New coronavirus infection COVID-19: clinical and prognostic significance of plasma fibrinogen level

Abstract

COVID-associated coagulopathy is currently widely discussed in the medical press. There are no unambiguous ideas about its mechanisms and significance at the present time. One of the manifestations is hyperfibrinogenemia. The study of specific changes in this laboratory indicator is of interest from the point of view of evaluating the prognosis of the course of coronavirus infection and selecting therapy.

Objectives. Analysis of plasma fibrinogen dynamics in patients with COVID-19, assessment of clinical and prognostic significance of the indicator.

Materials and methods. The retrospective study included 350 patients undergoing inpatient treatment for SARS-CoV-2 infection. At the time of analysis, 49 patients (14 %) died, and the rest were discharged from the hospital. The dynamics of fibrinogen content was evaluated, compared with the outcomes of the disease, clinical complications of a thrombotic or hemorrhagic nature, and other laboratory indicators.

Results and conclusion. A characteristic feature of COVID-associated coagulopathy is hyperfibrinogenemia (the maximum value of fibrinogen is 6.2 ± 1.7 g/l) as a manifestation of systemic inflammation with a transition in 14 % of patients to hypofibrinogenemia (the minimum value is 1.57 ± 0.29) due to hepatic dysfunction and consumption coagulopathy. In the context of pharmacological antithrombotic prevention, hyperfibrinogenemia did not show clinical significance as a risk factor for thrombosis, while a decrease in fibrinogen less than 2.0 g/l was associated with a 9-fold increase in the risk of hemorrhagic complications in patients with coronavirus infection (OR 9.913 СI 95 % [1.613–60.931]). A decrease in fibrinogen below normal values and an excess of 9.0 g/l are equally predictors of an adverse outcome in patients with COVID-19. The relative risk of death was 3.263 СI 95 % (1.970–5.407) and 2.574 СI 95 % (1.265–5.237), respectively.