Pilot study to evaluate hypercoagulation and inflammation using rotational thromboelastometry and calprotectin in COVID-19 patients

  1. Sophia Stanford
  2. Ashok Roy
  3. Catherine Rea
  4. Ben Harris
  5. Antony Ashton
  6. Sarah Mangles
  7. Tamara Everington
  8. Rayan Taher
  9. Daniel Burns
  10. Emily Arbuthnot
  11. Tom Cecil

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Abstract

Abnormal coagulation and inflammation are hallmarks of SARs-COV-19. Stratifying affected patients on admission to hospital may help identify those who at are risk of developing severe disease early on. Rotational Thromboelastometry (ROTEM) is a point of care test that can be used to measure abnormal coagulation and calprotectin is a measure of inflammation.

Aim

Assess if ROTEM can measure hypercoagulability on admission and identify those who will develop severe disease early on. Assess if calprotectin can measure inflammation and if there is a correlation with ROTEM and calprotectin.

Methods

COVID-19 patients were recruited on admission and ROTEM testing was undertaken daily for a period of 7 days. Additionally inflammatory marker calprotectin was also tested for the same period.

Results

33 patients were recruited to the study out of which 13 were admitted to ITU and 20 were treated on the ward. ROTEM detected a hypercoagulable state on admission but did not stratify between those admitted to a ward or escalated to ITU. Calprotectin levels were raised but there was no statistical difference (p = 0.73) between patients admitted to a ward or escalated to ITU. Significant correlations were observed between FIBA5 (r = 0.62; p<0.00), FIBCFT (r = -0.57; p<0.00), FIBMCF (r = 0.64; p<0.00) and INMCF (r = 0.57; p<0.00) and calprotectin.

Conclusion

COVID-19 patients were hypercoagulable on admission. The correlations between ROTEM and calprotectin underline the interactions between inflammation and coagulation.

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  1. Version published to 10.1371/journal.pone.0269738
  2. ScreenIT

    SciScore for 10.1101/2022.05.27.22275701: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: in line with the Declaration of Helsinki, ethical approval was obtained from the Cornwall and Plymouth Research Ethics Committee.
    Consent: As part of the ethical approval where patients had severe disease and were not able to consent, assent was obtained from an independent medical practitioner who was not involved in the direct care of the patient.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analysis was performed in Anaconda 3 with Python 3.8.8.
    Python
    suggested: (IPython, RRID:SCR_001658)

    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:
    Limitations: No definite conclusions can be drawn from this pilot study because of the small sample size. The study consisted mainly of Caucasian patients and as coagulation status and predisposition to the development of coagulopathies varies between race and ethnicity (38) this limits the generalisability of our study. Addendum: Dr S. Stanford designed the study, collected the data and wrote the paper. Dr D. Burns, Ms R. Taher and Dr S. Stanford undertook statistical analysis. Ms E. Arbuthnot co-ordinated the study. All other authors reviewed and provided expert comments on the paper.

    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.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

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

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.05.27.22275701v1 on medRxiv