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Letters to the Editor
50x109/L threshold value for DIC. Fibrinogen for patients admitted to the three care-intensity wards were higher than the upper limit of the normal range, with a gradient of increase across the care intensities and with values in patients at high-intensity care as high as 1,035 mg/dL. The lowest fibrinogen level (150 mg/dL) measure was higher than the 100 mg/dL DIC score threshold value incorporated to assign points. A similar trend of positive association with the level of care intensity was observed for D-dimer; as median values ranged from 870 ng/mL (low-intensity) to 1,347 ng/mL or to 2,217 ng/mL (inter- mediate- or high-intensity care) (Table 1). The median (min-max) DIC score for the whole patient cohort was 2 (range, 0-4), with only one patient scoring 4. SIC scores were similar in the three groups, all being below the cut- off of 4. Median FVIII, already high (208 U/dL) in low- intensity patients, was increased steadily in intermediate (223 U/dL) and high-intensity (302 U/dL) patients. Median antithrombin varied from 87 U/dL (low-intensi- ty) to 100 U/dL (high-intensity). PC was increased in low-intensity patients (120 U/dL) and was further increased in intermediate (126 U/dL) or high-intensity (143 U/dL) care patients. PS free antigen was lower than 100 U/dL, with small variations according to the intensity of care (Table 1; Figure 1). Median VWF:Ag was high in patients at low-intensity (262 U/dL) and was further increased in intermediate (371 U/dL) and high-intensity (466 U/dL) care patients. VWF:RCo values paralleled those of VWF:Ag, albeit at a lower level, and the
VWF:RCo/VWF:Ag ratio ranged between 0.85 (low), 0.86 (intermediate) and 0.81 (high) care intensity (Table 1; Figure 2). The median FVIII/VWF:Ag ratio ranged between 0.81 (low), 0.61 (intermediate) and 0.65 (high) care intensity. Median ferritin was extremely high, i.e., 380 mg/L (low), 705 ng/mL (intermediate) and 788 ng/mL (high) care intensity. C-reactive protein was 1.00 mg/dL (low), 3.32 mg/dL (intermediate) and 5.05 mg/dL (high- intensity) care patients (Table 1).
Several studies reported that COVID-19 patients have an acquired coagulopathy with an increased risk of VTE in critically ill patients.4-7 However, the frequency varies greatly and there is still an unsettled strategy for prophy- laxis.12 Therefore, besides the need of well-designed ran- domized clinical trials, we deemed crucial to better mech- anistically understand thrombosis, with the ultimate goal to implement more targeted approaches to management. We, therefore, investigated coagulation in infected patients hospitalized on the basis of their clinical severity in three different intensity-care wards by employing an array of measurements centralized in the same laborato- ry, with special emphasis on those used to diagnose DIC and SIC, the pro- and anticoagulant factors and those indicating endothelial perturbation. Our results did not confirm DIC, as high DD was the only compatible result, while other parameters indicating consumption coagu- lopathy, as low fibrinogen and platelet counts, were nor- mal or often increased. Furthermore, none of the patients had a DIC score of 5 or more (the threshold indicating a
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Figure 2. Box plots of results for (A) von Willebrand factor (VWF) antigen (VWF:Ag), (B) VWF ristocetin-cofactor (VWF:RCo), VWF:RCo/Ag ratio and factor VIII (FVIII)/VWF:Ag ratio for low-, intermediate- and high-intensity care patients.
haematologica | 2021; 106(5)