.M.A.), an unrestricted grant from CSL Behring (A.W.), grants from Karolinska Institutet (J.v.d.L.), a grant from the Swedish Society of Medicine (A.Å.), and a grant from the Tetra Laval Group through the Development Office of Karolinska Institutet (A.Å.).
› Further Information
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Abstract

Background Severe disease due to the novel coronavirus disease 2019 (COVID-19) has been shown to be associated with hypercoagulation. The aim of this study was to assess the Rotational Thromboelastometry (ROTEM) as a marker of coagulopathy in hospitalized COVID-19 patients.

Methods This was a prospective, observational study where patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. A prediction model, including variables ROTEM EXTEM-MCF (Maximum Clot Firmness) which in previous data has been suggested a suitable marker of hypercoagulation, age, and respiratory frequency, was developed using logistic regression to evaluate the probability of death.

Results Out of the 141 patients included, 18 (13%) died within 30 days. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased EXTEM-MCF, age, and respiratory frequency. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In an in vitro analysis, no heparin effect on EXTEM–coagulation time (CT) was observed, supporting a severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) effect on prolonged initiation of coagulation.

Conclusion Here, we show that hypercoagulation measured with ROTEM predicts 30-day mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19 and could potentially guide anticoagulation therapy.

Keywords

COVID-19 - thromboelastometry - coagulopathy - thrombosis - mortality

Ethics Approval and Consent to Participate

The study was approved by the Swedish Ethical Review Authority (identifier no.: D-nr 2020–01875).


Availability of Data and Materials

The study was published on the preprint server and open-access platform medRxiv.org prior to submission.


Authors' Contributions

L.M.A., A.W., J.S., M.B., C.-M.W., M.W., J.v.d.L. and A.Å. conceived and designed the study. L.M.A. performed the data collection and M.K. contributed to the data collection. J.S. and M.B. performed the data analyses and visualizations. L.M.A. drafted the manuscript. A.W., C.-M.W., M.W., J.v.d.L., and A.Å. provided input for interpretation of results and clinical expertise. All authors have read, critically revised, and approved the final manuscript.




Publication History

Received: 22 June 2021

Accepted: 15 December 2021

Accepted Manuscript online:
21 December 2021

Article published online:
07 March 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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