tetano
Editor, Senior Moderator
Am J Hematol
. 2020 Aug 11.
doi: 10.1002/ajh.25962. Online ahead of print.
Evaluation of the Prothrombin Fragment 1.2 in Patients with COVID-19
Hanny Al-Samkari[SUP] 1 2 [/SUP], Fei Song[SUP] 2 3 [/SUP], Elizabeth Van Cott[SUP] 2 4 [/SUP], David J Kuter[SUP] 1 2 [/SUP], Rachel Rosovsky[SUP] 1 2 [/SUP]
Affiliations
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) may cause a hypercoagulable state. The D-dimer is frequently elevated in COVID-19, but other markers of coagulation activation, including the prothrombin fragment 1.2 (PF1.2) are poorly described.
Methods: We studied hospitalized adults with COVID-19 and PF1.2 measurement performed at any time during hospitalization. We evaluated the relationship between PF1.2 and synchronously measured D-dimer. We utilized receiver operating characteristic (ROC) analysis to evaluate optimal thresholds for diagnosing thrombosis and multivariable logistic regression to evaluate association with thrombosis.
Results: 115 patients were included [110 (95.7%) critically ill]. PF1.2 and D-dimer were moderately positively correlated (r=0.542, P<0.001) but significant discordance was observed in elevation of each marker above the laboratory reference range (59.0% elevated PF1.2 vs. 98.5% elevated D-dimer). Median PF1.2 levels were higher in patients with thrombosis than those without (611 vs. 374 pmol/L, P=0.006). In ROC analysis, PF1.2 had superior specificity and conferred a higher positive likelihood ratio in identifying patients with thrombosis than D-dimer (PF1.2 threshold of >523 pmol/L: 69.2% sensitivity, 67.7% specificity; >924 pmol/L: 37.9% sensitivity, 87.8% specificity). In multivariable analysis, a PF1.2 >500 pmol/L was significantly associated with VTE [adjusted odds ratio (OR) 4.26, 95% CI, 1.12-16.21, P=0.034] and any thrombotic manifestation (adjusted OR 3.85, 95% CI, 1.39-10.65, P=0.010); conversely, synchronously measured D-dimer was not significantly associated with thrombosis. 90.6% of patients with a non-elevated PF1.2 result did not develop VTE.
Conclusions: PF1.2 may be a useful assay, and potentially more discriminant than D-dimer, in identifying thrombotic manifestations in hospitalized patients with COVID-19. This article is protected by copyright. All rights reserved.
. 2020 Aug 11.
doi: 10.1002/ajh.25962. Online ahead of print.
Evaluation of the Prothrombin Fragment 1.2 in Patients with COVID-19
Hanny Al-Samkari[SUP] 1 2 [/SUP], Fei Song[SUP] 2 3 [/SUP], Elizabeth Van Cott[SUP] 2 4 [/SUP], David J Kuter[SUP] 1 2 [/SUP], Rachel Rosovsky[SUP] 1 2 [/SUP]
Affiliations
- PMID: 32780525
- DOI: 10.1002/ajh.25962
Abstract
Introduction: Coronavirus disease 2019 (COVID-19) may cause a hypercoagulable state. The D-dimer is frequently elevated in COVID-19, but other markers of coagulation activation, including the prothrombin fragment 1.2 (PF1.2) are poorly described.
Methods: We studied hospitalized adults with COVID-19 and PF1.2 measurement performed at any time during hospitalization. We evaluated the relationship between PF1.2 and synchronously measured D-dimer. We utilized receiver operating characteristic (ROC) analysis to evaluate optimal thresholds for diagnosing thrombosis and multivariable logistic regression to evaluate association with thrombosis.
Results: 115 patients were included [110 (95.7%) critically ill]. PF1.2 and D-dimer were moderately positively correlated (r=0.542, P<0.001) but significant discordance was observed in elevation of each marker above the laboratory reference range (59.0% elevated PF1.2 vs. 98.5% elevated D-dimer). Median PF1.2 levels were higher in patients with thrombosis than those without (611 vs. 374 pmol/L, P=0.006). In ROC analysis, PF1.2 had superior specificity and conferred a higher positive likelihood ratio in identifying patients with thrombosis than D-dimer (PF1.2 threshold of >523 pmol/L: 69.2% sensitivity, 67.7% specificity; >924 pmol/L: 37.9% sensitivity, 87.8% specificity). In multivariable analysis, a PF1.2 >500 pmol/L was significantly associated with VTE [adjusted odds ratio (OR) 4.26, 95% CI, 1.12-16.21, P=0.034] and any thrombotic manifestation (adjusted OR 3.85, 95% CI, 1.39-10.65, P=0.010); conversely, synchronously measured D-dimer was not significantly associated with thrombosis. 90.6% of patients with a non-elevated PF1.2 result did not develop VTE.
Conclusions: PF1.2 may be a useful assay, and potentially more discriminant than D-dimer, in identifying thrombotic manifestations in hospitalized patients with COVID-19. This article is protected by copyright. All rights reserved.