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de Laat-Kremers R, De Jongh R, Ninivaggi M, Fiolet A, Fijnheer R, Remijn J, de Laat B. Coagulation parameters predict COVID-19-related thrombosis in a neural network with a positive predictive value of 98%. Front Immunol 2022; 13:977443. [PMID: 36248875 PMCID: PMC9554597 DOI: 10.3389/fimmu.2022.977443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/30/2022] [Indexed: 01/08/2023] Open
Abstract
Thrombosis is a major clinical complication of COVID-19 infection. COVID-19 patients show changes in coagulation factors that indicate an important role for the coagulation system in the pathogenesis of COVID-19. However, the multifactorial nature of thrombosis complicates the prediction of thrombotic events based on a single hemostatic variable. We developed and validated a neural net for the prediction of COVID-19-related thrombosis. The neural net was developed based on the hemostatic and general (laboratory) variables of 149 confirmed COVID-19 patients from two cohorts: at the time of hospital admission (cohort 1 including 133 patients) and at ICU admission (cohort 2 including 16 patients). Twenty-six patients suffered from thrombosis during their hospital stay: 19 patients in cohort 1 and 7 patients in cohort 2. The neural net predicts COVID-19 related thrombosis based on C-reactive protein (relative importance 14%), sex (10%), thrombin generation (TG) time-to-tail (10%), α2-Macroglobulin (9%), TG curve width (9%), thrombin-α2-Macroglobulin complexes (9%), plasmin generation lag time (8%), serum IgM (8%), TG lag time (7%), TG time-to-peak (7%), thrombin-antithrombin complexes (5%), and age (5%). This neural net can predict COVID-19-thrombosis at the time of hospital admission with a positive predictive value of 98%-100%.
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Affiliation(s)
- Romy de Laat-Kremers
- Department of Data Analysis and Artificial Intelligence, Synapse Research Institute, Maastricht, Netherlands
- *Correspondence: Romy de Laat-Kremers,
| | - Raf De Jongh
- Department of Anesthesiology, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Anesthesiology, Fondation Hopale, Berck-sur-Mer, France
| | - Marisa Ninivaggi
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands
| | - Aernoud Fiolet
- Department of Internal Medicine, Meander Medical Center, Amersfoort, Netherlands
| | - Rob Fijnheer
- Department of Internal Medicine, Meander Medical Center, Amersfoort, Netherlands
| | - Jasper Remijn
- Department of Clinical Chemistry, Meander Medical Center, Amersfoort, Netherlands
| | - Bas de Laat
- Department of Data Analysis and Artificial Intelligence, Synapse Research Institute, Maastricht, Netherlands
- Department of Functional Coagulation, Synapse Research Institute, Maastricht, Netherlands
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Brouwers J, Buis S, Haumann R, Karanzai A, De Laat B, De Groot P, Remijn J. Increased oral implant stability in patients treated with Platelet Rich Fibrin (PRF), which is associated with peripheral blood cell‐ and coagulation parameters. Clin Oral Implants Res 2019. [DOI: 10.1111/clr.207_13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Sharon Buis
- Institute for Dental Implantology, The Netherlands
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Chayoua W, Kelchtermans H, Moore GW, Gris JC, Musial J, Wahl D, Zuily S, Gianniello F, Fontana P, Remijn J, Urbanus RT, de Laat B, Devreese KMJ. Detection of Anti-Cardiolipin and Anti-β2glycoprotein I Antibodies Differs between Platforms without Influence on Association with Clinical Symptoms. Thromb Haemost 2019; 119:797-806. [PMID: 30822809 DOI: 10.1055/s-0039-1679901] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The anti-phospholipid syndrome (APS) is characterized by thrombosis and/or pregnancy morbidity with persistent presence of anti-phospholipid antibodies (aPL). Laboratory criteria include aPL detection by coagulation tests for lupus anticoagulant (LAC) or solid phase assays measuring anti-β2 glycoprotein I (aβ2GPI) or anti-cardiolipin (aCL) immunoglobulin (Ig) G/IgM antibodies. External quality control programs illustrate that commercially available aPL assays produce variable results. OBJECTIVE We aimed to investigate the agreement and diagnostic accuracy of solid phase assays. MATERIALS AND METHODS In this multi-centre study, 1,168 patient samples were tested on one site for aCL and aβ2GPI IgG/IgM antibodies by four solid phase test systems. Samples included APS patients, controls and monoclonal antibodies (MoAB) against different epitopes of β2GPI. LAC was determined by the local centre. RESULTS aCL IgM assays resulted in the most discrepancies (60%), while aCL IgG and aβ2GPI IgM assays resulted in lower discrepancies (36%), suggesting better agreement. Discrepant samples displayed lower median aPL titers. Dependent on the solid phase test system, odds ratios (ORs) for thrombosis and pregnancy morbidity ranged from 1.98 to 2.56 and 3.42 to 4.78, respectively. Three platforms showed lower sensitivity for MoAB directed against the glycine (Gly) 40-arginine (Arg) 43 epitope of domain I of β2GPI. CONCLUSION Poor agreement was observed between different commercially available aCL and aβ2GPI IgG/IgM assays, hampering uniformity in the identification of aPL-positive patients. Clinical association was globally concordant between solid phase test systems considering results of the four aPL together. An assay sensitive in detecting the MoAB against Gly40-Arg43 of domain I of β2GPI reached the highest OR for thrombosis.
