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Febrianti IK, Putra AE, Raveinal R, Elliyanti A. Transcriptomic analysis of profibrinolytic and fibrinolytic inhibitor genes in COVID-19 patients. NARRA J 2024; 4:e843. [PMID: 39280271 PMCID: PMC11391964 DOI: 10.52225/narra.v4i2.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/25/2024] [Indexed: 09/18/2024]
Abstract
The immunopathogenesis of COVID-19 infection is initiated by the entry of the SARS-CoV-2 virus into the human body through droplets, entering the lungs and binding to the ACE-2 receptor. Activated macrophages stimulate an immune and inflammatory response, leading to the activation of the coagulation cascade, including profibrinolytic and fibrinolytic inhibitor processes. One of the proteins involved in profibrinolytic is encoded by the PLAUR gene, while fibrinolytic inhibitor proteins are encoded by the A2M and SERPINE1 genes. This research aims to assess the transcriptomic analysis of genetic expression data of profibrinolytic genes, fibrinolytic inhibitor genes and their correlation with serum D-dimer levels, which describe the clinical condition of coagulation in COVID-19 patients. This cross-sectional study included 25 patients each for mild and moderate-to-severe COVID-19 at Dr. M. Djamil Padang General Hospital, Padang, Indonesia. Inter-group gene expression comparisons will be analyzed using log2 folds change, and bivariate tests will be analyzed using correlation. The results show that the PLAUR gene has higher expression in moderate-to-severe compared to mild cases. Similarly, the SERPINE1 and A2M genes expressions are higher in moderate-to-severe compared to mild cases. Furthermore, there is a significant correlation between serum D-dimer levels and profibrinolytic factor (PLAUR gene) expression in COVID-19 patients. The correlation between serum D-dimer levels with fibrinolytic inhibitor factor (SERPINE1 and A2M genes) expression was found. These conclude that there is a significant difference in the expression of the profibrinolytic and fibrinolytic inhibitor genes between mild and moderate-to-severe cases in COVID-19, demonstrating COVID-19 infection affects coagulation activities.
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Affiliation(s)
- Ika K Febrianti
- Doctoral Program of Biomedical, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
- Department of Internal Medicine, Regional Public Hospital District of Agam, Lubuk Basung, Indonesia
| | - Andani E Putra
- Department of Microbiology, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
- Dr. M. Djamil General Hospital, Padang, Indonesia
| | - Raveinal Raveinal
- Dr. M. Djamil General Hospital, Padang, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
| | - Aisyah Elliyanti
- Dr. M. Djamil General Hospital, Padang, Indonesia
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Universitas Andalas, Padang, Indonesia
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Wang H, Wu S, Pan D, Meng W, Hu L, Zhang H, Ning Y, Guo J, Gu Y. Causal relationships between COVID-19 and venous thromboembolism: A mendelian randomization analysis. Phlebology 2024:2683555241266659. [PMID: 39033375 DOI: 10.1177/02683555241266659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Objective: Observational studies show the correlation between COVID-19 and venous thromboembolism (VTE) risk. However, the causal effects remain uncertain. We aimed to explore the potential causal association between COVID-19 and VTE using Mendelian randomization (MR) design. Methods: Two-sample MR was used to evaluate the potential causality between COVID-19 and VTE by selecting single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs) from genome-wide association studies (GWAS). The weighted median, MR-Egger, simple mode, and weighted mode were employed as supplementary methods for MR estimations, with the inverse-variance weighted (IVW) method serving as the principal analysis. In addition, we took sensitivity analyses, including Cochran's test, MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO), and leave-one-out analysis to ensure that we obtained stable and reliable results. Results: Our study selected 26 COVID-19 severity, 31 COVID-19 hospitalization, and 13 COVID-19 susceptibility SNPs as instrumental variables. The IVW analysis results revealed that there was no causal relationship between COVID-19 severity, hospitalization, or susceptibility and VTE, with odds ratios of 0.974 (95%CI: 0.936-1.013, p = 0.19), 0.976 (95%CI: 0.918-1.039, p = 0.447), and 0.908 (95%CI: 0.775-1.065, p = 0.235), respectively. The IVW approach yielded consistent results with MR-Egger, Weighted Median simple mode, and weighted mode. MR-PRESSO and sensitivity analysis further confirmed the stability and consistency of the MR results. Conclusions: This study did not find evidence to support a causal relationship between COVID-19 and VTE at the genetic level. Further investigation is warranted to determine if the significant association reported in previous observational studies between the two is due to confounding factors.
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Affiliation(s)
- Hui Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sensen Wu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dikang Pan
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenzhuo Meng
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lefan Hu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hanyu Zhang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yachan Ning
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Okazaki E, Barion BG, da Rocha TRF, Di Giacomo G, Ho YL, Rothschild C, Fatobene G, de Carvalho Moraes BDG, Stefanello B, Villaça PR, Rocha VG, Orsi FA. Persistent hypofibrinolysis in severe COVID-19 associated with elevated fibrinolysis inhibitors activity. J Thromb Thrombolysis 2024; 57:721-729. [PMID: 38523179 DOI: 10.1007/s11239-024-02961-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/26/2024]
Abstract
Hypercoagulability and reduced fibrinolysis are well-established complications associated with COVID-19. However, the timelines for the onset and resolution of these complications remain unclear. The aim of this study was to evaluate, in a cohort of COVID-19 patients, changes in coagulation and fibrinolytic activity through ROTEM assay at different time points during the initial 30 days following the onset of symptoms in both mild and severe cases. Blood samples were collected at five intervals after symptoms onset: 6-10 days, 11-15 days, 16-20 days, 21-25 days, and 26-30 days. In addition, fibrinogen, plasminogen, PAI-1, and alpha 2-antiplasmin activities were determined. Out of 85 participants, 71% had mild COVID-19. Twenty uninfected individuals were evaluated as controls. ROTEM parameters showed a hypercoagulable state among mild COVID-19 patients beginning in the second week of symptoms onset, with a trend towards reversal after the third week of symptoms. In severe COVID-19 cases, hypercoagulability was observed since the first few days of symptoms, with a tendency towards reversal after the fourth week of symptoms onset. A hypofibrinolytic state was identified in severe COVID-19 patients from early stages and persisted even after 30 days of symptoms. Elevated activity of PAI-1 and alpha 2-antiplasmin was also detected in severe COVID-19 patients. In conclusion, both mild and severe cases of COVID-19 exhibited transient hypercoagulability, reverted by the end of the first month. However, severe COVID-19 cases sustain hypofibrinolysis throughout the course of the disease, which is associated with elevated activity of fibrinolysis inhibitors. Persistent hypofibrinolysis could contribute to long COVID-19 manifestations.
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Affiliation(s)
- Erica Okazaki
- University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Bárbara Gomes Barion
- University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Tania Rubia Flores da Rocha
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Giovanna Di Giacomo
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Yeh-Li Ho
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Cynthia Rothschild
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | | | | | - Bianca Stefanello
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Paula Ribeiro Villaça
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Vanderson Geraldo Rocha
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil
| | - Fernanda Andrade Orsi
- Hospital das Clínicas da Faculdade de Medicina de Sao Paulo da USP, 255 - Cerqueira César, Sao Paulo, SP, 05403-000, Brazil.
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
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Mitsiakos G, Gialamprinou D, Kontovazainitis CG, Moraitis A, Katsaras G, Pouliakis A, Diamanti E. Coagulation assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infected pregnant women and their offspring by using rotational thromboelastometry (ROTEM). J Perinat Med 2024; 52:327-342. [PMID: 38353249 DOI: 10.1515/jpm-2023-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/11/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES During pregnancy, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection may intensify the gestational procoagulant state. Coronavirus disease 2019 (COVID-19) associated coagulopathy (CAC) constitutes an exacerbated immunothrombosis response. There is limited data regarding the coagulation profile of SARS-CoV2-infected pregnant women, especially those with CAC, and the effect on their offspring. This prospective study aimed to compare the hemostatic profile of those women and their neonates with healthy mother-neonate pairs. METHODS Conventional coagulation tests (CCTs) and rotational thromboelastometry (ROTEM) were employed to evaluate the hemostatic profiles. Neonates were assessed at birth and on the fourth day of life. RESULTS We enrolled 46 SARS-CoV2-infected pregnant women and 22 healthy controls who gave birth to 47 and 22 neonates, respectively. CAC was present in 10 participants. SARS-CoV2-infected pregnant women manifested slightly prolonged APTT and higher fibrinogen levels. Regarding ROTEM, we noted decreased FIBTEM CFT, with higher A10, A-angle, and MCF. The CAC group presented lower platelet count, increased fibrinogen levels, and higher FIBTEM A10 and MCF. PT was slightly prolonged at birth in neonates born to SARS-CoV2-infected mothers. During the fourth day of life, D-dimers were significantly increased. Concerning ROTEM, neonates born to SARS-CoV2-infected mothers showed lower FIBTEM CT at birth. CONCLUSIONS SARS-CoV2-infected pregnant women present a hypercoagulable profile. Hypercoagulability with elevated fibrinolysis and lower platelet count is observed in participants with CAC. The coagulation profile of neonates born to SARS-CoV2 mothers seems unaffected. Elevated D-dimers on the fourth day may reflect a neonatal inflammatory response to maternal SARS-CoV2.
