Background: Endothelial injury and coagulation activation are prominent axis in coronavirus disease 19 (COVID-19) pathogenesis. However, only few studies have compared profiles of biomarkers of coagulopathy and endotheliopathy with regard to the initial severity of COVID-19 and the time course of the disease.

Aims: The main objective of our study is to point profiles of biomarkers of coagulopathy and endotheliopathy associated with initial severity of COVID-19 and the time course of the disease.

Methods: In a prospective longitudinal study, we explored coagulation and endothelial function biomarkers at admission, at day 3 and at day 7 in two cohorts of severe and moderate COVID-19 patients and according to outcome.

Results: We found that D-dimers, free tissue factor pathway inhibition (TFPI) and extracellular vesicles – tissue factor (EV-TF) at admission were associated with disease severity. Concerning outcome, TFPI, EV-TF and von Willebrand factor antigen (VWF)/ADAMTS13 ratio at admission, at day 3 and at day 7 were associated with not favorable outcome defined as the onset of death or need of invasive mechanical ventilation. TFPI with a cut-off value of 37.5 ng/mL had 87% sensitivity and 94% and specificity and EV-TF with a cut-off value of 13 fM had 87% sensitivity and 83% specificity. ROC curves analysis for severe outcome was significant with AUC = 0.90 for TFPI and AUC = 0.88 for EV-TF (p < 0.001 for both).

Conclusion(s): We found a specific profile of specialized biomarkers of coagulopathy and endotheliopathy associated with severe form of COVID-19 and not favorable outcome. We identified free TFPI and EV-TF of potential interest to stratify patient’s risk or to design specific treatment targeting coagulation pathways. Additional studies are warranted to confirm our results and study the interaction between these biomarkers’ values and anticoagulation treatment.

Table 1

Table 3 : Routine and specialized biomarkers at admission according to the outcome

Figure

Figure 2 : ROC curves of specialized biomarkers at admission for severe outcome -death or mechanical ventilation-
Definition of abbreviations: AUC, area under the curve ; TFPI, tissue factor pathway inhibitor ; EV-TF, extracellular vesicles – tissue factor ; VWF, von Willebrand factor ; Ag, antigen ; sTM, thrombomodulin.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/comparative-profiles-of-routine-and-specialized-biomarkers-of-coagulopathy-and-endotheliopathy-in-moderate-and-severe-covid-19-disease-a-prospective-observational-study/