Avaliação das alterações na hemostasia em indivíduos hospitalizados por suspeita de COVID-19

Abstract

Coronavirus Disease 2019 (COVID-19) is a disease resulting from infection by the new coronavirus, severe acute respiratory syndrome coronavirus 2. Several studies have shown an increased risk of thromboembolism in hospitalized patients with COVID-19 which also occur in hospitalized or outpatients with Severe Acute Respiratory Illness (SARI) due to other causes. This study aimed to evaluate coagulation and anticoagulation parameters in individuals hospitalized for COVID-19 compared with those hospitalized for other non-COVID-19 SARI. The study included 151 individuals, 138 with a diagnosis of COVID-19 and 13 with non-COVID-19 SARI. After the 2:1 matching by sex and age, 26 individuals with COVID-19 and 13 with non-COVID-19 SARI participated in the study. In addition to the INR, APTT and D-dimer tests, coagulation factors V, VII, XI, XII, XIII, prothrombin and the natural anticoagulant, antithrombin, were tested. Fisher's exact test and Mann-Whitney test were used to compare the parameters between individuals with COVID-19 and non-COVID-19. The group of individuals with COVID-19 had, in relation to the group non-COVID-19, higher levels of activity of antithrombin with median of 113.6% (interquartile range [IQR], 81.2-136.8%) versus 86.3% (IQR, 71.4 -105.9%), p=0.037; factor V 229.7% (IQR, 151.0-496.1%) versus 97.9% (IQR, 8.3-254.2%), p=0,04; factor VII 249.6% (IQR,142.4-365.5%) versus 96.9% (IQR, 44.1-268.2%), p=0,025; factor XI 138.3% (IQR, 103.4-179.4%) versus 100.3% (IQR, 68.8-123.9%), p=0.004 and prothrombin 111.6% (IQR, 86.9-134.5%) versus 79.8% (IQR, 61.8-107.9%), p=0.007. The non-COVID group had higher level of serum lactate compared with COVID-19 with median of 2.6 U/L (IQR, 1.9-3.9 U/L) versus 1.7 U/L (IQR, 1.4-2.2 U/L) p=0.01. After the adjusted analysis by the Sequential Organ Failure Assessment (SOFA), only factor XI (p = 0.041) and prothrombin (p = 0.042) levels remained elevated in the COVID-19 group compared with the non-COVID group. There was a very strong correlation between factors V and VII (r = 0.923) of participants with COVID-19. In conclusion, in this study, the severity of SARI (rather than its cause) is associated with elevated levels of clotting factors in hospitalized patients.