Background: The mortality of patients admitted to the intensive care unit (ICU) with COVID-19 remains significantly high. Severe COVID-19 pneumonia is characterised by refractory hypoxemia with significant shunting due to a combination of alveolar damage, vascular vasoconstriction, and occlusion due to microthrombi. Similar pathological features are seen in extra-pulmonary organs. However, the influence of thrombotic markers on the risk of mechanical ventilation (MV) and the development of acute kidney injury (AKI) is not fully defined. Methods: This was a cross-sectional evaluation of haemostatic and thrombotic markers of COVID-19 patients admitted to the ICU to determine their predictability for the development of thromboembolism and the need for non-invasive or invasive MV, development of AKI, and mortality. Results: An extended coagulation profile was obtained in 71 SARS-CoV-2 positive patients admitted to the ICU. All patients had acute severe hypoxic respiratory failure and required non-invasive or invasive MV. There were increases in peak D-dimer (3.0 mg/L), factor VIII levels (255 IU/dL) vWF antigen (471 IU/dL) with low ADAMTS13 activity (54.7 IU/dL) compared to the reference ranges. Peak D-dimer was consistently raised in patients who developed AKI and required invasive MV. ADAMTS13/vWF/platelet axis was associated with disease severity, multi-organ dysfunction, and mortality. Conclusions: Haematological abnormalities are a common feature of severe COVID-19 pneumonia. We found peak D-dimer and vWF-ADAMTS13-platelet axis are associated with increased ICU severity and outcome in severe COVID-19 patients admitted to ICU. Larger studies are needed to evaluate this more comprehensively.
【저자키워드】 D dimer, COVID 19, ADAMTS13, factor VIII, acute kidney injury care, acquired von willebrand, intensive respiratory care, 【초록키워드】 COVID-19, Severe COVID-19 pneumonia, Mortality, intensive care, hypoxic respiratory failure, mechanical ventilation, multi-organ dysfunction, Pneumonia, cross-sectional, severity, disease severity, risk, D-dimer, Acute kidney injury, outcome, ICU, Antigen, Coagulation, AKI, Hypoxemia, Patient, Thromboembolism, marker, Combination, COVID-19 patient, microthrombi, alveolar damage, Non-invasive, Vascular, reference ranges, thrombotic, vasoconstriction, abnormality, peak, feature, invasive, defined, evaluate, significantly, raised, required, determine, was obtained, increases in, admitted to ICU, extra-pulmonary organs, peak D-dimer, SARS-CoV-2 positive patient, severe COVID-19 patient, with COVID-19, 【제목키워드】 COVID-19, intensive care unit, determinant, role, Ill,