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Introduction: COVID-19 is associated with high levels of inflammation and high rates of thrombosis. We have shown previously that the inflammatory biomarker gamma' fibrinogen (GPF) is significantly associated with COVID-19 severity, as judged by SpO 2 levels. In addition, up to 70% of long COVID patients have GPF levels above the range of normal, even 6 weeks after infection. Hypothesis: We assessed the hypothesis that high GPF levels, by virtue of GPF's ability to bind and sequester active thrombin and prevent its inhibition by heparin/antithrombin III, would be associated with thrombotic events and adverse outcomes in COVID-19 patients. Methods: 52 COVID-19 patients at a tertiary care medical center in the IMPACC and Biobank studies were retrospectively enrolled, and GPF levels were measured using a commercial ELISA. Results: 11 patients died, and they had significantly higher peak levels of GPF, 135.2 ± 18.3 mg/dL (mean ± SE), compared to patients who lived, 87.5 ± 7.3 mg/dL, using a Wilcoxon rank-sum test (p = 0.013). Ten patients developed a VTE, either a deep vein thrombosis or a pulmonary embolism. The patients that developed a VTE had a trend towards higher levels of GPF, 125.4 ± 19.1 mg/dL (mean ± SE), compared to patients who did not develop a VTE (91.0 ± 7.7 mg/dL), but these results did not reach statistical significance (p = 0.067). ROC curve analysis revealed an area under the curve of 0.74 for GPF and death, whereas the area under the curve for GPF and VTE was 0.69. Conclusions: In conclusion, GPF levels are significantly associated with death in COVID-19 patients. Monitoring GPF levels in COVID-19 patients may therefore be warranted. Further studies are necessary to determine if the heparin resistance associated with GPF is involved.
Revollido et al. (Wed,) studied this question.