-Original-

Coagulation Influencing Liberation from Respiratory Support in Patients with Coronavirus Disease 2019: A Retrospective, Observational Study

Kota Shinada, Toru Miike, Ayaka Matsuoka, Mariko Miyazaki, Taku Goto, Akira Sasaki, Hirotaka Yamazaki, Kosuke Mori, Kento Nakayama, Ryota Sakurai, Miho Asahi, Kunimasa Yoshitake, Shogo Narumi, Mayuko Koba, Hiroyuki Koami and Yuichiro Sakamoto

Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan

Background: Patients with coronavirus disease 2019 (COVID-19) occasionally develop respiratory failure and coagulopathy. We aimed to determine whether coagulation abnormalities at admission and during the course of hospitalization can predict the liberation from respiratory support in critically ill patients with COVID-19 by combining the results of rotational thromboelastometry (ROTEM) with standard laboratory tests.
Methods: This single-center, retrospective, observational study included 31 consecutive adult patients with COVID-19 who were admitted to the intensive care unit (ICU) and who required respiratory support between April 2021 and August 2021. We divided the patients into two groups according to the liberation from respiratory support and analyzed the differences between the groups.
Results: There were 20 patients in the liberation group and 11 in the non-liberation group. There were no significant differences in the overt disseminated intravascular coagulation scores or abnormal counts in the ROTEM parameters at admission between groups, although there was a significant difference in the highest score in the ICU. The Sequential Organ Failure Assessment and sepsis-induced coagulopathy scores were significantly different between both groups at admission and at the time when the highest values were reported during the ICU stay.
Conclusions: High sepsis-induced coagulopathy scores at admission to the ICU were found to be useful predictors of difficulties in the liberation from respiratory support in patients with severe COVID-19. However, increased overt disseminated intravascular coagulation scores and abnormal counts in the ROTEM parameters during the ICU stay were associated with difficulties in the liberation from respiratory support.

J Nippon Med Sch 2022; 89: 479-486

Keywords
COVID-19, intensive care units, respiratory insufficiency

Correspondence to
Kota Shinada, MD, Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga 849-8501, Japan
st9137@cc.saga-u.ac.jp

Received, December 27, 2021
Accepted, March 23, 2022