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Boyarchuk O, Perestiuk V, Kosovska T, Volianska L. Coagulation profile in hospitalized children with COVID-19: pediatric age dependency and its impact on long COVID development. Front Immunol 2024; 15:1363410. [PMID: 38510249 PMCID: PMC10950941 DOI: 10.3389/fimmu.2024.1363410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Pulmonary endotheliopathy and microvascular immunothrombosis play a key role in acute COVID-19. Moreover, persistent endotheliopathy and heightened coagulability frequently occur in individuals recovering from COVID-19, suggesting the intriguing possibility of their role in the development of long COVID. The aim of our study was to investigate the coagulation profile in patients with COVID-19 based on age and their role in the development of long COVID. Methods We conducted a prospective single-center cohort study from September 2022 to August 2023. The study involved 190 patients younger than 18 years who were hospitalized at the Ternopil City Children's Hospital, Ukraine due to COVID-19. Patients underwent determination of coagulation profile in addition to the general clinical examination. After discharge from the hospital, patients were monitored for the presence of long COVID symptoms. Among the 157 participants who consented for follow-up, 62 patients (39.5%) had long COVID symptoms according to the WHO definition, while the rest (95 patients) did not have symptoms of long COVID (fully recovered). Results The study revealed the normal count of platelets in the majority of patients (86.8%), whereas abnormalities in the coagulation profile were revealed in 94.5% of children with COVID-19, and these changes were age-dependent. The patients were mostly presented with increased activated partial thromboplastin time (69.1%), prothrombin time (PT) (39.8%) and D-dimer (45.0%). There was no significant difference between the median of platelet levels and coagulation profile indicators between the groups with long COVID and recovered. Among children who developed persistent long COVID symptoms there was a statistically higher percentage of abnormal PT values (53% versus 36.1%, p=0.0432), with no significant differences in other coagulation profile indicators. Abnormal PT along with female gender, comorbidities, especially allergic pathology, nutritional disorder, including obesity, were determined as potential risk factors of the long COVID development (Odds ratio - 2.0611; 95% 1.0179-4.1737, p=0.0445). Conclusions The study highlights the need for more extensive research into the coagulation profiles of pediatric populations, considering age-specific factors. This could enhance our understanding of thromboinflammation in COVID-19 and its potential contribution to the development of persistent symptoms.
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Nieto-Gutierrez W, Campos-Chambergo J, Gonzalez-Ayala E, Oyola-Garcia O, Alejandro-Mora A, Luis-Aguirre E, Pasquel-Santillan R, Leiva-Aguirre J, Ugarte-Gil C, Loyola S. Prediction models of COVID-19 fatality in nine Peruvian provinces: A secondary analysis of the national epidemiological surveillance system. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002854. [PMID: 38285714 PMCID: PMC10824411 DOI: 10.1371/journal.pgph.0002854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/05/2024] [Indexed: 01/31/2024]
Abstract
There are initiatives to promote the creation of predictive COVID-19 fatality models to assist decision-makers. The study aimed to develop prediction models for COVID-19 fatality using population data recorded in the national epidemiological surveillance system of Peru. A retrospective cohort study was conducted (March to September of 2020). The study population consisted of confirmed COVID-19 cases reported in the surveillance system of nine provinces of Lima, Peru. A random sample of 80% of the study population was selected, and four prediction models were constructed using four different strategies to select variables: 1) previously analyzed variables in machine learning models; 2) based on the LASSO method; 3) based on significance; and 4) based on a post-hoc approach with variables consistently included in the three previous strategies. The internal validation was performed with the remaining 20% of the population. Four prediction models were successfully created and validate using data from 22,098 cases. All models performed adequately and similarly; however, we selected models derived from strategy 1 (AUC 0.89, CI95% 0.87-0.91) and strategy 4 (AUC 0.88, CI95% 0.86-0.90). The performance of both models was robust in validation and sensitivity analyses. This study offers insights into estimating COVID-19 fatality within the Peruvian population. Our findings contribute to the advancement of prediction models for COVID-19 fatality and may aid in identifying individuals at increased risk, enabling targeted interventions to mitigate the disease. Future studies should confirm the performance and validate the usefulness of the models described here under real-world conditions and settings.