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Affiliation(s)
- Georgios Mitsiakos
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, PC, Greece
| | - Dimitra Gialamprinou
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, PC, Greece
| | - Christos-Georgios Kontovazainitis
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, PC, Greece
| | - Athanasios Moraitis
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, PC, Greece
| | - Georgios Katsaras
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, PC, Greece
| | - Abraham Pouliakis
- 2nd Department of Pathology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, PC, Greece
| | - Elissavet Diamanti
- 2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, PC, Greece
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Minutti-Zanella C, Gallardo-Pérez MM, Ruiz-Argüelles GJ. D-dimer in Coronavirus 2019: An Acute Phase Reactant? Semin Thromb Hemost 2024; 50:295-297. [PMID: 37353044 DOI: 10.1055/s-0043-1770365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Affiliation(s)
- Claudia Minutti-Zanella
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Laboratorios Ruiz/SYNLAB, Puebla, México
| | - Moisés M Gallardo-Pérez
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México
| | - Guillermo J Ruiz-Argüelles
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México
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Valencia I, Lumpuy-Castillo J, Magalhaes G, Sánchez-Ferrer CF, Lorenzo Ó, Peiró C. Mechanisms of endothelial activation, hypercoagulation and thrombosis in COVID-19: a link with diabetes mellitus. Cardiovasc Diabetol 2024; 23:75. [PMID: 38378550 PMCID: PMC10880237 DOI: 10.1186/s12933-023-02097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/14/2023] [Indexed: 02/22/2024] Open
Abstract
Early since the onset of the COVID-19 pandemic, the medical and scientific community were aware of extra respiratory actions of SARS-CoV-2 infection. Endothelitis, hypercoagulation, and hypofibrinolysis were identified in COVID-19 patients as subsequent responses of endothelial dysfunction. Activation of the endothelial barrier may increase the severity of the disease and contribute to long-COVID syndrome and post-COVID sequelae. Besides, it may cause alterations in primary, secondary, and tertiary hemostasis. Importantly, these responses have been highly decisive in the evolution of infected patients also diagnosed with diabetes mellitus (DM), who showed previous endothelial dysfunction. In this review, we provide an overview of the potential triggers of endothelial activation related to COVID-19 and COVID-19 under diabetic milieu. Several mechanisms are induced by both the viral particle itself and by the subsequent immune-defensive response (i.e., NF-κB/NLRP3 inflammasome pathway, vasoactive peptides, cytokine storm, NETosis, activation of the complement system). Alterations in coagulation mediators such as factor VIII, fibrin, tissue factor, the von Willebrand factor: ADAMST-13 ratio, and the kallikrein-kinin or plasminogen-plasmin systems have been reported. Moreover, an imbalance of thrombotic and thrombolytic (tPA, PAI-I, fibrinogen) factors favors hypercoagulation and hypofibrinolysis. In the context of DM, these mechanisms can be exacerbated leading to higher loss of hemostasis. However, a series of therapeutic strategies targeting the activated endothelium such as specific antibodies or inhibitors against thrombin, key cytokines, factor X, complement system, the kallikrein-kinin system or NETosis, might represent new opportunities to address this hypercoagulable state present in COVID-19 and DM. Antidiabetics may also ameliorate endothelial dysfunction, inflammation, and platelet aggregation. By improving the microvascular pathology in COVID-19 and post-COVID subjects, the associated comorbidities and the risk of mortality could be reduced.
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Affiliation(s)
- Inés Valencia
- Molecular Neuroinflammation and Neuronal Plasticity Research Laboratory, Hospital Universitario Santa Cristina, IIS Hospital Universitario de La Princesa, 28009, Madrid, Spain.
| | - Jairo Lumpuy-Castillo
- Laboratory of Diabetes and Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040, Madrid, Spain
- Spanish Biomedical Research Centre On Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain
| | - Giselle Magalhaes
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain
| | - Carlos F Sánchez-Ferrer
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain
- Vascular Pharmacology and Metabolism (FARMAVASM), IdiPAZ, Madrid, Spain
| | - Óscar Lorenzo
- Laboratory of Diabetes and Vascular Pathology, IIS-Fundación Jiménez Díaz, 28040, Madrid, Spain.
- Spanish Biomedical Research Centre On Diabetes and Associated Metabolic Disorders (CIBERDEM) Network, Madrid, Spain.
| | - Concepción Peiró
- Department of Pharmacology, School of Medicine, Universidad Autónoma de Madrid, 28029, Madrid, Spain.
- Vascular Pharmacology and Metabolism (FARMAVASM), IdiPAZ, Madrid, Spain.
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Hulshof AM, Nab L, van Rosmalen F, de Kok J, Mulder MMG, Hellenbrand D, Sels JWEM, Ten Cate H, Cannegieter SC, Henskens YMC, van Bussel BCT. Rotational thromboelastometry as a biomarker for mortality - The Maastricht Intensive Care COVID cohort. Thromb Res 2024; 234:51-58. [PMID: 38159324 DOI: 10.1016/j.thromres.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Patients with severe coronavirus disease 2019 (COVID-19) present with persisting hypercoagulability, hypofibrinolysis and prolonged clot initiation as measured with viscoelastic assays. The objective of this study was to investigate the trajectories of traditional assays of hemostasis, routine and tissue plasminogen activator (tPA) rotational thromboelastometry (ROTEM) in COVID-19 patients and to study their association with mortality. METHODS Patients enrolled within the Maastricht Intensive Care COVID (MaastrICCht) cohort were included. Traditional assays of hemostasis (prothrombin time; PT, fibrinogen and D-dimer) were measured daily and ROTEM EXTEM, FIBTEM and tPA assays were performed weekly. Trajectories of these biomarkers were analyzed over time for survivors and non-survivors using linear mixed-effects models. Additional Fine and Gray competing risk survival analysis was performed for the first available measurement after intubation. RESULTS Of the 138 included patients, 57 (41 %) died in the intensive care unit (ICU). Over 450, 400 and 1900 individual measurements were available for analysis of routine, tPA ROTEM and traditional assays of hemostasis, respectively, with a median [IQR] follow-up of 15 [8-24] days. Non-survivors on average had prolonged CT (clotting time) and increased fibrinogen compared to survivors. MCF (maximum clot firmness), LOT (lysis onset time), LT (lysis time) and PT measurements increased more over time in non-survivors compared to survivors. Associations persisted after adjustment for demographics and disease severity. EXTEM and FIBTEM CT at intubation were associated with increased 45-day ICU mortality. CONCLUSIONS ROTEM measurements demonstrate a further increase of hypercoagulability and (hypo)fibrinolysis parameters in non-survivors throughout ICU admission. Furthermore, prolonged CT at intubation was associated with higher 45-day ICU mortality.
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Affiliation(s)
- Anne-Marije Hulshof
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - Linda Nab
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank van Rosmalen
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Jip de Kok
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Mark M G Mulder
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Anesthesiology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Dave Hellenbrand
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Jan Willem E M Sels
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Hugo Ten Cate
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands; Thrombosis Expert Centre Maastricht, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Medicine - Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Yvonne M C Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Centre+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Bas C T van Bussel
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Intensive Care, Maastricht University Medical Centre+, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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8
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He S, Blombäck M, Wallén H. COVID-19: Not a thrombotic disease but a thromboinflammatory disease. Ups J Med Sci 2024; 129:9863. [PMID: 38327640 PMCID: PMC10845889 DOI: 10.48101/ujms.v129.9863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/17/2023] [Accepted: 10/21/2023] [Indexed: 02/09/2024] Open
Abstract
While Coronavirus Disease in 2019 (COVID-19) may no longer be classified as a global public health emergency, it still poses a significant risk at least due to its association with thrombotic events. This study aims to reaffirm our previous hypothesis that COVID-19 is fundamentally a thrombotic disease. To accomplish this, we have undertaken an extensive literature review focused on assessing the comprehensive impact of COVID-19 on the entire hemostatic system. Our analysis revealed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection significantly enhances the initiation of thrombin generation. However, it is noteworthy that the thrombin generation may be modulated by specific anticoagulants present in patients' plasma. Consequently, higher levels of fibrinogen appear to play a more pivotal role in promoting coagulation in COVID-19, as opposed to thrombin generation. Furthermore, the viral infection can stimulate platelet activation either through widespread dissemination from the lungs to other organs or localized effects on platelets themselves. An imbalance between Von Willebrand Factor (VWF) and ADAMTS-13 also contributes to an exaggerated platelet response in this disease, in addition to elevated D-dimer levels, coupled with a significant increase in fibrin viscoelasticity. This paradoxical phenotype has been identified as 'fibrinolysis shutdown'. To clarify the pathogenesis underlying these hemostatic disorders in COVID-19, we also examined published data, tracing the reaction process of relevant proteins and cells, from ACE2-dependent viral invasion, through induced tissue inflammation, endothelial injury, and innate immune responses, to occurrence of thrombotic events. We therefrom understand that COVID-19 should no longer be viewed as a thrombotic disease solely based on abnormalities in fibrin clot formation and proteolysis. Instead, it should be regarded as a thromboinflammatory disorder, incorporating both classical elements of cellular inflammation and their intricate interactions with the specific coagulopathy.
