Русский
Prognostication of thrombotic and hemorrhagic events in patients hospitalized with novel coronavirus infection COVID-19
DOI: https://dx.doi.org/10.18565/therapy.2022.6.41-53
Korshunova A.A., Kulikov A.N., Trofimov V.I., Teplov V.M., Kovalchuk Yu.P., Kadinskaya M.I., Ginzburg A.M., Lapin S.V.
Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia
The aim of the research was to assess the predictive ability of conventional thrombosis and bleeding prognostication scales in the cohort of NCI COVID-19 patients, and to develop the own predictive thrombosis scale.
Material and methods. The work was carried out on the basis of the Center for treatment of patients with NCI of I.P. Pavlov State medical university: medical records of 945 patients hospitalized in the Center from November 01, 2020 to March 05, 2021 were retrospectively analyzed, cases of hospitalization accompanied by thrombotic and hemorrhagic events were verified. To determine the efficacy of predicting the development of these complications before they occur, the parameters of all those examined persons at the time of admission were evaluated using the commonly known probability scales for thrombosis and bleeding.
Results. Twenty-seven thrombotic and 44 hemorrhagic events were identified, all of them were registered in patients with severe infection. The IMPROVEDD scale (AUC=0,83) was the most preferable for predicting thrombosis in patients with NCI COVID-19, according to the results of the accuracy and completeness analysis. When assessing hemorrhagic scales, the ATRIA scale had the highest AUC (0,92). The most significant parameters associated with thrombotic events were disease severity, extent of changes according to CT, type of anticytokine therapy, D-dimer and procalcitonin levels. AUC of the developed thrombosis scale was 0,92, which was significantly higher than the data of the best conventional models.
Conclusion. The commonly known thrombotic events prognostication scales have insufficient predictive accuracy in NCI COVID-19 patients, which makes the task of developing a special thrombosis scale relevant. Our proposed thrombosis scale is superior to the traditional scales in these characteristics, but requires prospective validation on a wide sample of patients with NCI COVID-19 infection.
Literature
1. Gerber G.F., Chaturvedi S. How to recognize and manage COVID-19-associated coagulopathy. Hematology Am Soc Hematol Educ Program. 2021; 2021(1): 614–20. https://dx.doi.org/10.1182/hematology.2021000297. 2. Song J.C., Wang G., Zhang W. et al. Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19. Mil Med Res. 2020; 7(1): 19. https://dx.doi.org/10.1186/s40779-020-00247-7. 3. Salabei J.K., Fishman T.J., Asnake Z.T. et al. COVID-19 coagulopathy: Current knowledge and guidelines on anticoagulation. Heart Lung. 2021; 50(2): 357–60. https://dx.doi.org/10.1016/j.hrtlng.2021.01.011. 4. Zhang S., Li Y., Liu G., Su B. Intermediate-to-therapeutic versus prophylactic anticoagulation for coagulopathy in hospitalized COVID-19 patients: a systemic review and meta-analysis. Thromb J. 2021; 19(1): 91. https://dx.doi.org/10.1186/s12959-021-00343-1. 5. Monfardini L., Morassi M., Botti P. et al. Pulmonary thromboembolism in hospitalised COVID-19 patients at moderate to high risk by Wells score: A report from Lombardy, Italy. Br J Radiol. 2020; 93(1113): 20200407. https://dx.doi.org/10.1259/bjr.20200407. 6. Schulman S., Hu Y., Konstantinides S. Venous thromboembolism in COVID-19. Thromb Haemost. 2020; 120(12): 1642–53.https://dx.doi.org/10.1055/s-0040-1718532. 7. Olesen J.B., Torp-Pedersen C., Hansen M.L., Lip G.Y. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0–1: A nationwide cohort study. Thromb Haemost. 