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Affiliation(s)
- Wendy Nieto-Gutierrez
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| | - Jaid Campos-Chambergo
- Dirección de Epidemiología e Investigación, Dirección Regional de Salud Lima Provincias, Lima, Perú
| | - Enrique Gonzalez-Ayala
- Dirección de Epidemiología e Investigación, Dirección Regional de Salud Lima Provincias, Lima, Perú
| | - Oswaldo Oyola-Garcia
- Dirección de Epidemiología e Investigación, Dirección Regional de Salud Lima Provincias, Lima, Perú
| | - Alberti Alejandro-Mora
- Dirección de Epidemiología e Investigación, Dirección Regional de Salud Lima Provincias, Lima, Perú
| | - Eliana Luis-Aguirre
- Dirección de Epidemiología e Investigación, Dirección Regional de Salud Lima Provincias, Lima, Perú
| | - Roly Pasquel-Santillan
- Dirección de Epidemiología e Investigación, Dirección Regional de Salud Lima Provincias, Lima, Perú
| | - Juan Leiva-Aguirre
- Dirección de Epidemiología e Investigación, Dirección Regional de Salud Lima Provincias, Lima, Perú
| | - Cesar Ugarte-Gil
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Steev Loyola
- Dirección de Epidemiología e Investigación, Dirección Regional de Salud Lima Provincias, Lima, Perú
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
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Uzun G, Althaus K, Hammer S, Bakchoul T. Assessment and Monitoring of Coagulation in Patients with COVID-19: A Review of Current Literature. Hamostaseologie 2022; 42:409-419. [PMID: 35477118 DOI: 10.1055/a-1755-8676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coagulation abnormalities are common in patients with COVID-19 and associated with high morbidity and mortality. It became a daily challenge to navigate through these abnormal laboratory findings and deliver the best possible treatment to the patients. The unique character of COVID-19-induced coagulopathy necessitates not only a dynamic follow-up of the patients in terms of hemostatic findings but also the introduction of new diagnostic methods to determine the overall function of the coagulation system in real time. After the recognition of the high risk of thromboembolism in COVID-19, several professional societies published their recommendations regarding anticoagulation in patients with COVID-19. This review summarizes common hemostatic findings in COVID-19 patients and presents the societal recommendations regarding the use of coagulation laboratory findings in clinical decision-making. Although several studies have investigated coagulation parameters in patients with COVID-19, the methodological shortcomings of published studies as well as the differences in employed anticoagulation regimens that have changed over time, depending on national and international guidelines, limit the applicability of these findings in other clinical settings. Accordingly, evidence-based recommendations for diagnostics during acute COVID-19 infection are still lacking. Future studies should verify the role of coagulation parameters as well as viscoelastic methods in the management of patients with COVID-19.
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Affiliation(s)
- Günalp Uzun
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Karina Althaus
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany.,Medical Faculty of Tuebingen, Institute for Clinical and Experimental Transfusion Medicine, Tuebingen, Germany
| | - Stefanie Hammer
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Tamam Bakchoul
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany.,Medical Faculty of Tuebingen, Institute for Clinical and Experimental Transfusion Medicine, Tuebingen, Germany
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Kovács EH, Tánczos K, Szabó L, Turan C, Dembrovszky F, Ocskay K, Lee BY, Hegyi P, Molnár Z. Higher Dose Anticoagulation Cannot Prevent Disease Progression in COVID-19 Patients: A Systematic Review and Meta-Analysis. Biomedicines 2022; 10:2194. [PMID: 36140295 PMCID: PMC9496532 DOI: 10.3390/biomedicines10092194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
Implementation of higher dose (HD) thromboprophylaxis has been considered in patients infected with coronavirus disease 2019 (COVID-19). Our aim was to compare HD to standard dose (SD) thromboprophylaxis in COVID-19 patients. The protocol is registered on PROSPERO (CRD42021284808). We searched for randomised controlled studies (CENTRAL, Embase, Medline and medRxviv) that compared HD to SD anticoagulation in COVID-19 and analysed outcomes such as mortality, thrombotic events, bleedings, and disease progression. The statistical analyses were made using the random effects model. Fourteen articles were included (6253 patients). HD compared with SD showed no difference in mortality (OR 0.83 [95% CI 0.54−1.28]). The use of HD was associated with a decreased risk of thrombosis (OR 0.58 [95% CI 0.44−0.76]), although with an increased risk of major bleeding (OR 1.64 [95% CI 1.25−2.16]). The cohort with D-dimer < 1 mg/mL showed no effect (OR 1.19 [95% CI 0.67−2.11]), but in the case of D-dimer > 1 mg/mL, a tendency of lower risk in the HD group was observed (OR 0.56 [95% CI 0.31−1.00]). The need for intubation in moderately ill patients showed a nonsignificant lower likelihood in the HD group (OR 0.82 [95% CI 0.63−1.08]). We cannot advocate for HD in all COVID-19 patients, although it shows some nonsignificant benefits on disease progression in those with elevated D-dimer who do not need ICU admission.