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Affiliation(s)
- Shu He
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Division of Coagulation Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Blombäck
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Division of Coagulation Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Wallén
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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9
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Madera‐Sandoval RL, Cérbulo‐Vázquez A, Arriaga‐Pizano LA, Cabrera‐Rivera GL, Basilio‐Gálvez E, Miranda‐Cruz PE, García de la Rosa MT, Prieto‐Chávez JL, Rivero‐Arredondo SV, Cruz‐Cruz A, Rodríguez‐Hernández D, Salazar‐Ríos ME, Salazar‐Ríos E, Serrano‐Molina ED, De Lira‐Barraza RC, Villanueva‐Compean AH, Esquivel‐Pineda A, Ramírez‐Montes de Oca R, Unzueta‐Marta O, Flores‐Padilla G, Anda‐Garay JC, Sánchez‐Hurtado LA, Calleja‐Alarcón S, Romero‐Gutiérrez L, Torres‐Rosas R, Bonifaz LC, Pelayo R, Márquez‐Márquez E, López‐Macías CIIIR, Ferat‐Osorio E. Potential biomarkers for fatal outcome prognosis in a cohort of hospitalized COVID-19 patients with pre-existing comorbidities. Clin Transl Sci 2023; 16:2687-2699. [PMID: 37873554 PMCID: PMC10719476 DOI: 10.1111/cts.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023] Open
Abstract
The difficulty in predicting fatal outcomes in patients with coronavirus disease 2019 (COVID-19) impacts the general morbidity and mortality due to severe acute respiratory syndrome-coronavirus 2 infection, as it wears out the hospital services that care for these patients. Unfortunately, in several of the candidates for prognostic biomarkers proposed, the predictive power is compromised when patients have pre-existing comorbidities. A cohort of 147 patients hospitalized for severe COVID-19 was included in a descriptive, observational, single-center, and prospective study. Patients were recruited during the first COVID-19 pandemic wave (April-November 2020). Data were collected from the clinical history whereas immunophenotyping by multiparameter flow cytometry analysis allowed us to assess the expression of surface markers on peripheral leucocyte. Patients were grouped according to the outcome in survivors or non-survivors. The prognostic value of leucocyte, cytokines or HLA-DR, CD39, and CD73 was calculated. Hypertension and chronic renal failure but not obesity and diabetes were conditions more frequent among the deceased patient group. Mixed hypercytokinemia, including inflammatory (IL-6) and anti-inflammatory (IL-10) cytokines, was more evident in deceased patients. In the deceased patient group, lymphopenia with a higher neutrophil-lymphocyte ratio (NLR) value was present. HLA-DR expression and the percentage of CD39+ cells were higher than non-COVID-19 patients but remained similar despite the outcome. Receiver operating characteristic analysis and cutoff value of NLR (69.6%, 9.4), percentage NLR (pNLR; 71.1%, 13.6), and IL-6 (79.7%, 135.2 pg/mL). The expression of HLA-DR, CD39, and CD73, as many serum cytokines (other than IL-6) and chemokines levels do not show prognostic potential, were compared to NLR and pNLR values.
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Affiliation(s)
- Ruth Lizzeth Madera‐Sandoval
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | | | - Lourdes Andrea Arriaga‐Pizano
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Graciela Libier Cabrera‐Rivera
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado en InmunologíaInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Edna Basilio‐Gálvez
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado de Ciencias Químicobiológicas, Escuela Nacional de Ciencias BiológicasInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Patricia Esther Miranda‐Cruz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - María Teresa García de la Rosa
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado en InmunologíaInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Jessica Lashkmin Prieto‐Chávez
- Centro de Instrumentos, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Silvia Vanessa Rivero‐Arredondo
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Alonso Cruz‐Cruz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Daniela Rodríguez‐Hernández
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - María Eugenia Salazar‐Ríos
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Enrique Salazar‐Ríos
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Esli David Serrano‐Molina
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | | | | | - Alejandra Esquivel‐Pineda
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Rubén Ramírez‐Montes de Oca
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Omar Unzueta‐Marta
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Guillermo Flores‐Padilla
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Juan Carlos Anda‐Garay
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Luis Alejandro Sánchez‐Hurtado
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Salvador Calleja‐Alarcón
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Laura Romero‐Gutiérrez
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Rafael Torres‐Rosas
- Laboratorio de Inmunología, Centro de Estudios en Ciencias de la Salud y la Enfermedad, Facultad de OdontologíaUniversidad Autónoma “Benito Juárez” de Oaxaca (UABJO)Oaxaca de JuárezMexico
| | - Laura C. Bonifaz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialCiudad de MéxicoMexico
| | - Rosana Pelayo
- Centro de Investigación Biomédica de OrienteIMSSPueblaMexico
- Unidad de Educación e Investigación, IMSSCiudad de MéxicoMexico
| | | | | | - Eduardo Ferat‐Osorio
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialCiudad de MéxicoMexico
- División de Investigación en Salud, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
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10
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Yazdani AN, Abdi A, Velpuri P, Patel P, DeMarco N, Agrawal DK, Rai V. A Review of Hematological Complications and Treatment in COVID-19. Hematol Rep 2023; 15:562-577. [PMID: 37873794 PMCID: PMC10594461 DOI: 10.3390/hematolrep15040059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/30/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
COVID-19, caused by SARS-CoV-2, and its variants have spread rapidly across the globe in the past few years, resulting in millions of deaths worldwide. Hematological diseases and complications associated with COVID-19 severely impact the mortality and morbidity rates of patients; therefore, there is a need for oversight on what pharmaceutical therapies are prescribed to hematologically at-risk patients. Thrombocytopenia, hemoglobinemia, leukopenia, and leukocytosis are all seen at increased rates in patients infected with COVID-19 and become more prominent in patients with severe COVID-19. Further, COVID-19 therapeutics may be associated with hematological complications, and this became more important in immunocompromised patients with hematological conditions as they are at higher risk of hematological complications after treatment. Thus, it is important to understand and treat COVID-19 patients with underlying hematological conditions with caution. Hematological changes during COVID-19 infection and treatment are important because they may serve as biomarkers as well as to evaluate the treatment response, which will help in changing treatment strategies. In this literature review, we discuss the hematological complications associated with COVID-19, the mechanisms, treatment groups, and adverse effects of commonly used COVID-19 therapies, followed by the hematological adverse events that could arise due to therapeutic agents used in COVID-19.
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Affiliation(s)
- Armand N. Yazdani
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Arian Abdi
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Prathosh Velpuri
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Parth Patel
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Nathaniel DeMarco
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Devendra K. Agrawal
- Department of Translational Research, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Vikrant Rai
- Department of Translational Research, Western University of Health Sciences, Pomona, CA 91766, USA
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11
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Zong XJ, Liu L, Wu J, Yuan P, Cao J, Li JJ, Yu XK. Combination of Ultrasound and Molecular Markers in Evaluating Isolated Distal Deep Vein Thrombosis in Lower Limbs: A Prospective Cohort Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2073-2082. [PMID: 37010437 DOI: 10.1002/jum.16227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/09/2023] [Accepted: 02/26/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To evaluate the risk factors of isolated distal deep vein thrombosis (IDDVT) in the lower limbs by using a combination of Doppler ultrasound and thrombus molecular markers. METHODS A prospective cohort study was used. We selected 145 patients with deep vein thrombosis of the lower limbs. They were divided into the IDDVT group and the non-IDDVT group. We compared the differences in Doppler ultrasound and biochemical indexes between the two groups. The independent influencing factors of IDDVT were analyzed using logistic regression, and we plotted the receiver operating characteristic (ROC) curve. RESULTS We compared 47 IDDVT cases diagnosed by DSA with 47 non-IDDVT cases selected at random. The diameter of the common femoral vein (CFV) of the affected side, deep femoral vein, and the great saphenous vein, thickness of subcutaneous tissue, and serum D-dimer (D-D) and thrombin-antithrombin III complexes (TAT) were significantly higher in the IDDVT group than the non-IDDVT group (P < .05). Logistic regression analysis showed that CFV diameter, subcutaneous tissue thickening, D-D, and TAT were all independent risk factors for IDDVT (P < .05). The combined predictor had higher predictive sensitivity, specificity, and Youden's index (93.6, 87.2, and 0.808, respectively) than using thrombus molecular markers alone or Doppler ultrasound alone. CONCLUSION D-D and TAT, the thrombosis molecular markers, CFV diameter, and thickening of subcutaneous tissue, as well as the Doppler ultrasound, all have their own independent effects on IDDVT. When Thrombosis molecular markers and Doppler ultrasound are used in combination, they can predict which patients are at high risk of IDDVT and help doctors in making clinical decisions pertaining to prevention and treatment.
