Combined coagulation and inflammation markers as predictors of venous thrombo-embolism and death in COVID-19

Jaja Zhu; Raïda Bouzid; Benoît Travert; Guillaume Géri; Yves Cohen; Adrien Picod; Nicholas Heming; Martin Rottman; Bérangère Joly-Laffargue; Agnès Veyradier; Claude Capron; Paul Coppo

doi:10.3389/fmed.2024.1399335

Combined coagulation and inflammation markers as predictors of venous thrombo-embolism and death in COVID-19

Front Med (Lausanne). 2024 Jun 10:11:1399335. doi: 10.3389/fmed.2024.1399335. eCollection 2024.

Authors

Jaja Zhu^#^{1

2}, Raïda Bouzid^#³, Benoît Travert⁴, Guillaume Géri⁵, Yves Cohen⁶, Adrien Picod⁶, Nicholas Heming^{7

8

9

10}, Martin Rottman^{11

12}, Bérangère Joly-Laffargue^{3

13

14}, Agnès Veyradier^{3

13

14}, Claude Capron^{1

15}, Paul Coppo^{3

16

17}

Affiliations

¹ Service d'Hématologie-Immunologie-Transfusion, AP-HP Paris Saclay, CHU Ambroise Paré, Université de Versailles Saint Quentin-Université Paris Saclay, Montigny-le-Bretonneux, France.
² Laboratoire Cellules Souches et Applications Thérapeutiques, UMR INSERM 1184, Commissariat à l'Energie Atomique et aux Energies Alternatives, Fontenay-aux-Roses, France.
³ Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT), AP-HP, Paris, France.
⁴ Service de Médecine Interne, Hôpital Ambroise-Paré, AP-HP, Boulogne-Billancourt, France.
⁵ Service de Médecine Intensive et Réanimation, Hôpital Ambroise-Paré, AP-HP, Boulogne-Billancourt, France.
⁶ Service de Médecine Intensive et Réanimation, Hôpital Avicenne, AP-HP, Paris, France.
⁷ Department of Intensive Care, Raymond Poincaré Hospital, APHP University Versailles Saint Quentin-University Paris Saclay, Garches, France.
⁸ Institut Hospitalo Universitaire PROMETHEUS, Garches, France.
⁹ Innovative Biomarkers Plateform, Laboratory of Infection & Inflammation-U1173, School of Medicine, INSERM, University Versailles Saint Quentin-University Paris Saclay, Garches, France.
¹⁰ FHU SEPSIS, Garches, France.
¹¹ Innovative Biomarkers Plateform, Laboratory of Infection & Inflammation-U1173, School of Medicine, INSERM, University Versailles Saint Quentin-University Paris Saclay, Garches, France; FHU SEPSIS, Garches, France.
¹² General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), FHU SEPSIS, Laboratory of Infection and Inflammation-U1173, School of Medicine Simone Veil, Université Versailles Saint Quentin, University Paris Saclay, INSERM, Garches, France.
¹³ EA3518, Institut de Recherche Saint Louis, Université de Paris, Paris, France.
¹⁴ Service D'hématologie Biologique, Laboratoire ADAMTS13, Hôpital Lariboisière, AP-HP Nord, Université de Paris, Paris, France.
¹⁵ Université Paris-Saclay, Université de Versailles Saint Quentin en Yvelines (UVSQ), Biomarqueurs en cancérologie et onco-hématologie (BECCOH), Boulogne-Billancourt, France.
¹⁶ Service d'Hématologie, Hôpital Saint-Antoine, AP-HP-Sorbonne Université, Paris, France.
¹⁷ NSERM UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.

^# Contributed equally.

Abstract

Background: The COVID-19 pandemic related to SARS-CoV-2 virus was responsible for global pandemic. The severe form of the disease was linked to excessive activation of immune pathways together with a systemic cytokine storm response and thrombotic venous or arterial complications. Factors predicting severe outcomes including venous and/or pulmonary thrombosis (VT) and death were identified, but the prognostic role of their combination was not addressed extensively.

Objectives: We investigated the role of prognostic factors from the coagulation or inflammatory pathways to better understand the outcome of the disease.

Methods: For this, we prospectively studied 167 SARS-CoV-2-positive patients from admission in intensive care units (ICU) or emergency departments from four academic hospitals over a 14-month period. Besides standard biology, we assessed serum concentrations of inflammatory markers, coagulation factors and peripheral blood cells immunophenotyping.

Results: Thirty-nine patients (23.3%) developed VT and 30 patients (18%) died. By univariate analysis, C-reactive protein (CRP) level > 150 mg/L, interleukin-6 (IL-6) ≥ 20 pg/mL, D-dimers > 1,500 μg/L, ADAMTS13 activity ≤ 50%, Von.

Conclusion: A combination of coagulation and inflammatory markers can refine the prognostication of severe outcome in COVID-19, and could be useful for the initial evaluation of other types of viral infection.

Keywords: ADAMTS13; C-reactive protein; COVID-19; interleukin-6; prognosis; thrombosis; von Willebrand factor.

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This work was partly funded by the Association de recherche sur les microangiopathies thrombotiques et autres maladies rares en Hématologie (ARMAT).