Hypercoagulable Rotational Thromboelastometry During Hospital Stay Is Associated with Post-Discharge DLco Impairment…, 2024, Loutsidi+

[SNT Gatchaman]

Hypercoagulable Rotational Thromboelastometry During Hospital Stay Is Associated with Post-Discharge DLco Impairment in Patients with COVID-19-Related Pneumonia
Loutsidi, Natasa-Eleni; Politou, Marianna; Vlahakos, Vassilios; Korakakis, Dimitrios; Kassi, Theodora; Nika, Asimina; Pouliakis, Abraham; Eleftheriou, Konstantinos; Balis, Evangelos; Pappas, Apostolos G.; Kalomenidis, Ioannis

Hypercoagulation is central to the pathogenesis of acute and post-acute COVID-19. This prospective observational study explored whether rotational thromboelastometry (ROTEM), a method that unveils coagulation status, predicts outcomes of hospitalized patients with COVID-19 pneumonia.

We investigated 62 patients using ROTEM that was conducted at enrollment, clinical deterioration, discharge and follow-up visits 1 and 3 months post-discharge.

A hypercoagulable ROTEM was more common at clinical deterioration than at enrollment and the levels of hypercoagulable ROTEM indices correlated with the clinical severity score. Hypercoagulable ROTEM at enrollment was not associated with in-hospital death. Patients with hypercoagulable ROTEM at enrollment, discharge and 1 month post-discharge had an increased risk of persistent symptoms 1 and 3 months after discharge. Patients with hypercoagulable ROTEM at enrollment, discharge, and 1 month after discharge were more likely to have lung diffusion capacity (DLco) impairment 3 months after discharge.

High levels of hypercoagulable ROTEM indices were associated with the increased risk of persistent symptoms at later stages of the disease. In a multivariate analysis, (i) hypercoagulable ROTEM at discharge and female gender were linked to the presence of symptoms at one month post-discharge, (ii) hypercoagulable ROTEM at one month after discharge was linked to the presence of symptoms at three months post-discharge, (iii) hypercoagulable ROTEM at enrollment and at discharge and female gender were linked to the presence of impaired DLco at three months post-discharge.

Excessive coagulation may contribute to long-COVID pathogenesis and ROTEM findings during hospitalization may predict post-acute-COVID-19 sequelae in patients with COVID-19-related pneumonia.

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[SNT Gatchaman]

We prospectively enrolled non-ICU patients with COVID-19-related pneumonia hospitalized […] Patients received treatment and respiratory support according to the national guidelines

The primary outcome of the study was “hospital mortality”. Secondary outcomes included “clinical deterioration during hospital stay”, the “presence of symptoms at 1 and 3 months post-discharge” and “DLco at 3 months post-discharge”.

One month after discharge, 16 (36.3%) of the patients had at least one symptom (fatigue, dyspnea, hair loss, anxiety, ageusia, memory disorders, palpitations), 9/44 patients experienced exertional dyspnea and 9/44 experienced fatigue. One patient, who had a normal ROTEM at enrollment and at discharge, was re-admitted with myocardial infarction and the ROTEM was hypercoagulable at the time of the second admission. At three months, 9/44 had exertional dyspnea, 2/44 had fatigue and in total, 10/44 (22.7%) had at least one symptom.

along with an increased mean platelet volume (suggesting the presence of, for the most part, “large” platelets) at 1 month post-discharge. The multivariate analysis showed that only a hypercoagulable ROTEM profile at enrollment and at discharge was independently linked to low DLco at three months post-discharge.