See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/359758524

Increased levels of factor VIII on admission, predict intensive care unit

transferal and mortality in hospitalized COVID-19 patients

Conference Paper · April 2022

CITATIONS READS

0 20

14 authors, including:

Mohamed El Horri Benglia Abderrezzak

Algiers University 1 Algiers University
21 PUBLICATIONS 1 CITATION 8 PUBLICATIONS 9 CITATIONS

SEE PROFILE SEE PROFILE

Ahmed Berrah
Centre Hospitalier Régional d'Oran
9 PUBLICATIONS 1 CITATION

SEE PROFILE

All content following this page was uploaded by Mohamed El Horri on 06 April 2022.

The user has requested enhancement of the downloaded file.

210 | ABSTRACT
stop, positive pre-DOAC stop. For this group the mean rivo-
roxaban level was 127.38 ng/ml. Two were negative pre- and
post-DOAC stop with rivoroxaban levels of 43 and 16.7 ng/
ml. In the rivoroxaban group there was a trend for those with
positive screens post-DOAC stop to have higher rivaroxaban
levels than those who has negative screens although this did
not reach statistical significance.
Variability was noted in the follow-up for those who had
positive LAC screens post-DOAC stop being used with
13/29 patients having their LAC screens repeated: 2 on anti-
coagulation and 11 after a variable time off anticoagulation
(36–72 h). Three patients had subsequent LAC positive re-
sults: of these three, one patient had their apixaban contin-
ued for an unprovoked PE and two patients were counselled
to consider a change in their anticoagulant to warfarin, one
of whom had triple positive APS and one of whom had had
a clot on rivoroxaban.
In conclusion, DOAC stop alone is unable to fully neutralise
the presence of a DOAC and in the event of a positive LAC
screen further testing is advised, with an interruption to the
DOAC. There was also variability in the clinical and labora-
tory follow-up for those who had positive LAC screens on
DOACs, which may reflect the different clinical factors in
each case.
Disclosure of Interest: None declared.
BSH22-EP60 | Increased levels of factor VIII on
admission, predict intensive care unit transferal and
mortality in hospitalized COVID-19 patients
Mohamed El Horri1,*, Souhil Nour Elain Touati2,
Abdelkrim Chikh Khelifa1, Ibrahim Khachaa3, Mohamed
Nadir Smahi4, Abderrezak Benglia5, Ahmed Berrah1,
Khadidja Benbouhadi1, Hanaa Mimene3, Khalil Kebir1,
Khadidja Benhalima6, Lahcene Benmahdi7, Hacene Brouk8,
Nadjet Mouffok9
1
Laboratory Haematology, Military University Hospital
of Oran, Algeria, 2Infectious diseases, Military University
Hospital of Oran ,Algeria, 3Blood Bank, 4 Pneumology,
5
Clinical Chemistry and Laboratory Medicine, Military
University Hospital of Oran, Algeria, 6Blood Bank,
Military University Hospital of Oran ,Algeria, 7Laboratory
Medicine, Military University Hospital of Oran, Algeria,
Oran, 8Laboratory Haematology and Blood Transfusion,
University Hospital Center of Annaba, Annaba, 9Infectious
diseases, University Hospital Center of Oran, Algeria,
Oran, Algeria
Abstract Content: Background: Despite the necessity, there
is no reliable biomarker to predict disease severity and prog-
nosis of patients with COVID-19. Factor VIII is a procoagu-
lant factor that is stored in endothelial cells and is released
during inflammation. COVID-19 is clearly an inflammatory
and thromboembolic disease, especially in its severe forms.
That is why we hypothesized that FVIII could be a potential
prognostic marker in this disease.
View publication stats
Method
A prospective observational cohort study was performed
from 1 September 2020 to 31 August 2021. This study cohort
included 91 consecutive patients admitted to the Military
University Hospital of Oran (Algeria), with COVID-19 con-
firmed by the PCR. All these patients underwent FVIIIc
assay at the admission. The primary end-point was transfe-
ral from respiratory intermediate care unit (RICU) to inten-
sive care unit (ICU) and in-hospital mortality.
Objectives
To assess the prognostic value of FVIIIc, in the prediction
of the transferal to ICU during the first days of hospitaliza-
tion as well as in the prediction of mortality in patients with
COVID-19.
Results:
Ninety-one patients with a confirmed COVID-19 were en-
rolled in this study, with a mean age of 58.5 years [CI: 55–
62]; 67 men (73.6%) and 24 women (26.4%) with a sex ratio of
2.79. Thirty-six patients (39.6%) were admitted with moder-
ate acute respiratory distress syndrome (ARDS), 47 (51.6%)
with severe and eight (8.8%) with critical ARDS. Among
these patients, 20 (22.0%) were transferred to the ICU.
Eighteen (19.8%) died, of whom 3 (16.7%) died in the RICU
and 15 (83.3%) died in the ICU.
FVIIIc levels in patients transferred to ICU were signifi-
cantly higher, compared to those who were not: 408% [CI:
334–483] vs. 261% [CI: 234–289] respectively (p = 0.001).
Same for those who died in which we found a significant
increase in FVIIIc levels, compared to survivors: 409% [CI:
335–483] vs. 265% [237–294] respectively (p = 0.001).
By using the ROC curves, we established the predictive thresh-
old values. The value of 371% for FVIIIc, predicted the risk of
transfer to ICU with a sensitivity (Se) of 65% and a specificity
(Sp) of 83.1%. Beyond this threshold value, patients were more
likely to see their condition worsen and to be transferred to
the ICU with an odds ratio of 8.29 [CI: 2.76–24.85].
While for the prediction of mortality, we had two cut-
off values: 341% (Se = 72.2%; Sp = 78.1%; PPV = 44.9%;
NPV = 91.9%) and 520% (Se = 27.8%; Sp = 98.6%; PPV = 83.4%;
NPV = 84.7%). Using these two threshold values, we created
three prognostic groups: group 1 (FVIIIc < 341%), group 2
(341% ≤ FVIIIc < 520%) and group 3 (FVIIIc ≥ 520%).
Using Kaplan–Meier model, we found that these three groups
had a highly different survival probability. The best survival
probability for the group 1 (88.2% after 15 days of hospitaliza-
tion). This probability decreased in the group 2, only 51% with
a Hazard ratio (HR) of 5.11 [CI: 1.58–16.47], meaning that
these patients had a higher risk of dying compared to those
of the group 1. The worst survival probability was recorded
in the group 3, only 15.6% with a HR = 11.22 [CI: 1.96–64.36].
Conclusion
Factor VIII can predict the need for transfer from the RICU
to the ICU and also mortality in patients with COVID-19.
This biomarker could be a valuable one for better clinical
stratification by early and meaningful profiles in patients
admitted to the RICU who are at risk of transferal to the ICU.
Disclosure of Interest: None declared.