Clot Stiffness Measured By Seer Sonorheometry As a Marker Of Poor Prognosis In Hospitalized COVID-19 Patients

  1. Francisco José López-Jaime
  2. Ihosvany Fernández-Bello
  3. Sandra Martín-Téllez
  4. Alberto Doblas-Márquez
  5. Yohannes Tesfay
  6. Ignacio Márquez-Gómez
  7. José María Reguera-Iglesias
  8. Manuel Isidro Muñoz-Pérez
  9. Adrián Montaño

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Abstract

A high risk of thrombotic complications has been observed among severely ill COVID-19 patients. Viscoelastic tests (VET) have shown a hypercoagulable profile in these patients, although so far there is no clear evidence on the use of these tools as predictors of risk in the clinical course of patients. In this study we aimed to evaluate the association between Quantra® sonorheometry VET parameters, standard coagulation tests and inflammatory markers in 69 patients with COVID-19 on hospital admission with disease severity and outcome. Inflammatory markers were elevated in a high percentage of patients, as were coagulation-related parameters such as fibrinogen and D-dimer levels. Quantra® sonorheometry analysis revealed increased clot stiffness (CS), especially due to increased fibrinogen contribution (FCS) in 63.7%. Analysis of clot stability to lysis (CSL) on the Quantra showed a value of 100%, suggesting hypofibrinolysis, in 32.4%. Age > 65 years, elevated values of fibrinogen, D-dimer, LDH, increased CS and CSL were significantly associated with worsening disease. The combination of elevated FCS and D-dimer values showed a particularly high prognostic value in distinguishing patients with severe symptomatology. In conclusion, FCS measured by Quantra® system and its combination with D-dimer could be established as a powerful tool to identify poor prognosis in COVID-19 patients on hospital admission.

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  1. Version published to 10.1177/10760296221112085
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    SciScore for 10.1101/2021.07.13.21260256: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIACUC: The study was approved by the local ethical committee.
    Consent: Written informed consent was obtained from patients or legal guardians before inclusion. 2.2 Inflammatory and procoagulant status: Citrated, EDTA and non-anticoagulated blood samples were drawn on hospital admission and after confirmation of SARS-CoV-2 infection.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, the prognostic value of D-dimer has several limitations such as long analysis times, highlighting the need to identify other powerful markers. On the other hand, increased clot stiffness has been observed especially in patients with ARDS or ICU admission, revealing a possible association between these parameters and a worse prognosis of the disease [32]. Nevertheless, the prognostic value of clot stiffness measured by VET techniques has not yet been extensively studied. Our results demonstrate that clot stiffness parameters measured by Quantra® had a high prognostic value according to ROC analysis. In particular, fibrinogen contribution to clot stiffness (FCS) had the highest AUC compared to other parameters strongly associated with worse prognosis such as age or D-dimer. These findings highlight the potential use of this marker as predictor of poor prognosis in COVID-19 patients. One of the limitations of our study is, however, that patients were analyzed only at the time of diagnosis. Previous studies have shown that the predictive value of D-dimer on the risk of death is much higher when measured just before the clinical outcome compared to the time of diagnosis, suggesting the importance of dynamically monitoring D-dimer levels to detect thrombotic complications and thus reduce the mortality rate of patients [20]. The results of our study, which found that FCS has a higher predictive value for an adverse event than D-dimer, indicate that FCS may also be an import...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.07.13.21260256v1 on medRxiv