2012; 107(6): 1172–79.https://dx.doi.org/10.1160/TH12-03-0175. 8. Geersing G.J., Zuithoff N.P., Kearon C. et al. Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: Individual patient data meta-analysis. BMJ. 2014; 348: g1340. https://dx.doi.org/10.1136/bmj.g1340. 9. Le Gal G., Righini M., Roy P.M. et al. Prediction of pulmonary embolism in the emergency department: The revised Geneva score. Ann Intern Med. 2006; 144(3): 165–71. https://dx.doi.org/10.7326/0003-4819-144-3-200602070-00004. 10. Kandagatla P., Goranta S., Antoine H. et al. PADUA score as a predictor for pulmonary embolism: a potential strategy for reducing unnecessary imaging. J Thromb Thrombolysis. 2019; 47(4): 566–71. https://dx.doi.org/10.1007/s11239-018-01801-w. 11. Gibson C.M., Spyropoulos A.C., Cohen A.T. et al. The IMPROVEDD VTE risk score: incorporation of D-Dimer into the IMPROVE score to improve venous thromboembolism risk stratification. TH open. 2017; 1(1): e56–e65. https://dx.doi.org/10.1055/s-0037-1603929. 12. Fang M.C., Go A.S., Chang Y. et al. A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011; 58(4): 395–401. https://dx.doi.org/10.1016/j.jacc.2011.03.031. 13. Laursen S.B., Hansen J.M., de Muckadell O.B.S. The Glasgow Blatchford score is the most accurate assessment of patients with upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol. 2012; 10(10): 1130–35.e1. https://dx.doi.org/10.1016/j.cgh.2012.06.022. 14. Pisters R., Lane D.A., Nieuwlaat R. et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010; 138(5): 1093–100. https://dx.doi.org/10.1378/chest.10-0134. 15. Apostolakis S., Lane D.A., Guo Y. et al. Performance of the HEMORR2HAGES, ATRIA, and HAS-BLED bleeding risk – prediction scores in nonwarfarin anticoagulated atrial fibrillation patients. J Am Coll Cardiol. 2013; 61(3): 386–87.https://dx.doi.org/10.1016/j.jacc.2012.10.010. 16. O’Brien E.C., Simon D.N., Thomas L.E. et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J. 2015; 36(46): 3258–64. https://dx.doi.org/10.1093/eurheartj/ehv476. 17. Временные методические рекомендации «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)». Версия 9 (26.10.2020). Минздрав России. Доступ: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/052/548/original/%D0%9C%D0%A0_COVID-19_%28v.9%29.pdf (дата обращения – 28.07.2022). [Interim guidelines «Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19)». Version 9 (10/26/2020). Ministry of Healthcare of Russia.URL: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/052/548/original/%D0%9C%D0%A0_COVID- 19_%28v.9%29.pdf (date of access – 28.07.2022)]. 18. Rindi L.V., Al Moghazi S., Donno D.R. et al. Predictive scores for the diagnosis of Pulmonary Embolism in COVID-19: A systematic review. Int J Infect Dis. 2022; 115: 93–100. https://dx.doi.org/10.1016/j.ijid.2021.11.038. 19. Mestre-Gomez B., Lorente-Ramos R.M., Rogado J. et al. Incidence of pulmonary embolism in non-critically ill COVID-19 patients. Predicting factors for a challenging diagnosis. J Thromb Thrombolysis. 2021; 51(1): 40–46.https://dx.doi.org/10.1007/s11239-020-02190-9. 20. Garcia-Ortega A., Oscullo G., Calvillo P. et al. Incidence, risk factors, and thrombotic load of pulmonary embolism in patients hospitalized for COVID-19 infection. J Infect. 2021; 82(2): 261–69. https://dx.doi.org/10.1016/j.jinf.2021.01.003. 21. Zhan H., Chen H., Liu C. et al. Diagnostic value of D-dimer in COVID-19: A meta-analysis and meta-regression. Clin Appl Thromb Hemost. 2021; 27: 10760296211010976. https://dx.doi.org/10.1177/10760296211010976. 22. Ahmed S., Jafri L., Hoodbhoy Z., Siddiqui I. Prognostic value of serum procalcitonin in COVID-19 patients: A systematic review. Indian J Crit Care Med. 2021; 25(1): 77–84. https://dx.doi.org/10.5005/jp-journals-10071-23706. 