Low antithrombin levels tied to ECMO ventilation in COVID-19 patients

Low levels of antithrombin upon admission to the intensive care unit (ICU) appears to increase the need for extracorporeal membrane oxygenation (ECMO) among patients with COVID-19, reports a recent study.

Researchers conducted a retrospective study of 66 consecutive COVID-19 patients who were admitted to the ICU. The objective of the study was to identify predictive factors for mechanical ventilation (MV) and ECMO.

Logistic regression found that older age was a significant risk factor for MV (odds ratio [OR], 1.04, 95 percent confidence interval [CI], 1.00–1.08; p=0.03), as were scores in the Sequential Organ Failure Assessment (OR, 1.53, 95 percent CI, 1.18–1.97; p<0.001), lactate dehydrogenase levels (OR, 1.01, 95 percent CI, 1.00–1.02; p<0.001) and C-reactive protein (OR, 1.09, 95 percent CI, 1.00–1.19; p=0.04).

Meanwhile, those who eventually needed ECMO had significantly lower estimated glomerular filtration rate (OR, 0.98, 95 percent CI, 0.96–1.00; p=0.04) and antithrombin levels (OR, 0.94, 95 percent CI, 0.88–1.00; p=0.03) at ICU admission.

Fully adjusted analysis confirmed that lower antithrombin at ICU admission aggravated the likelihood of needing ECMO (OR, 0.94, 95 percent CI, 0.88–1.00; p=0.03).

“Early recognition of COVID-19 patients with a high risk of exacerbation allows physicians to make adequate clinical decisions, including the need for hospitalization, strict monitoring, and medication,” the researchers said. “Identification of high-risk patients will improve their outcomes and would enable more appropriate distribution of medical resources.”