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Affiliation(s)
- Emőke Henrietta Kovács
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Selye János Doctoral College for Advanced Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Krisztián Tánczos
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
| | - László Szabó
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Caner Turan
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
| | - Fanni Dembrovszky
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Klementina Ocskay
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Bo-Young Lee
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary
| | - Zsolt Molnár
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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Yang Q, Gao J, Zeng X, Chen J, Wen D. Relationship Between Platelet Count and In-hospital Mortality in Adult Patients With COVID-19: A Retrospective Cohort Study. Front Med (Lausanne) 2022; 9:802412. [PMID: 35775003 PMCID: PMC9238274 DOI: 10.3389/fmed.2022.802412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/19/2022] [Indexed: 01/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) has become a global pandemic. Systemic inflammation in COVID-19 patients has been associated with poor clinical outcome. This study aims to determine the relationship between platelet count and in-hospital mortality. Methods The original data of this study were from article development and validation of a predictive model of in-hospital mortality in COVID-19 patients. In this secondary analysis, we adopted multi-variable logistic regression analyses and smooth curve fitting to assess the independent association between platelet count and in-hospital mortality. We further applied a two-piecewise linear regression model to examine the nonlinear association between platelet count and in-hospital mortality. Results Of the 2006 patients, the average age of the participants was 65.9 ± 16.5 years and 42.6% were women. We observed a U-shaped relationship between platelet count and in-hospital mortality. We found two different slopes, the correlations between platelet count and in-hospital mortality of COVID-19 patients were totally different below and above the inflection point which was around 370 × 109/L. On the left side of the inflection point, the OR was 0.996 (OR: 0.996, 95%CI: 0.994–0.998, p < 0.001). On the right side of the inflection point, the OR was 1.011 (OR: 1.011, 95%CI: 1.001–1.021, p = 0.029). Conclusions A U-shaped association between platelet count and in-hospital mortality was found in the patients with COVID-19. The optimal of platelet count associated with the lowest risk of in-hospital mortality was around 370 × 109/L.
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Affiliation(s)
- Qilin Yang
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jun Gao
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Xiaomei Zeng
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junyu Chen
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Junyu Chen
| | - Deliang Wen
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Deliang Wen
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Santos RS, Barros DS, Moraes TM, Hayashi CY, Ralio RB, Minenelli FF, van Zon K, Ripardo JP. Clinical characteristics and outcomes of hospitalized patients with COVID-19 in a Brazilian hospital: a retrospective study of the first and second waves. IJID REGIONS 2022; 3:189-195. [PMID: 35720152 PMCID: PMC9007747 DOI: 10.1016/j.ijregi.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 12/15/2022]
Abstract
Objectives To describe clinical characteristics, hospitalization flow and outcomes in a cohort of patients with coronavirus disease 2019 (COVID-19) in a Brazilian hospital in the first and second waves of the pandemic. Methods This retrospective, observational study included patients with confirmed COVID-19 who were evaluated in the emergency department (ED) between 1 March 2020 and 30 June 2021. Descriptive statistics have been used to report clinical characteristics, admissions and outcomes. Comparison between the two waves was inferred using hypothesis test techniques. Results During the study period, 7723 (86.54%) patients were evaluated in the ED, of which 1908 (24.70%) were admitted. Of these, 476 (24.95%) patients were initially allocated to the intensive care unit (ICU) and 1432 (75.05%) to the general ward. Of the patients initially allocated to the general ward, 349 (24.37%) were later transferred to the ICU. One hundred and fifty-eight patients were intubated (19.15% of ICU admissions) and 110 patients died (5.77% of all admissions). In the second wave, the admission rates decreased in both the ICU (from 13.84% to 9.56%; P<0.01) and the general ward (from 22.41% to 17.16%; P<0.01). The average age in the second wave decreased from 44.06 to 41.87 years (P<0.01). Patients with severe symptoms, such as dyspnoea, decreased from 25.51% to 13.13% (P<0.01) in the second wave. The death rate among admitted patients decreased by 17.84% (from 6.52% to 5.38%; P<0.01). Conclusion Despite the greater number of patients in the second wave, the admission and death rates were lower compared with the first wave. The mean age of patients was lower in the second wave, and patients arrived at the hospital with less severe symptoms compared with the first wave.
