Association of Plasma Biomarkers of Immunothrombosis With Death in Patients With Coronavirus Disease 2019 on Extracorporeal Membrane Oxygenation.

BACKGROUND

Critical illness in coronavirus disease 2019 may require extracorporeal membrane oxygenation support. We quantified immunothrombotic markers in patients with COVID-19 receiving ECMO and evaluated their predictive capacity for death.

METHODS

We performed a retrospective analysis of 74 consecutive patients with COVID-19 on ECMO at a single academic medical center between March 2020 and February 2021. Severe acute respiratory syndrome coronavirus-2 nucleocapsid RNA and 16 immunothrombotic biomarkers were longitudinally quantified and their trajectories were used to predict death and decannulation across multiple models.

RESULTS

Male sex, smoking, serum bilirubin levels, and low partial arterial oxygen pressure-fraction of inspired oxygen ratio were associated with increased risk of death. Plasma levels of 10 immunothrombotic markers were significantly elevated in fatal cases and some were associated with an increased hazard of death (eg, interleukin 8, von Willebrand factor) or decreased hazard for decannulation (eg, angiopoietin 2, interleukin 1β) when adjusting for sex, smoking status, and time to cannulation. Predictive models incorporating biomarkers were superior to demographics alone and equivalent to models including clinical information.

CONCLUSIONS

We found that male sex, smoking, and select clinical variables and immunothrombotic markers were risk factors for death in patients with COVID-19 on ECMO informing pathogenesis and prognostication of severe COVID-19.