CLOT STIFFNESS MEASURED BY SEER SONORHEOMETRY AS A MARKER OF POOR PROGNOSIS IN HOSPITALIZED COVID-19 PATIENTS

SUMMARY Background High incidence of life-threatening thrombotic complications is observed in severely ill COVID-19 patients. D-dimer may help evaluate disease severity and predict outcomes at hospital admission. However, its non-specificity and long analysis times strongly constrain its clinical value. Viscoelastic tests (VET) are widely available rapid point-of-care devices that have been shown to detect a hypercoagulable state (increased clot stiffness and fibrinolysis shutdown) as major contributors of the thrombotic complication in COVID-19. Nevertheless, based on the data obtained so far, definitive conclusions have not been drawn. Objectives We aim to evaluate the association between VET parameters, standard coagulation tests and inflammation markers assessed in COVID-19 patients at hospital admission with disease severity and outcomes. Patients/Methods A total of 69 COVID-19 patients requiring hospitalization were included in the study. The pro-inflammatory and pro-thrombotic state was analyzed by a panel of inflammation markers (IL-6, CRP, LDH, ferritin), routine coagulation tests (PT, aPTT, platelet count, fibrinogen, D-dimer) and a SEER sonorheometry VET profile (Quantra® System). Results Inflammatory markers IL-6, CRP, LDH and ferritin were elevated in a high percentage of patients (73.6%, 89.2%, 57.1% and 52.4%), as were coagulation-related parameters such as fibrinogen (81.4%) and D-dimer levels (66.2%). Quantra® analysis revealed increased clot stiffness (CS) in 34.8%, particularly due to increased fibrinogen contribution (FCS) in 63.7%. Increased clot stability to lysis (CSL) was observed in 32.4%. Age > 65 years, elevated values of fibrinogen, D-dimer, LDH, increased clot stiffness and resistance to clot lysis were significantly associated with worsening disease. The Quantra® FCS parameter showed a particularly high prognostic value in distinguishing patients with severe symptomatology. Conclusion The global study of hemostasis by the whole blood point-of-care Quantra® VET system may be a powerful tool for identifying poor prognosis in COVID-19 patients at hospital admission. In particular, FCS measured by Quantra® could be established as a plausible prognostic marker to aid the clinical management of COVID-19 patients.