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Affiliation(s)
- Xiao-Jian Zong
- Department of ultrasound, The Fourth Centre Hospital of Tianjin, Tianjin, China
| | - Lei Liu
- Department of ultrasound, The Fourth Centre Hospital of Tianjin, Tianjin, China
| | - Jie Wu
- Department of ultrasound, The Fourth Centre Hospital of Tianjin, Tianjin, China
| | - Ping Yuan
- Department of ultrasound, The Fourth Centre Hospital of Tianjin, Tianjin, China
| | - Jian Cao
- Department of ultrasound, The Fourth Centre Hospital of Tianjin, Tianjin, China
| | - Jing-Jing Li
- Department of ultrasound, The Fourth Centre Hospital of Tianjin, Tianjin, China
| | - Xiao-Kun Yu
- Department of Radiology, The Fifth Centre Hospital of Tianjin, Tianjin, China
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12
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Gharib A, Nematollahi Z, Kazeminejad B, Najafi G, Pashapour H, Javadi A, Mollasharifi T. Status of Inflammatory and Coagulation Factors in COVID-19 and Its Relation with the Disease Severity. TANAFFOS 2023; 22:389-394. [PMID: 39176136 PMCID: PMC11338501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/22/2023] [Indexed: 08/24/2024]
Abstract
Background The role of activation of inflammatory processes in the exacerbation of COVID-19 disease has been fully confirmed. In addition, the occurrence of thromboembolic events in patients with COVID-19 is expected even long after recovery from the disease. However, which factors are essentially prognostic for this disease is still not theoretically agreed upon. What we did in the present study was to evaluate the prognostic role of some inflammatory and coagulation factors in predicting the severity of COVID-19 disease. In this study, the need for ICU admission was considered as a symbol of disease severity. Materials and Methods Forty-six cases were studied in this cross-sectional study. Patients over 18 years of age with a definitive diagnosis of COVID-19 were assessed in terms of coagulation profiles and inflammatory and cytokine markers. Regarding laboratory data, serum levels of D-dimer, protein S, protein C, FDP, and fibrinogen were measured using an automated coagulation analyzer, and serum levels of interleukin-6 were measured using the ELISA technique. Results In total, 21 patients (45.7%) were admitted to the ICU due to the severity of the disease. In comparing inflammatory and coagulation factors between the two groups of patients, with and without ICU admission, a significant difference was revealed between fibrinogen (P=0.023), D-dimer (P=0.047), protein C (P=0.001), and protein S level (P=0.014). The decrease in protein C level had the highest value for predicting the severity of the disease and therefore the need for ICU admission. Conclusion Among various inflammatory and coagulation factors, the role of fibrinogen, D-dimer, protein C, and protein S in predicting the severe form of COVID-19 and the patient's need for ICU admission was confirmed.
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Affiliation(s)
- Atoosa Gharib
- Department of Pathology and Laboratory Medicine, Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Nematollahi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrang Kazeminejad
- Department of Pathology and Laboratory Medicine, Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Najafi
- School of Medicine, Imperial College of London, London, United Kingdom
| | - Hadi Pashapour
- Department of Epidemiology, School of Public Health & Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolreza Javadi
- Department of Pathology and Laboratory Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahmineh Mollasharifi
- Department of Pathology and Laboratory Medicine, Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Matsudo M, Aladio JM, Costa D, Scazziota AS, Swieszkowski S, Perez de la Hoz R. Association of hemostasis and inflammation biomarkers with outcomes in acute coronary syndromes. Blood Coagul Fibrinolysis 2023; 34:179-183. [PMID: 36966807 DOI: 10.1097/mbc.0000000000001208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Plaque rupture triggers a prothrombotic response that is counterbalanced by a fibrinolytic response. d -dimer serves as a marker of both processes. Inflammatory mediators are also released, evidenced with the rise of high-sensitive C reactive protein (hsCRP). Current evidence with these biomarkers has shown conflicting results. Determine an association between d -dimer and hsCRP within hospital and 1-year mortality in patients with acute coronary syndromes. In total, 127 patients were included. In-hospital mortality was 5.7%, and 1-year all-cause and cardiovascular mortality were 14.6 and 9.7%, respectively. The median of admission d -dimer for patients who died during hospital stay was higher than those who survived [4.59 (interquartile ranges (IQR) 1.94-6.05 μg/ml fibrinogen equivalent units (FEU)) vs. 0.56 (IQR 0.31-1.12 μg/ml FEU), P = 0.001]. At 1-year follow-up, the median of admission d -dimer for patients who died was significantly higher than those who survived: 1.55 (IQR 0.91-5.08 μg/ml FEU) vs. 0.53 (IQR 0.29-0.90 μg/ml FEU), P < 0.001. Positive d -dimer vs. negative d -dimer at admission analysis evidenced that almost 25% of the positive patients were dead at 1-year follow-up (22.4 vs. 2.4% negative d -dimer, P = 0.011). Multivariate logistic regression analysis showed that d -dimer has an independent association with 1-year mortality [odds ratio 1.06 (95% confidence interval 1.02-1.10), P = 0.006]. Positive significative correlations between d -dimer and hsCRP levels ( R = 0.56, P < 0.001) were found. High levels of admission d -dimer were strongly associated with in-hospital and 1-year mortality. Significant correlations with hsCRP could explain the inflammatory nature that led to poorer outcomes. d -dimer could be useful in risk stratification in acute coronary syndromes; however, a specific threshold should be defined for this type of patient.
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Affiliation(s)
- Maia Matsudo
- Unidad Coronaria, Hospital de Clinicas Jose de San Martin, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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14
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Yagi T, Fujita M, Harada K, Shin M, Esaki Y, Ayata R, Koga Y, Kaneda K, Tsuruta R. Time Course of Coagulopathy Evaluated with Rotational Thromboelastometry in Patients with Severe Coronavirus Disease 2019. Intern Med 2023; 62:717-722. [PMID: 36543214 PMCID: PMC10037019 DOI: 10.2169/internalmedicine.0993-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Coronavirus disease 2019 (COVID-19) reportedly causes thromboembolic complications due to coagulopathy with hypercoagulability and a hypofibrinolytic state. We evaluated the time-course of coagulopathy in patients with severe COVID-19 from admission to discharge from our intensive-care unit (ICU). Methods We conducted a retrospective study of adults with severe COVID-19 admitted to our ICU between January 20, 2021, and March 31, 2022. We obtained clinical information, laboratory data, and rotational thromboelastometry (ROTEM) parameters at admission and discharge. Results Fifteen patients were included. Fibrinogen and D-dimer values did not change significantly but were above the normal ranges at admission and discharge. Regarding ROTEM parameters, the maximum clot firmness in fibrinogen function (FIBTEM), a marker of hypercoagulability, did not change significantly but was above the normal range at admission and discharge [median (interquartile range), admission vs. discharge: 31 (25-34) mm vs. 31 (27-32) mm, p=0.589]. The maximum lysis at 60 minutes in the extrinsic coagulation pathway (EXTEM) and intrinsic coagulation pathway (INTEM), as markers of the fibrinolytic function, were both significantly lower at discharge than at admission [median (interquartile range), admission vs. discharge: EXTEM, 3 (2-4) vs. 1 (0-2), p=0.011; INTEM, 3 (1-6) vs. 1 (0-2), p=0.008]. Conclusion This study revealed a persistent hypercoagulable state at ICU discharge and a worse hypofibrinolytic state at discharge than at admission. These results may contribute to a better understanding of coagulopathies in the acute to subacute phases of severe COVID-19.
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Affiliation(s)
- Takeshi Yagi
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Motoki Fujita
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Kayoko Harada
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Masaru Shin
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Yusuke Esaki
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Ryo Ayata
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Yasutaka Koga
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Kotaro Kaneda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan
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15
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Varlas VN, Borș RG, Plotogea M, Iordache M, Mehedințu C, Cîrstoiu MM. Thromboprophylaxis in Pregnant Women with COVID-19: An Unsolved Issue. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1949. [PMID: 36767320 PMCID: PMC9915713 DOI: 10.3390/ijerph20031949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
SARS-CoV-2 infection in pregnant women is of growing interest due to controversy over the use of antiplatelet and/or anticoagulant drugs during pregnancy and postpartum. Pregnant women are susceptible to develop severe forms of viral infections due to pregnancy-related immune alterations, changes in lung functions, and hypercoagulability. The association of pregnancy with SARS-CoV-2 infection can cause an increased incidence of thrombotic complications, especially in the case of patients with some genetic variants that favor inflammation and thrombosis. Compared to the general population, pregnant women may be at increased risk of thrombotic complications related to COVID-19. The lack of extensive clinical trials on thromboprophylaxis and extrapolating data from non-pregnant patients lead to major discrepancies in treating pregnant women with COVID-19. Currently, a multidisciplinary team should determine the dose and duration of prophylactic anticoagulant therapy for these patients, depending on the disease severity, the course of pregnancy, and the estimated due date. This narrative review aims to evaluate the protective effect of thromboprophylaxis in pregnant women with COVID-19. It is unknown at this time whether antiplatelet or anticoagulant therapy initiated at the beginning of pregnancy for various diseases (preeclampsia, intrauterine growth restriction, thrombophilia) offers a degree of protection. The optimal scheme for thromboprophylaxis in pregnant women with COVID-19 must be carefully established through an individualized decision concerning gestational age and the severity of the infection.
