PB0282 - Evaluation of Plasma Coagulative and Fibrinolytic Function in Critically Ill Children with COVID-19 or MIS-C an Analysis of the COVAC-TP Trial

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

AS

Austin R. Sellers, DO

Resident
Johns Hopkins All Children's Hospital
St. Petersburg, Florida, United States

Co-Author(s)

Steven Bruzek, MS, MB(ASCP)

Senior Research Specialist
Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, USA
Saint Petersburg, Florida, United States
EA

Ernest Amankwah

Associate Professor
Johns Hopkins All Children's Hospital
St Petersburg, Florida, United States
Vera Ignjatovic, PhD (she/her/hers)

Assistant Director for Translational Research
Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, USA
St. Petersburg, Florida, United States
Marisol Betensky, MD, MPH

Assistant Professor
Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, USA
Saint Petersburg, Florida, United States
Neil A. Goldenberg, MD, PhD (he/him/his)

Professor
Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins University, USA
Saint Petersburg, Florida, United States
AS

Anthony Sochet

Assistant Professor, Anesthesia and Critical Care Medicine
Johns Hopkins All Children's Hospital
St. Petersburg, Florida, United States

Background: Pediatric clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include primary acute respiratory infection (COVID-19) and multisystem inflammatory syndrome (MIS-C). Prior work has examined common indicators of hypercoagulability, but has not measured both coagulative and fibrinolytic capacities in plasma of children hospitalized for COVID-19.

Aims: To evaluate and compare coagulation and fibrinolytic capacities over time, as measured by the clot formation and lysis (CloFAL) global assay, on plasma specimens from patients with primary COVID-19 and MIS-C phenotypes enrolled in the COVAC-TP trial.

Methods: Study participants were children ≤ 18 years of age, admitted to an intensive care unit with COVID-19 or MIS-C and enrolled in the COVAC-TP trial. Plasma samples were obtained on admission days 0, 1, 2, 3, 7, and 14. The CloFAL assay was performed using previously published methods. Data were collected prospectively. Descriptive statistics were used to summarize patient characteristics, and laboratory data.

Results: The CloFAL assay was performed in 31(82%) of the 38 patients enrolled in the trial. Patients in the MIS-C cohort were younger, and had higher partial thromboplastin time and D-dimer levels compared to those with primary COIVD-19 (Table 1). Figure 1 displays CloFAL findings over time for primary COVID-19 vs. MIS-C patients. The coagulation and fibrinolytic indices demonstrated no difference between groups across all timepoints. Over time, parameters of hypercoagulability tended to normalize in both groups, however, children with MIS-C remained hypofibrinolytic while improvements were observed in the COVID-19 cohort.

Conclusion(s): This study provides novel insight into quantifying coagulation and fibrinolysis in children hospitalized with COVID-19 and MIS-C. Future work will include investigation of plasma biomarkers of inflammation and their correlation with CloFAL findings.