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Affiliation(s)
- Walid Chayoua
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Synapse Research Institute, Maastricht, The Netherlands
| | - Hilde Kelchtermans
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Synapse Research Institute, Maastricht, The Netherlands
| | - Gary W Moore
- Department of Haemostasis and Thrombosis, Viapath Analytics, Guy's & St. Thomas' Hospitals, London, United Kingdom
| | - Jean-Christophe Gris
- Centre Hospitalier Universitaire de Nîmes et Université de Montpellier, Montpellier, France.,Ivan Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jacek Musial
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jagiellonian University, Krakow, Poland
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Centre Hospitalier Regional Universitaire de Nancy, Université de Lorraine, Inserm, DCAC, Nancy, France
| | - Stéphane Zuily
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Centre Hospitalier Regional Universitaire de Nancy, Université de Lorraine, Inserm, DCAC, Nancy, France
| | - Francesca Gianniello
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierre Fontana
- Division of Angiology and Haemostasis, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Jasper Remijn
- Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Rolf T Urbanus
- Department of Clinical Chemistry and Haematology, Center for Circulatory Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bas de Laat
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Synapse Research Institute, Maastricht, The Netherlands
| | - Katrien M J Devreese
- Coagulation Laboratory, Department of Diagnostic Sciences, Ghent University Hospital, Ghent University, Ghent, Belgium
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van der Vorm L, Huskens D, Kicken C, Remijn J, Roest M, de Laat B, Miszta A. Effects of Repeated Bouts of Exercise on the Hemostatic System. Semin Thromb Hemost 2018; 44:710-722. [DOI: 10.1055/s-0038-1673619] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractPhysical activity is beneficial for health, for example, by lowering the risk of cardiovascular events. However, vigorous exercise is associated with the occurrence of thromboembolic events and sudden cardiac death, in particular in untrained individuals. Whereas acute exercise is known to cause a hypercoagulable state, repeated exposure to (strenuous) exercise by means of training may actually condition the hemostatic response to exercise. To date, the effects of exercise training on blood coagulability and the underlying mechanisms have yet to be fully discerned. In this review, the authors provide an overview of existing literature on how training programs and training status influence hemostasis in healthy individuals. Furthermore, they present data of a pilot study in which we studied the effects of repetitive submaximal intensity cycling on procoagulant and anticoagulant processes. It is known that factor VIII (FVIII) and von Willebrand factor (VWF) increase after exercise, but we found that this increase in FVIII and VWF (antigen, propeptide, and VWF in active conformation) was smaller on each of three subsequent days, suggesting either adaptation of endothelial activation or exhaustion of endothelial VWF supplies. With respect to thrombin generation, elevated FVIII significantly increased the thrombin generation peak but not the endogenous thrombin potential. In contrast, platelet activation in terms of P-selectin expression after stimulation with protease-activated receptor-1 and glycoprotein VI agonists decreased after exercise and did not recover, indicating exhaustion of the platelet response to repetitive exercise.
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Affiliation(s)
- Lisa van der Vorm
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Synapse Research Institute, Maastricht, The Netherlands
- Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Dana Huskens
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Synapse Research Institute, Maastricht, The Netherlands
| | - Cécile Kicken
- Synapse Research Institute, Maastricht, The Netherlands
- Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Jasper Remijn
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Mark Roest
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Synapse Research Institute, Maastricht, The Netherlands
| | - Bas de Laat
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Synapse Research Institute, Maastricht, The Netherlands
- Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Adam Miszta
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
- Synapse Research Institute, Maastricht, The Netherlands
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Remijn J, Van Der Vorm L, Mondria C, De Laat B, De Groot P, Brouwers J. Saliva-derived tissue factor induces thrombin generation in a diurnal rhythm. Clin Oral Implants Res 2018. [DOI: 10.1111/clr.50_13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jasper Remijn
- Gelre Hospitals, Department of Clinical Chemistry and Hematology, Netherlands
| | - Lisa Van Der Vorm
- Gelre Hospitals, Department of Clinical Chemistry and Hematology, Netherlands
| | - Ceraya Mondria
- Gelre Hospitals, Department of Clinical Chemistry and Hematology, Netherlands
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Wu YP, IJsseldijk M, Zwaginga J, Sixma J, de Groot P, Remijn J. Absence of Fibrinogen in Afibrinogenemia Results in Large but Loosely Packed Thrombi under Flow Conditions. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615661] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryWe studied the role of fibrinogen in platelet thrombus formation under flow on adhesive proteins using afibrinogenemic blood (LMWH anticoagulated) in a perfusion system. Perfusions with afibrinogenemic blood showed strong increased surface coverage and thrombus volume that normalized upon addition of fibrinogen. Similar studies using citrate anticoagulated blood showed that this was due to fibrinogen and not fibrin. Morphological analysis showed that afibrinogenemic thrombi were loosely packed and consisted mainly of dendritic platelets that contacted one another through filopodia. However, in the presence of fibrinogen, platelets formed lamellipodia and spread out on top of one another. Studies with radiolabeled platelets showed similar numbers of platelets in both conditions demonstrating that the difference is one of packing and the larger size is due to absence of lamellipodia formation and spreading. The found increased thrombus size and loosely packed platelets might help to understand thrombotic complications sometimes seen in afibrinogenemia patients.
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