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Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
| | - Roxana Georgiana Borș
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
| | - Mihaela Plotogea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
- Department of Obstetrics and Gynecology, Nicolae Malaxa Clinical Hospital Bucharest, 022441 Bucharest, Romania
| | - Madalina Iordache
- Doctoral School, “Carol Davila”, University of Medicine and Pharmacy, 4192910 Bucharest, Romania
| | - Claudia Mehedințu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
| | - Monica Mihaela Cîrstoiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu St., 050451 Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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16
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Coagulation Disorders in Sepsis and COVID-19-Two Sides of the Same Coin? A Review of Inflammation-Coagulation Crosstalk in Bacterial Sepsis and COVID-19. J Clin Med 2023; 12:jcm12020601. [PMID: 36675530 PMCID: PMC9866352 DOI: 10.3390/jcm12020601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Sepsis is a major cause of morbidity and mortality worldwide. Sepsis-associated coagulation disorders are involved in the pathogenesis of multiorgan failure and lead to a subsequently worsening prognosis. Alongside the global impact of the COVID-19 pandemic, a great number of research papers have focused on SARS-CoV-2 pathogenesis and treatment. Significant progress has been made in this regard and coagulation disturbances were once again found to underlie some of the most serious adverse outcomes of SARS-CoV-2 infection, such as acute lung injury and multiorgan dysfunction. In the attempt of untangling the mechanisms behind COVID-19-associated coagulopathy (CAC), a series of similarities with sepsis-induced coagulopathy (SIC) became apparent. Whether they are, in fact, the same disease has not been established yet. The clinical picture of CAC shows the unique feature of an initial phase of intravascular coagulation confined to the respiratory system. Only later on, patients can develop a clinically significant form of systemic coagulopathy, possibly with a consumptive pattern, but, unlike SIC, it is not a key feature. Deepening our understanding of CAC pathogenesis has to remain a major goal for the research community, in order to design and validate accurate definitions and classification criteria.
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17
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Kolotylo TR, Moskaliuk VD, Syrota BV, Balaniuk IV, Melenko SR, Chernetska NV, Boiko YI. EVALUATION OF D-DIMER LEVEL AS A BIOMARKER OF DISEASE SEVERITY AND MORTALITY IN PATIENTS WITH COVID-19. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1636-1641. [PMID: 37622508 DOI: 10.36740/wlek202307118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE The aim: To examine risk factors and evaluate the use of D-dimer as a biomarker of disease severity and mortality in patients with COVID-19. PATIENTS AND METHODS Materials and methods: Data from a large NYU Langone Health system were analyzed to examine the prevalence of elevated D-dimer levels at first detection and the trend. A retrospective cohort study of 2,377 patients (NYU Langone Health) with severe COVID-19. Also we conducted a retrospective study based on the mortality database of 247 patients from COVID-19 at the Chernivtsi Regional Clinical Hospital. RESULTS Results: Patients with elevated baseline D-dimer were more likely to have critical illness than patients with normal D-dimer (43.9% vs. 18.5%). The frequency of adverse events increased with increasing D-dimer levels. Individuals with D-dimer >2000 ng/mL had the highest risk of critical illness (66.0%). CONCLUSION Conclusions: Thus, the level of D-dimer can be considered an important prognostic factor in COVID-19, as its level is elevated in the vast majority of patients with COVID-19 and correlates with a severe course and high mortality.
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Affiliation(s)
| | | | - Borys V Syrota
- BUKOVINIAN STATE MEDICAL UNIVERSITY, CHERNIVTSI, UKRAINE
| | | | | | | | - Yuliia I Boiko
- BUKOVINIAN STATE MEDICAL UNIVERSITY, CHERNIVTSI, UKRAINE
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18
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Fiorentino G, Benincasa G, Coppola A, Franzese M, Annunziata A, Affinito O, Viglietti M, Napoli C. Targeted genetic analysis unveils novel associations between ACE I/D and APO T158C polymorphisms with D-dimer levels in severe COVID-19 patients with pulmonary embolism. J Thromb Thrombolysis 2023; 55:51-59. [PMID: 36371754 PMCID: PMC9660132 DOI: 10.1007/s11239-022-02728-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/14/2022]
Abstract
Only a percentage of COVID-19 patients develop thrombotic complications. We hypothesized that genetic profiles may explain part of the inter-individual differences. Our goal was to evaluate the genotypic distribution of targeted DNA polymorphisms in COVID-19 patients complicated (PE+) or not (PE-) by pulmonary embolism. We designed a retrospective observational study enrolling N = 94 consecutive patients suffering severe COVID-19 with pulmonary embolism (PE+, N = 47) or not (PE-, N = 47) during hospitalization. A panel of N = 13 prothrombotic DNA polymorphisms (FV R506Q and H1299R, FII G20210A, MTHFR C677T and A1298C, CBS 844ins68, PAI-1 4G/5G, GPIIIa HPA-1 a/b, ACE I/D, AGT T9543C, ATR-1 A1166C, FGB - 455G > A, FXIII103G > T) and N = 2 lipid metabolism-related DNA polymorphisms (APOE T 112C and T158C) were investigated using Reverse Dot Blot technique. Then, we investigated possible associations between genotypic subclasses and demographic, clinical, and laboratory parameters including age, obesity, smoking, pro-inflammatory cytokines, drug therapy, and biomarkers of thrombotic risk such as D-dimer (DD). We found that 58.7% of PE+ had homozygous mutant D/D genotype at ACE I/D locus vs. PE- (40.4%) and 87% of PE+ had homozygous mutant C/C genotype at APOE T158C locus vs. PE- (68.1%). In PE+ group, DD levels were significantly higher in D/D and I/D genotypes at ACE I/D locus (P = 0.00066 and P = 0.00023, respectively) and in C/C and T/C genotypes at APOE T158C locus (P = 1.6e-06 and P = 0.0012, respectively) than PE- group. For the first time, we showed significant associations between higher DD levels and ACE I/D and APOE T158C polymorphisms in PE+ vs. PE- patients suggesting potential useful biomarkers of poor clinical outcome.
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Affiliation(s)
| | - Giuditta Benincasa
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Antonietta Coppola
- Department of Intensive Care, A.O.R.N. Ospedali dei Colli, Naples, Italy
| | | | - Anna Annunziata
- Department of Intensive Care, A.O.R.N. Ospedali dei Colli, Naples, Italy
| | | | - Mario Viglietti
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Claudio Napoli
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “Luigi Vanvitelli”, Naples, Italy
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19
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Picon Y, Joveleviths D, Alvares-DA-Silva MR. MINIMAL LIVER ENZYMES ABNORMALITIES AT ADMISSION ARE RELATED TO SEVERE COVID-19 CLINICAL COURSE IN A LARGE BRAZILIAN COHORT. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:11-20. [PMID: 37194770 DOI: 10.1590/s0004-2803.202301000-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/08/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND COVID-19 is a multisystemic disease, primarily affecting the respiratory system. Liver involvement is frequent, but the impact on the clinical course and outcomes are controversial. OBJECTIVE The aim was to assess liver function at the admission and evaluate its effects on severity and mortality in hospitalized patients with COVID-19. METHODS This is a retrospective study of hospitalized patients in a tertiary hospital in Brazil, with a PCR-confirmed SARS-CoV-2 infection between April and October 2020. 1080 out of 1229 patients had liver enzymes on admission and were divided in two cohorts, based on the presence or absence of abnormal liver enzymes (ALE). Demographic, clinical, laboratory, imaging, clinical severity, and mortality were evaluated. Patients were followed until discharge, death or transfer to another institution. RESULTS Median age was 60 years and 51.5% were male. The more frequent comorbidities were hypertension (51.2%), and diabetes (31.6%). Chronic liver disease and cirrhosis were present in 8.6% and 2.3%, respectively. ALE (aminotransferases higher than 40 IU/L) were present in 56.9% of patients [mild (1-2 times): 63.9%; moderate (2-5 times): 29.8%; severe (>5 times): 6.3%]. Male gender [RR 1.49, P=0.007], increased total bilirubin [RR 1.18, P<0.001] and chronic liver disease [RR 1.47, P=0.015] were predictors of abnormal aminotransferases on admission. Patients with ALE had a higher risk of disease severity [RR 1.19; P=0.004]. There was no association among ALE and mortality. CONCLUSION ALE is common in COVID-19 hospitalized patients and were independently correlated with severe COVID-19. Even mild ALE at admission may be a severity prognostic marker.
