Introduction The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood and is an indicator of the overall real-time coagulopathic state of the patient. Methods A single-centre, prospective, observational cohort study was conducted in South Africa, analysing the coagulation patterns of 41 patients with hypoxia related to SARS-CoV-2 using serial thromboelastography (TEG) on admission, after 48 hours, and at resolution of hypoxia/day 10. Results: Two-thirds ( n = 26) were women. The median age was 61 (IQR 50–67), and the majority (88%) were Black patients. Almost half (22) of the patients were critically ill and ventilated, with median SOFA and SAPS2 scores of 3 and 22 (IQR2-4 and 18–30), respectively. The prevalence of hypercoagulability was 0.54 (95% CI 0.46–0.62), whilst 29/41 (0.71, CI 0.64–0.78)) met the definition of hypofibrinolysis. Differences between the hypercoagulable (HC) and non-hypercoagulable groups remained apparent at 48 hours after anticoagulation. At this time point, the K time was significantly lower ( p ˂ 0,01), and the α -angle ( p ˂ 0,01) and maximum amplitude (MA) ( p ˂ 0,01) were significantly higher in the HC cohort. At resolution of hypoxia, or day 10, only MA was significantly higher in the hypercoagulable group compared to the non-hypercoagulable group ( p = 0.01). The initial impairment in fibrinolysis (Ly30), α angle, and MA were significantly associated with mortality, with p values of 0.006, 0.031, and 0.04, respectively. Conclusions In this South African population, hypercoagulability was a highly prevalent phenomenon in COVID-19 disease. It was typified by hypofibrinolysis and a persistently elevated MA, despite anticoagulation therapy.
【초록키워드】 SARS-CoV-2, Inflammation, Cytokine storm, coronavirus, therapy, Mortality, anticoagulation, hypoxia, COVID-19 disease, Coagulation, Prevalence, point-of-care, Cohort, South Africa, Critically ill, Whole blood, African, Patient, SOFA, women, Degradation, group, Black patients, Admission, hypercoagulability, thromboelastography, hypercoagulable, Observational cohort study, acute respiratory syndrome, Ventilated, 95% CI, median age, South, impairment, abnormality, amplitude, significantly lower, difference, prevalent, initial, resulting, significantly, the patient, subsequent, remained, elevated, conducted, median, majority, significantly higher, IQR, 【제목키워드】 Population, African, thromboelastography, South,