Thrombogenicity markers for early diagnosis and prognosis in COVID-19: a change from the current paradigm?

Journal Article (Journal Article)

Standard biomarkers have been widely used for COVID-19 diagnosis and prognosis. We hypothesize that thrombogenicity metrics measured by thromboelastography will provide better diagnostic and prognostic utility versus standard biomarkers in COVID-19 positive patients. In this observational prospective study, we included 119 hospitalized COVID-19 positive patients and 15 COVID-19 negative patients. On admission, we measured standard biomarkers and thrombogenicity using a novel thromboelastography assay (TEG-6s). In-hospital all-cause death and thrombotic occurrences (thromboembolism, myocardial infarction and stroke) were recorded. Most COVID-19 patients were African--Americans (68%). COVID-19 patients versus COVID-19 negative patients had higher platelet-fibrin clot strength (P-FCS), fibrin clot strength (FCS) and functional fibrinogen level (FLEV) (P ≤ 0.003 for all). The presence of high TEG-6 s metrics better discriminated COVID-19 positive from negative patients. COVID-19 positive patients with sequential organ failure assessment (SOFA) score at least 3 had higher P-FCS, FCS and FLEV than patients with scores less than 3 (P ≤ 0.001 for all comparisons). By multivariate analysis, the in-hospital composite endpoint occurrence of death and thrombotic events was independently associated with SOFA score more than 3 [odds ratio (OR) = 2.9, P = 0.03], diabetes (OR = 3.3, P = 0.02) and FCS > 40 mm (OR = 3.4, P = 0.02). This largest observational study suggested the early diagnostic and prognostic utility of thromboelastography to identify COVID-19 and should be considered hypothesis generating. Our results also support the recent FDA guidance regarding the importance of measurement of whole blood viscoelastic properties in COVID-19 patients. Our findings are consistent with the observation of higher hospitalization rates and poorer outcomes for African--Americans with COVID-19.

Full Text

Duke Authors

Cited Authors

  • Gurbel, PA; Bliden, KP; Levy, JH; Walia, N; Rapista, N; Cho, A; Jerjian, C; Tantry, US

Published Date

  • December 2021

Published In

Volume / Issue

  • 32 / 8

Start / End Page

  • 544 - 549

PubMed ID

  • 34369413

Pubmed Central ID

  • PMC8630843

Electronic International Standard Serial Number (EISSN)

  • 1473-5733

International Standard Serial Number (ISSN)

  • 0957-5235

Digital Object Identifier (DOI)

  • 10.1097/mbc.0000000000001069


  • eng