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Affiliation(s)
- Ysela Picon
- Hospital de Clínicas de Porto Alegre, Serviço de Gastroenterologia, Porto Alegre, RS, Brasil
- Organização Mundial de Gastroenterologia, WGO Porto Alegre Hepatology Training Center, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação Ciências em Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil
| | - Dvora Joveleviths
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação Ciências em Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil
| | - Mario Reis Alvares-DA-Silva
- Hospital de Clínicas de Porto Alegre, Serviço de Gastroenterologia, Porto Alegre, RS, Brasil
- Organização Mundial de Gastroenterologia, WGO Porto Alegre Hepatology Training Center, Porto Alegre, RS, Brasil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação Ciências em Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil
- Pesquisador CNPq
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20
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Peak Plasma Levels of mtDNA Serve as a Predictive Biomarker for COVID-19 in-Hospital Mortality. J Clin Med 2022; 11:jcm11237161. [PMID: 36498735 PMCID: PMC9740249 DOI: 10.3390/jcm11237161] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Several predictive biomarkers for coronavirus disease (COVID-19)-associated mortality in critically ill patients have been described. Although mitochondrial DNA (mtDNA) is elevated in patients with COVID-19, the association with coagulation function and its predictive power for mortality is unclear. Accordingly, this study investigates the predictive power of mtDNA for in-hospital mortality in critically ill patients with COVID-19, and whether combining it with thromboelastographic parameters can increase its predictive performance. This prospective explorative study included 29 patients with COVID-19 and 29 healthy matched controls. mtDNA encoding for NADH dehydrogenase 1 (ND1) was quantified using a quantitative polymerase chain reaction analysis, while coagulation function was evaluated using thromboelastometry and impedance aggregometry. Receiver operating characteristic (ROC) curves were used for the prediction of in-hospital mortality. Within the first 24 h, the plasma levels of mtDNA peaked significantly (controls: 65 (28-119) copies/µL; patients: 281 (110-805) at t0, 403 (168-1937) at t24, and 467 (188-952) copies/µL at t72; controls vs. patients: p = 0.02 at t0, p = 0.03 at t24, and p = 0.44 at t72). The mtDNA levels at t24 showed an excellent predictive performance for in-hospital mortality (area under the ROC curve: 0.90 (0.75-0.90)), which could not be improved by the combination with thromboelastometric or aggregometric parameters. Critically ill patients with COVID-19 present an early increase in the plasma levels of ND1 mtDNA, lasting over 24 h. They also show impairments in platelet function and fibrinolysis, as well as hypercoagulability, but these do not correlate with the plasma levels of fibrinogen. The peak plasma levels of mtDNA can be used as a predictive biomarker for in-hospital mortality; however, the combination with coagulation parameters does not improve the predictive validity.
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21
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Wang Z, Le TT. The COVID-19 pandemic's effects on SMEs and travel agencies: The critical role of corporate social responsibility. ECONOMIC ANALYSIS AND POLICY 2022; 76:46-58. [PMID: 35919271 PMCID: PMC9334160 DOI: 10.1016/j.eap.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
This study is based on the system resilience framework, which outlines the aspects of community behavior, employees, the environment, history, and corporate social responsibility. We used a partial least squares structural equation model to evaluate a sample of 300 Vietnamese SMEs and travel agencies. We discovered that SMEs' strategies positively influence performance and are co-created with corporate social responsibility. The dependability of internal integrity was then determined. The empirical results showed that the overall confidence index for all facilities ranged from 0.70 to 0.95, with values ranging from 0.809 to 0.931. Furthermore, the A and Cronbach's alpha reliability values ranged from 0.70 to 0.90. As a result, the reliability of internal consistency was established. The convergence validity of the configurations was assessed by comparing the extracted mean values of variance (AVE), which, for all configurations, exceeded the limit of 0.50. This approach emphasizes the impact of corporate social responsibility practices on communities, the environment, and heritage.
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Affiliation(s)
| | - Thanh Tiep Le
- Ho Chi Minh City University of Economics and Finance, Viet Nam
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22
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Sugimoto MA, Perucci LO, Tavares LP, Teixeira MM, Sousa LP. Fibrinolysis in COVID-19: Impact on Clot Lysis and Modulation of Inflammation. Curr Drug Targets 2022; 23:1578-1592. [PMID: 36221881 DOI: 10.2174/1389450123666221011102250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/26/2022] [Accepted: 09/14/2022] [Indexed: 01/25/2023]
Abstract
COVID-19 is a multisystem disease caused by SARS-CoV-2 and is associated with an imbalance between the coagulation and fibrinolytic systems. Overall, hypercoagulation, hypofibrinolysis and fibrin-clot resistance to fibrinolysis predispose patients to thrombotic and thromboembolic events. In the lungs, the virus triggers alveolar and interstitial fibrin deposition, endothelial dysfunction, and pulmonary intravascular coagulation, all events intrinsically associated with the activation of inflammation and organ injury. Adding to the pathogenesis of COVID-19, there is a positive feedback loop by which local fibrin deposition in the lungs can fuel inflammation and consequently dysregulates coagulation, a process known as immunothrombosis. Therefore, fibrinolysis plays a central role in maintaining hemostasis and tissue homeostasis during COVID-19 by cleaning fibrin clots and controlling feed-forward products of coagulation. In addition, components of the fibrinolytic system have important immunomodulatory roles, as evidenced by studies showing the contribution of Plasminogen/Plasmin (Plg/Pla) to the resolution of inflammation. Herein, we review clinical evidence for the dysregulation of the fibrinolytic system and discuss its contribution to thrombosis risk and exacerbated inflammation in severe COVID-19. We also discuss the current concept of an interplay between fibrinolysis and inflammation resolution, mirroring the well-known crosstalk between inflammation and coagulation. Finally, we consider the central role of the Plg/Pla system in resolving thromboinflammation, drawing attention to the overlooked consequences of COVID-19-associated fibrinolytic abnormalities to local and systemic inflammation.
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Affiliation(s)
- Michelle A Sugimoto
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Division of Medicine, University College London, London, UK.,Signaling in Inflammation Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luiza O Perucci
- Signaling in Inflammation Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Nucleus of Research on Biological Sciences, Institute of Exact and Biological Sciences, Federal University of Ouro Preto, Ouro Preto, Brazil.,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Luciana P Tavares
- Signaling in Inflammation Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Pulmonary and Critical Care Medicine Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Mauro M Teixeira
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Lirlândia P Sousa
- Signaling in Inflammation Laboratory, Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
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23
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Hypercoagulability in critically ill patients with COVID 19, an observational prospective study. PLoS One 2022; 17:e0277544. [PMID: 36417476 PMCID: PMC9683576 DOI: 10.1371/journal.pone.0277544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE COVID 19 is often associated with hypercoagulability and thromboembolic (TE) events. The aim of this study was to assess the characteristics of hypercoagulability and its relationship with new-onset TE events and the composite outcome of need for intubation and/or death in intensive care unit (ICU) patients admitted for COVID. DESIGN Prospective observational study. SETTING Monocentric, intensive care, University Hospital of Clermont Ferrand, France. PATIENTS Patients admitted to intensive care from January 2020 to May 2021 for COVID-19 pneumonia. INTERVENTIONS Standard hemostatic tests and rotational thromboelastometry (ROTEM) were performed on admission and on day 4. Hypercoagulability was defined by at least one of the following criteria: D-dimers > 3000 μg/dL, fibrinogen > 8 g/L, EXTEM CFT below the normal range, EXTEM A5, MCF, Li 60 above the normal range, and EXTEM G-score ((5000 x MCF) / (100-MCF)) ≥ 11 dyne/cm2. MEASUREMENTS AND MAIN RESULTS Of the 133 patients included, 17 (12.7%) developed new-onset TE events, and 59 (44.3%) required intubation and/or died in the ICU. ROTEM was performed in 133 patients on day 1 and in 67 on day 4. Hypercoagulability was present on day 1 in 115 (86.4%) patients. None of the hypercoagulability indices were associated with subsequent new-onset TE events on days 1 and 4 nor with the need for intubation and/or ICU death. Hyperfibrinogenemia > 8g/dL, higher D-dimers and higher EXTEM Li 60 on day 4 were predictive of need for intubation and/or of ICU death. CONCLUSIONS Our study confirmed that most COVID-19 ICU patients have hypercoagulability on admission and almost all on day 4. Hyperfibrinogenemia or fibrinolysis shutdown on day 4 were associated with unfavorable outcome.
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24
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Yudhawati R, Sakina S, Fitriah M. Interleukin-1β and Interleukin-10 Profiles and Ratio in Serum of COVID-19 Patients and Correlation with COVID-19 Severity: A Time Series Study. Int J Gen Med 2022; 15:8043-8054. [PMID: 36389025 PMCID: PMC9645129 DOI: 10.2147/ijgm.s381404] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/18/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Coronavirus disease-19 (COVID-19) can, in severe cases, lead to cytokine-release syndrome owing to an excessive immune response. The release of different cytokines aggravates disease severity. IL-1β is a pro-inflammatory cytokine, while IL-10 is an anti-inflammatory cytokine, and both are involved in the human immune response to infection. This study aimed to determine whether serum levels of IL-1β and IL-10 and the ratio of the two over time in patients with COVID-19 could facilitate early identification of disease severity. METHODS An analytical, observational time-series design was employed. Fifty participants were enrolled between May and October 2020 and were divided into two groups-non-severe (n = 20), and severe (n = 30). IL-1β and IL-10 were analyzed using BD cytometric bead array sets. Association of the IL-1β:IL-10 ratio with COVID-19 severity was analyzed using a Mann-Whitney test and Fisher's exact test. Optimal cut-off values to predict disease severity were determined by Youden's index. RESULTS In non-severe and severe groups, the median serum levels of IL-1β decreased on day 3 (1.72 ng/mL and 2.10 ng/mL, respectively), then increased on day 6 (2.05 ng/mL and 3.31 ng/mL, respectively). However, the median of IL-10 increased on day 3 (1.88 ng/mL and 2.30 ng/mL, respectively) and day 6 (2.02 ng/mL and 2.39 ng/mL, respectively). There was no significant association between the IL-1β:IL-10 ratio and COVID-19 severity at any time-point (p>0.05). The cutoff value of serum IL-10 between the two groups on days 0, 3, and 6 was 1.09 pg/mL (sensitivity: 66.6%; PPV: 71.4%), 2.11 pg/mL (sensitivity: 67.7%; PPV: 50.0%), and 2.08 pg/mL (sensitivity: 78.6%; PPV: 70.9%), respectively. CONCLUSION The IL-1β:IL-10 ratio was not correlated to COVID-19 severity. However, owing to its high sensitivity, IL-10 may be a potential biomarker for disease severity in severe COVID-19.
