Immunothrombosis Biomarkers for Distinguishing COVID-19 Patients from Non-COVID Septic Pneumonia Patients and for Predicting ICU Mortality

E. Cani¹, D. Dwivedi¹, K.L. Liaw², D. Fraser³, C. Yeh⁴, C. Martin³, M. Slessarev³, S. Cerroni¹, A. Fox-Robichaud¹, J. Weitz¹, P. Kim¹, P. Liaw¹, DYNAMICS and COVID-BEACONS Investigators

¹McMaster University, Thrombosis & Atherosclerosis Research Institute (TaARI), Hamilton, Canada, ²McMaster University, Hamilton, Canada, ³Western University, London, Canada, ⁴University of Toronto, Toronto, Canada

Abstract Number: PB0138

Meeting: ISTH 2021 Congress

Theme: COVID and Coagulation » COVID and Coagulation, Basic Science

Background: COVID-19 infection is characterized by immunothrombosis that likely reflects hypercoagulation, endothelial dysfunction, and increased formation of neutrophil extracellular traps.

Aims: In this study, we investigated the utility of immunothrombosis biomarkers to distinguish between COVID-19 patients and non-COVID septic pneumonia patients. We also investigated the prognostic utility of the biomarkers in predicting ICU mortality in the two patients groups.

Methods: The participants in this study were ICU COVID-19 patients (n=14), ICU non-COVID septic pneumonia patients (n=19), and age- and sex-matched healthy controls (n=14). Blood samples were collected on Days 4, 7, 10, and/or 14. We measured plasma levels of the following biomarkers: thrombin-antithrombin (TAT) complexes, protein C, antithrombin, soluble TM, soluble EPCR, fibrinogen, D-dimer, cell-free DNA (cfDNA), and citrullinated histones (H3-Cit). Data analysis was based on binomial logit models and receiver operating characteristic curve analyses.

Results: We identified 8 biomarkers that distinguish COVID-19 patients from healthy individuals: cfDNA, D-dimer, sEPCR, PC, sTM, fibrinogen, H3-Cit, and TAT complexes. In comparison, 4 biomarkers distinguish COVID-19 from non-COVID septic pneumonia patients: fibrinogen, sEPCR, antithrombin, and cfDNA. With respect to prognosis, the main predictors of ICU mortality differ between the two patient groups. In COVID-19 patients, non-survivors have higher sTM and H3-Cit compared with survivors. In septic pneumonia patients, non-survivor patients have lower levels of protein C and higher cfDNA levels compared with survivors. In addition, the most recent values of the biomarkers have stronger prognostic value compared to their Day 1 values.

Conclusions: Our results suggest that fibrinogen, sEPCR, antithrombin, and cfDNA have utility for distinguishing COVID-19 patients from non-COVID septic pneumonia patients. Our data also suggest that the predictors of ICU mortality differ between the two patient groups: sTM and H3-Cit for COVID-19 patients, and protein C and cfDNA for non-COVID septic pneumonia patients. These findings suggests that there are pathophysiological differences between the two patients groups.

To cite this abstract in AMA style:

Cani E, Dwivedi D, Liaw KL, Fraser D, Yeh C, Martin C, Slessarev M, Cerroni S, Fox-Robichaud A, Weitz J, Kim P, Liaw P, DYNAMICS and COVID-BEACONS Investigators . Immunothrombosis Biomarkers for Distinguishing COVID-19 Patients from Non-COVID Septic Pneumonia Patients and for Predicting ICU Mortality [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/immunothrombosis-biomarkers-for-distinguishing-covid-19-patients-from-non-covid-septic-pneumonia-patients-and-for-predicting-icu-mortality/. Accessed September 16, 2021.

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