Abstract
BackgroundThere is limited data on the markers of coagulation and hemostatic activation (MOCHA) profile in Coronavirus disease 2019 (COVID-19) and its ability to identify COVID-19 patients at risk for thrombotic events and other complications.MethodsHospitalized patients with confirmed SARS-COV-2 from four Atlanta hospitals were included in this observational cohort study and underwent admission testing of MOCHA parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer). Clinical outcomes included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, access line thrombosis, ICU admission, intubation and mortality.Main resultsOf 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American), 45 (16%) had a thrombotic endpoint. Each MOCHA parameter was independently associated with a thrombotic event (p<0.05) and ≥ 2 abnormalities was associated with thrombotic endpoints (OR 3.3, 95% CI 1.2–8.8) as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5–6.6) and ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6–7.9). However, only ≥ 2 MOCHA abnormalities were associated with ICU admission (OR 3.0, 95% CI 1.7–5.2) and intubation (OR 3.2, 95% CI 1.6–6.4). MOCHA and D-dimer cutoffs were not associated with mortality. MOCHA with <2 abnormalities (26% of the cohort) had 89% sensitivity and 93% negative predictive value for a thrombotic endpoint.ConclusionsAn admission MOCHA profile is useful to risk-stratify COVID-19 patients for thrombotic complications and more effective than isolated d-dimer for predicting risk of ICU admission and intubation.
Highlights
Coronavirus disease 2019 (COVID-19) has been widely associated with the development of a systemic coagulopathy that is likely multifactorial in etiology [1]
Each markers of coagulation and hemostatic activation (MOCHA) parameter was independently associated with a thrombotic event (p
Plasma D-dimer in COVID-19 patients was found to be a useful predictor of venous thromboembolic events (VTE) [5, 6] and thresholds of 2000 ng/mL or 3000 ng/mL have been suggested as indicators of disease severity [7, 8]
Summary
Coronavirus disease 2019 (COVID-19) has been widely associated with the development of a systemic coagulopathy that is likely multifactorial in etiology [1]. Elevated levels of fibrin degradation products, Ddimer, have been used to predict venous thromboembolic events (VTE) and hypercoagulable states in various disease states [3, 4]. A biomarker panel called the markers of coagulation and hemostatic activation (MOCHA), which includes plasma D-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex and fibrin monomer levels, has been shown to predict subsequent diagnosis of new malignancy, VTE, and other hypercoagulable states in patients with cryptogenic stroke [9, 10]. One study suggested that the presence of multiple abnormal coagulation parameters could predict ICU admission and poor outcomes in COVID-19 patients [12]. There is limited data on the markers of coagulation and hemostatic activation (MOCHA) profile in Coronavirus disease 2019 (COVID-19) and its ability to identify COVID-19 patients at risk for thrombotic events and other complications
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