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Affiliation(s)
- Resti Yudhawati
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga – Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Sakina Sakina
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga – Dr Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Munawaroh Fitriah
- Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga – Dr Soetomo General Academic Hospital, Surabaya, Indonesia
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25
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Heubner L, Petrick PL, Güldner A, Bartels L, Ragaller M, Mirus M, Rand A, Tiebel O, Beyer-Westendorf J, Rößler M, Schmitt J, Koch T, Spieth PM. Extreme obesity is a strong predictor for in-hospital mortality and the prevalence of long-COVID in severe COVID-19 patients with acute respiratory distress syndrome. Sci Rep 2022; 12:18418. [PMID: 36319681 PMCID: PMC9626466 DOI: 10.1038/s41598-022-22107-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022] Open
Abstract
Acute Respiratory Distress Syndrome (ARDS) is common in COVID-19 patients and is associated with high mortality. The aim of this observational study was to describe patients' characteristics and outcome, identifying potential risk factors for in-hospital mortality and for developing Long-COVID symptoms. This retrospective study included all patients with COVID-19 associated ARDS (cARDS) in the period from March 2020 to March 2021 who were invasively ventilated at the intensive care unit (ICU) of the University Hospital Dresden, Germany. Between October 2021 and December 2021 patients discharged alive (at minimum 6 months after hospital discharge-midterm survival) were contacted and interviewed about persistent symptoms possibly associated with COVID-19 as well as the quality of their lives using the EQ-5D-5L-questionnaire. Long-COVID was defined as the occurrence of one of the symptoms at least 6 months after discharge. Risk factors for mortality were assessed with Cox regression models and risk factors for developing Long-COVID symptoms by using relative risk (RR) regression. 184 Patients were included in this study (male: n = 134 (73%), median age 67 (range 25-92). All patients were diagnosed with ARDS according to the Berlin Definition. 89% of patients (n = 164) had severe ARDS (Horovitz-index < 100 mmHg). In 27% (n = 49) extracorporeal membrane oxygenation was necessary to maintain gas exchange. The median length of in-hospital stay was 19 days (range 1-60). ICU mortality was 51%, hospital mortality 59%. Midterm survival (median 11 months) was 83% (n = 55) and 78% (n = 43) of these patients presented Long-COVID symptoms with fatigue as the most common symptom (70%). Extreme obesity (BMI > 40 kg/m2) was the strongest predictor for in-hospital mortality (hazard ratio: 3.147, confidence interval 1.000-9.897) and for developing Long-COVID symptoms (RR 1.61, confidence interval 1.26-2.06). In-hospital mortality in severe cARDS patients was high, but > 80% of patients discharged alive survived the midterm observation period. Nonetheless, most patients developed Long-COVID symptoms. Extreme obesity with BMI > 40 kg/m2 was identified as independent risk factor for in-hospital mortality and for developing Long-COVID symptoms.Trial registration DRKS-ID DRKS00027856.
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Affiliation(s)
- Lars Heubner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Paul Leon Petrick
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Andreas Güldner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Lea Bartels
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Maximillian Ragaller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Martin Mirus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Axel Rand
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Oliver Tiebel
- Institute of Clinical Chemistry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Jan Beyer-Westendorf
- Division of Hematology and Hemostasis, Department of Medicine I Thrombosis Research, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Martin Rößler
- Center for Evidence-Based Healthcare (ZEGV), University Hospital "Carl Gustav Carus" and "Carl Gustav Carus" Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare (ZEGV), University Hospital "Carl Gustav Carus" and "Carl Gustav Carus" Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Peter Markus Spieth
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.
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26
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Mortazavi-Jahromi SS, Aslani M. Dysregulated miRNAs network in the critical COVID-19: An important clue for uncontrolled immunothrombosis/thromboinflammation. Int Immunopharmacol 2022; 110:109040. [PMID: 35839566 PMCID: PMC9271492 DOI: 10.1016/j.intimp.2022.109040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
Known as a pivotal immunohemostatic response, immunothrombosis is activated to restrict the diffusion of pathogens. This beneficial intravascular defensive mechanism represents the close interaction between the immune and coagulation systems. However, its uncontrolled form can be life-threatening to patients with the critical coronavirus disease 2019 (COVID-19). Hyperinflammation and ensuing cytokine storm underlie the activation of the coagulation system, something which results in the provocation of more immune-inflammatory responses by the thrombotic mediators. This vicious cycle causes grave clinical complications and higher risks of mortality. Classified as an evolutionarily conserved family of the small non-coding RNAs, microRNAs (miRNAs) serve as the fine-tuners of genes expression and play a key role in balancing the pro/anticoagulant and pro-/anti-inflammatory factors maintaining homeostasis. Therefore, any deviation from their optimal expression levels or efficient functions can lead to severe complications. Despite their extensive effects on the molecules and processes involved in uncontrolled immunothrombosis, some genetic agents and uncontrolled immunothrombosis-induced interfering factors (e.g., miRNA-single nucleotide polymorphysms (miR-SNPs), the complement system components, nicotinamide adenine dinucleotide phosphate (NADPH) oxidases, and reactive oxygen species (ROS)) have apparently disrupted their expressions/functions. This review study aims to give an overview of the role of miRNAs in the context of uncontrolled immunothrombosis/thromboinflammation accompanied by some presumptive interfering factors affecting their expressions/functions in the critical COVID-19. Detecting, monitoring, and resolving these interfering agents mafy facilitate the design and development of the novel miRNAs-based therapeutic approaches to the reduction of complications incidence and mortality in patients with the critical COVID-19.
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Affiliation(s)
- Seyed Shahabeddin Mortazavi-Jahromi
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Cellular and Molecular Biology, Kish International Campus, University of Tehran, Kish, Iran.
| | - Mona Aslani
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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27
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Atalay B, Cesur A, Agirbasli M. Discrepancy between biomarkers of lung injury and 1-year mortality in COVID-19. Eur J Clin Invest 2022; 52:e13827. [PMID: 35753029 PMCID: PMC9350115 DOI: 10.1111/eci.13827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/05/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 global pandemic started in late 2019 with the first wave. In this cross-sectional and observational study, we evaluated the associations between the biomarkers, COVID-19 pneumonia severity and 1-year mortality. METHODS A sample of 276 polymerase chain reaction (PCR)-positive patients for SARS-CoV-2 was included. Computerized tomography severity score (CT-SS) was used to assess the severity of COVID-19 pneumonia in 222 cases. Multivariate analyses were performed to find the predictors of CT-SS, severe CT-SS (≥20) and 1-year mortality. Biomarkers of ferritin, high-sensitive C-reactive protein (CRP), lactate dehydrogenase (LDH), cardiac troponin (cTn), neutrophil-to-lymphocyte ratio (NLR), uric acid (UA) and d-dimer were routinely measured. RESULTS Severe CT-SS (>20) was observed in 86 (31.2%) cases. Mortality was observed in 75 (27.2%) patients at 1 year. LDH displayed the highest predictive accuracy for severe CT-SS (AUC 0.741, sensitivity = 81% and specificity = 68%, cut-off value: 360 mg/dl). Linear regression analysis displayed that LDH predicted CT-SS [B = 11 (95% CI for B = 5-17, p < .001)]. Age was the most significant parameter that was associated with severe CT-SS (OR 0.96, 95% CI 0.92-0.99, p = .015). d-dimer was the only biomarker that predicted with 1-year mortality (OR 1.62, 95% CI 1.08-2.42, p = .020). CONCLUSION LDH is a sensitive and specific biomarker to determine patients with severe lung injury in COVID-19. d-dimer is the only biomarker that predicts 1-year mortality. Neither LDH nor CT-SS is associated with 1-year mortality.