23. Bonaventura A., Vecchie A., Dagna L. et al. Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19. Nat Rev Immunol. 2021; 21(5): 319–29. https://dx.doi.org/10.1038/s41577-021-00536-9. 24. Roncon L., Zuin M., Barco S. et al. Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis. Eur J Intern Med. 2020; 82: 29–37. https://dx.doi.org/10.1016/j.ejim.2020.09.006. 25. Maruhashi T., Higashi Y. Pathophysiological association of endothelial dysfunction with fatal outcome in COVID-19. Int J Mol Sci. 2021; 22(10): 5131. https://dx.doi.org/10.3390/ijms22105131. 26. Hsu J.Y., Mao Y.C., Liu P.Y., Lai K.L. Pharmacology and adverse events of emergency-use authorized medication in moderate to severe COVID-19. Pharmaceuticals (Basel). 2021; 14(10): 955. https://dx.doi.org/10.3390/ph14100955. 27. Lin Z., Niu J., Xu Y. et al. Clinical efficacy and adverse events of baricitinib treatment for coronavirus disease-2019 (COVID-19): A systematic review and meta-analysis. J Med Virol. 2022; 94(4): 1523–34. https://dx.doi.org/10.1002/jmv.27482. 28. Ravid J.D., Leiva O., Chitalia V.C. Janus kinase signaling pathway and its role in COVID-19 inflammatory, vascular, and thrombotic manifestations. Cells. 2022; 11(2): 306. https://dx.doi.org/10.3390/cells11020306. 29. Aciksari G., Cetinkal G., Kocak M. et al. Evaluation of modified ATRIA risk score in predicting mortality in hospitalized patients with COVID-19. Am J Med Sci. 2021; 362(6): 553–61. https://dx.doi.org/10.1016/j.amjms.2021.06.001.
About the Autors
Alexandra A. Korshunova, deputy chief physician for clinical and expert work, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo Str. E-mail: aftotrof@yandex.ru. ORCID: https://orcid.org/0000-0002-7419-7227
Alexander N. Kulikov, Dr. med. habil., professor, head of the Department of propaedeutics of internal diseases with the clinic, head of the Department of functional diagnostics, deputy chief physician of the clinic for the medical part (therapy), Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo Str. E-mail: ankulikov2005@yandex.ru.
ORCID: https://orcid.org/0000-0002-4544-2967
Vasily I. Trofimov, Dr. med. habil., professor, head of the Department of hospital therapy with the course of allergology and immunology named after academician M.V. Chernorutsky with the clinic, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo Str. E-mail: trofvi@mail.ru
Vadim M. Teplov, Dr. med. habil., associate professor, head of the Department of emergency of Research Institute of Surgery and Emergency Medicine, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo Str. E-mail: vadteplov@mail.ru. ORCID: https://orcid.org/0000-0002-4299-4379
Yuri P. Kovalchuk, PhD in Medicine, deputy chief physician of the clinic for laboratory diagnostics, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo Str. E-mail: yuriikowalchuk@yandex.ru
Margarita I. Kadinskaya, PhD in Medicine, associate professor of Department of clinical laboratory diagnostics, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo Str. E-mail: mkadinskaya@mail.ru
Alexander M. Ginzburg, PhD in Medicine, head of the laboratory – doctor of clinical laboratory diagnostics of the laboratory of preanalytical modification of biomaterial of the department of laboratory diagnostics, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo Str. E-mail: ginzalex@yandex.ru
Sergei V. Lapin, PhD in Medicine, head of the Laboratory for diagnostics of autoimmune diseases of the Scientific and Methodological Center for molecular medicine of the Ministry of Healthcare of Russia, Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo Str. E-mail: svlapin@mail.ru
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