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Affiliation(s)
| | - Danilo S. Barros
- Hospital Samaritano Higienópolis – Americas Serviços Médicos, São Paulo, SP, Brazil
| | - Thiago M.P. Moraes
- Hospital Samaritano Higienópolis – Americas Serviços Médicos, São Paulo, SP, Brazil
| | - Cintya Y. Hayashi
- Hospital Samaritano Higienópolis – Americas Serviços Médicos, São Paulo, SP, Brazil
| | - Renata B. Ralio
- Hospital Samaritano Higienópolis – Americas Serviços Médicos, São Paulo, SP, Brazil
| | | | - Kees van Zon
- Philips Research North America, Cambridge, MA, USA
| | - João P.S. Ripardo
- Hospital Samaritano Higienópolis – Americas Serviços Médicos, São Paulo, SP, Brazil
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Siedlik JA, Watson CJ, Raine MA, Cheng AV, Goering RV, Stessman HAF, Belshan M. Epidemiologic and Genomic Analysis of the Severe Acute Respiratory Syndrome Coronavirus 2 Epidemic in the Nebraska Region of the United States, March 2020-2021. Front Microbiol 2022; 13:878342. [PMID: 35663859 PMCID: PMC9158493 DOI: 10.3389/fmicb.2022.878342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022] Open
Abstract
COVID-19 emerged at varying intervals in different regions of the United States in 2020. This report details the epidemiologic and genetic evolution of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first year of the epidemic in the state of Nebraska using data collected from the Creighton Catholic Health Initiatives (CHI) health system. Statistical modelling identified age, gender, and previous history of diabetes and/or stroke as significant risk factors associated with mortality in COVID-19 patients. In parallel, the viral genomes of over 1,000 samples were sequenced. The overall rate of viral variation in the population was 0.07 mutations/day. Genetically, the first 9 months of the outbreak, which include the initial outbreak, a small surge in August and a major outbreak in November 2020 were primarily characterized by B.1. lineage viruses. In early 2021, the United Kingdom variant (B.1.1.7 or alpha) quickly became the dominant variant. Notably, surveillance of non-consensus variants detected B.1.1.7 defining mutations months earlier in Fall 2020. This work provides insights into the regional variance and evolution of SARS-CoV-2 in the Nebraska region during the first year of the pandemic.
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Affiliation(s)
- Jacob A. Siedlik
- Department of Exercise Science and Pre-Health Professions, Creighton University, Omaha, NE, United States
| | - Cynthia J. Watson
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Morgan A. Raine
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Anne V. Cheng
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE, United States
| | - Richard V. Goering
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
| | - Holly A. F. Stessman
- Department of Pharmacology and Neuroscience, Creighton University School of Medicine, Omaha, NE, United States
| | - Michael Belshan
- Department of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE, United States
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Simple Coagulation Profile as Predictor of Mortality in Adults Admitted with COVID-19: A Meta-Analysis. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.115442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Context: COVID-19 severe manifestations must be detected as soon as possible. One of the essential poor characteristics is the involvement of coagulopathy. Simple coagulation parameters, including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and platelet, are widely accessible in many health centers. Objectives: This meta-analysis aimed to determine the association between simple coagulation profiles and COVID-19 in-hospital mortality. Method: We systematically searched five databases for studies measuring simple coagulation parameters in COVID-19 on admission. The random-effects and inverse-variance weighting were used in the study, which used a standardized-mean difference of coagulation profile values. The odds ratios were computed using the Mantel-Haenszel formula for dichotomous variables. Results: This meta-analysis comprised a total of 30 studies (9,175 patients). In our meta-analysis, we found that non-survivors had a lower platelet count [SMD = -0.56 (95% CI: -0.79 to -0.33), P < 0.01; OR = 3.00 (95% CI: 1.66 to 5.41), P < 0.01], prolonged PT [SMD = 1.22 (95%CI: 0.71 to 1.72), P < 0.01; OR = 1.86 (95%CI: 1.43 to 2.43), P < 0.01], prolonged aPTT [SMD = 0.24 (95%CI: -0.04 to 0.52), P = 0.99], and increased INR [SMD = 2.21 (95%CI: 0.10 to 4.31), P = 0.04] than survivors. Conclusions: In COVID-19 patients, abnormal simple coagulation parameters on admission, such as platelet, PT, and INR, were associated with mortality outcomes.
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