Staging Severity of COVID-19 according to Hemostatic Abnormalities (CAHA Score)

Abstract

This is the first study to show a stepwise increase in venous thrombotic events according to COVID-19 coagulopathy (COVID-19-associated hemostatic abnormalities [CAHA]) staging and lung injuries assessed by chest computed tomography. Excess mortality and/or transfer to intensive care unit according to CAHA staging.

Keywords

COVID-19 - lung injuries - thrombosis - venous thromboembolism - D-dimer - CAHA

Authors' Contributions

B.M.: drafting of the manuscript and critical revision for important intellectual content; A.T.: data collection and drafting of the manuscript; A.C.: data collection and interpretation; A.C.: data collection and interpretation; K.M.: data collection and interpretation; C.S.: data collection and interpretation; I.L.-L.: data collection and interpretation; L.S.: data collection and interpretation; L.G.: data collection and interpretation; M.O.: data collection, interpretation, and critical revision for important intellectual content; P.O.: interpretation of data and critical revision for important intellectual content; L.J.: drafting of the manuscript, interpretation of data, and critical revision for important intellectual content; O.M.: study conception and design, data collection and interpretation, drafting of the manuscript, and critical revision for important intellectual content. The manuscript has been read and approved for submission by all authors. All the authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Publication History

Received: 04 July 2020

Accepted: 21 July 2020

Article published online:
30 August 2020

• References

• 1 Leonard-Lorant I, Delabranche X, Severac F. et al. Acute pulmonary embolism in COVID-19 patients on CT angiography and relationship to D-dimer levels. Radiology 2020; 201561
• 2 Spiezia L, Boscolo A, Poletto F. et al. COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thromb Haemost 2020; 120 (06) 998-1000
• 3 Zhai Z, Li C, Chen Y. et al; Prevention Treatment of VTE Associated with COVID-19 Infection Consensus Statement Group. Prevention and treatment of venous thromboembolism associated with coronavirus disease 2019 infection: a consensus statement before guidelines. Thromb Haemost 2020; 120 (06) 937-948
• 4 Violi F, Pastori D, Cangemi R, Pignatelli P, Loffredo L. Hypercoagulation and antithrombotic treatment in coronavirus 2019: a new challenge. Thromb Haemost 2020; 120 (06) 949-956
• 5 Thachil J, Cushman M, Srivastava A. A proposal for staging COVID-19 coagulopathy. Res Pract Thromb Haemost 2020; 4 (05) 731-736
• 6 Revel MP, Parkar AP, Prosch H. et al; European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI). COVID-19 patients and the radiology department - advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI). Eur Radiol 2020; 1-7
• 7 Zhou F, Yu T, Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062
• 8 Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost 2020; 120 (05) 876-878
• 9 McGonagle D, O'Donnell JS, Sharif K, Emery P, Bridgewood C. Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia. Lancet 2020; 2 (07) E437-E445
• 10 Ranucci M, Ballotta A, Di Dedda U. et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost 2020; 18 (07) 1747-1751
• 11 Ciceri F, Beretta L, Scandroglio AM. et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc 2020; 22 (02) 95-97
• 12 Dolhnikoff M, Duarte-Neto AN, de Almeida Monteiro RA. et al. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost 2020; 18 (06) 1517-1519
• 13 Ackermann M, Verleden SE, Kuehnel M. et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med 2020; 383 (02) 120-128
• 14 Bikdeli B, Madhavan MV, Gupta A. et al; Global COVID-19 Thrombosis Collaborative Group. Pharmacological agents targeting thromboinflammation in COVID-19: review and implications for future research. Thromb Haemost 2020; 120 (07) 1004-1024