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Affiliation(s)
- Basak Atalay
- Department of Radiology, School of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | | | - Mehmet Agirbasli
- Department of Cardiology, School of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
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Heubner L, Greiner M, Vicent O, Beyer-Westendorf J, Tiebel O, Scholz U, Güldner A, Mirus M, Fries D, Koch T, Spieth PM. Predictive ability of viscoelastic testing using ClotPro® for short-term outcome in patients with severe Covid-19 ARDS with or without ECMO therapy: a retrospective study. Thromb J 2022; 20:48. [PMID: 36038895 PMCID: PMC9421107 DOI: 10.1186/s12959-022-00403-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infections are suspected to trigger the coagulation system through various pathways leading to a high incidence of thromboembolic complications, hypercoagulation and impaired fibrinolytic capacity were previously identified as potentially mechanisms. A reliable diagnostic tool for detecting both is still under discussion. This retrospective study is aimed to examine the prognostic relevance of early viscoelastic testing compared to conventional laboratory tests in COVID-19 patients with acute respiratory distress syndrome (ARDS). METHODS All mechanically ventilated patients with COVID-19 related ARDS treated in our intensive care unit (ICU) between January and March 2021 were included in this study. Viscoelastic testing (VET) was performed using the ClotPro® system after admission to our ICU. Prevalence of thromboembolic events was observed by standardized screening for venous and pulmonary thromboembolism using complete compression ultrasound and thoracic computed tomography pulmonary angiography at ICU admission, respectively. We examined associations between the severity of ARDS at admission to our ICU, in-hospital mortality and the incidence of thromboembolic events comparing conventional laboratory analysis and VET. ECMO related coagulopathy was investigated in a subgroup analysis. The data were analyzed using the Mann-Whitney U test. RESULTS Of 55 patients enrolled in this study, 22 patients required treatment with ECMO. Thromboembolic complications occurred in 51% of all patients. Overall hospital mortality was 55%. In patients with thromboembolic complications, signs of reduced fibrinolytic capacity could be detected in the TPA assay with prolonged lysis time, median 460 s (IQR 350-560) vs 359 s (IQR 287-521, p = 0.073). Patients with moderate to severe ARDS at admission to our ICU showed increased maximum clot firmness as a sign of hypercoagulation in the EX-test (70 vs 67 mm, p < 0.05), FIB-test (35 vs 24 mm, p < 0.05) and TPA-test (52 vs 36 mm, p < 0.05) as well as higher values of inflammatory markers (CRP, PCT and IL6). ECMO patients suffered more frequently from bleeding complications (32% vs 15%). CONCLUSION Although, the predictive value for thromboembolic complications or mortality seems limited, point-of-care viscoelastic coagulation testing might be useful in detecting hypercoagulable states and impaired fibrinolysis in critically ill COVID-19 ARDS patients and could be helpful in identifying patients with a potentially very severe course of the disease.
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Affiliation(s)
- Lars Heubner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Marvin Greiner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Oliver Vicent
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Jan Beyer-Westendorf
- Division of Hematology and Hemostasis, Department of Medicine I, Thrombosis Research University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Oliver Tiebel
- Institute of Clinical Chemistry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Ute Scholz
- MVZ Labor Dr. Reising-Ackermann Und Kollegen, Center of Hemostasis, Leipzig, Germany
| | - Andreas Güldner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Martin Mirus
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Dietmar Fries
- Department for General and Surgical Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Peter Markus Spieth
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.
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Gorog DA, Storey RF, Gurbel PA, Tantry US, Berger JS, Chan MY, Duerschmied D, Smyth SS, Parker WAE, Ajjan RA, Vilahur G, Badimon L, Berg JMT, Cate HT, Peyvandi F, Wang TT, Becker RC. Current and novel biomarkers of thrombotic risk in COVID-19: a Consensus Statement from the International COVID-19 Thrombosis Biomarkers Colloquium. Nat Rev Cardiol 2022; 19:475-495. [PMID: 35027697 PMCID: PMC8757397 DOI: 10.1038/s41569-021-00665-7] [Citation(s) in RCA: 166] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) predisposes patients to thrombotic and thromboembolic events, owing to excessive inflammation, endothelial cell activation and injury, platelet activation and hypercoagulability. Patients with COVID-19 have a prothrombotic or thrombophilic state, with elevations in the levels of several biomarkers of thrombosis, which are associated with disease severity and prognosis. Although some biomarkers of COVID-19-associated coagulopathy, including high levels of fibrinogen and D-dimer, were recognized early during the pandemic, many new biomarkers of thrombotic risk in COVID-19 have emerged. In this Consensus Statement, we delineate the thrombotic signature of COVID-19 and present the latest biomarkers and platforms to assess the risk of thrombosis in these patients, including markers of platelet activation, platelet aggregation, endothelial cell activation or injury, coagulation and fibrinolysis as well as biomarkers of the newly recognized post-vaccine thrombosis with thrombocytopenia syndrome. We then make consensus recommendations for the clinical use of these biomarkers to inform prognosis, assess disease acuity, and predict thrombotic risk and in-hospital mortality. A thorough understanding of these biomarkers might aid risk stratification and prognostication, guide interventions and provide a platform for future research.
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Affiliation(s)
- Diana A Gorog
- National Heart and Lung Institute, Imperial College, London, UK.
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
| | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Jeffrey S Berger
- New York University Grossman School of Medicine, New York, NY, USA
| | - Mark Y Chan
- Yong Loo-Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Heart Centre, Singapore, Singapore
| | - Daniel Duerschmied
- Cardiology and Angiology I and Medical Intensive Care, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
| | - Susan S Smyth
- UAMS College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - William A E Parker
- Cardiovascular Research Unit, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Gemma Vilahur
- Cardiovascular Research Center-ICCC, Research Institute - Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
- CiberCV, Institute Carlos III, Madrid, Spain
| | - Lina Badimon
- Cardiovascular Research Center-ICCC, Research Institute - Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
- CiberCV, Institute Carlos III, Madrid, Spain
- Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Hugo Ten Cate
- Cardiovascular Research Institute Maastricht (CARIM) and Thrombosis Expertise Center, Maastricht University Medical Center, Maastricht, Netherlands
- Center for Thrombosis and Haemostasis, University Medical Center of Gutenberg University, Mainz, Germany
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Taia T Wang
- Department of Medicine, Division of Infectious Diseases, Stanford University, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Richard C Becker
- Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Sukhomlin T. Is it a high time to focus on iron-mediated pathology initiated by COVID-induced inflammation? ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022229. [PMID: 35545994 PMCID: PMC9171865 DOI: 10.23750/abm.v93i2.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
A comment to paper published in the current issue by Duca et al (Acta Biomed 2022; Vol. 93, N. 2: e2022057 - DOI 10.23750/abm.v93i2.12937 - https://mattioli1885journals.com/index.php/actabiomedica/article/view/12937). The paper demonstrated a link between deregulated iron homeostasis and hyperinflammation in nontreated COVID-19 patients. Iron homeostasis links two generally accepted COVID-initiated pathological events: hyperinflammation and abnormal fibrin clotting. Intensive research is needed to look for the ways how to support and recover FeH in COVID infected patients.
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Affiliation(s)
- Tatiana Sukhomlin
- a:1:{s:5:"en_US";s:81:"N.M.Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow";}.
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31
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Bunch CM, Moore EE, Moore HB, Neal MD, Thomas AV, Zackariya N, Zhao J, Zackariya S, Brenner TJ, Berquist M, Buckner H, Wiarda G, Fulkerson D, Huff W, Kwaan HC, Lankowicz G, Laubscher GJ, Lourens PJ, Pretorius E, Kotze MJ, Moolla MS, Sithole S, Maponga TG, Kell DB, Fox MD, Gillespie L, Khan RZ, Mamczak CN, March R, Macias R, Bull BS, Walsh MM. Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation. Front Surg 2022; 9:889999. [PMID: 35599794 PMCID: PMC9119324 DOI: 10.3389/fsurg.2022.889999] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 12/12/2022] Open
Abstract
Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data-in conjunction with the recent American Society of Anesthesiologists guidelines-offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon's preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient's fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical procedure. Although the most common manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is COVID-19 pneumonitis, every system in the body is potentially afflicted by an endotheliitis. This endothelial derangement most often manifests as a hypercoagulable state on admission with associated occult and symptomatic venous and arterial thromboembolisms. The delicate balance between hyper and hypocoagulable states is defined by the local immune-thrombotic crosstalk that results commonly in a hemostatic derangement known as fibrinolytic shutdown. In tandem, the hemostatic derangements that occur during acute COVID-19 infection affect not only the timing of surgical procedures, but also the incidence of postoperative hemostatic complications related to COVID-19-associated coagulopathy (CAC). Traditional methods of thromboprophylaxis and treatment of thromboses after surgery require a tailored approach guided by an understanding of the pathophysiologic underpinnings of the COVID-19 patient. Likewise, a prolonged period of risk for developing hemostatic complications following hospitalization due to COVID-19 has resulted in guidelines from differing societies that recommend varying periods of delay following SARS-CoV-2 infection. In conclusion, we propose the perioperative, personalized assessment of COVID-19 patients' CAC using viscoelastic hemostatic assays and fluorescent microclot analysis.
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Affiliation(s)
- Connor M. Bunch
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Ernest E. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States
| | - Hunter B. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States
| | - Matthew D. Neal
- Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anthony V. Thomas
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Nuha Zackariya
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Jonathan Zhao
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Sufyan Zackariya
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Toby J. Brenner
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Margaret Berquist
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hallie Buckner
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Grant Wiarda
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Daniel Fulkerson
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Wei Huff
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hau C. Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Genevieve Lankowicz
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | | | | | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Maritha J. Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Muhammad S. Moolla
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sithembiso Sithole
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Tongai G. Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Douglas B. Kell
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mark D. Fox
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Laura Gillespie
- Department of Quality Assurance and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Rashid Z. Khan
- Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN, United States
| | - Christiaan N. Mamczak
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Orthopaedic Trauma, Memorial Hospital South Bend, South Bend, IN, United States
| | - Robert March
- Department of Cardiothoracic Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Rachel Macias
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Plastic and Reconstructive Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Brian S. Bull
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Mark M. Walsh
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
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Heubner L, Mirus M, Vicent O, Güldner A, Tiebel O, Beyer-Westendorf J, Fries D, Spieth PM. Point of care coagulation management in anesthesiology and critical care. Minerva Anestesiol 2022; 88:615-628. [PMID: 35416466 DOI: 10.23736/s0375-9393.22.16380-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Point of care (POC) devices are increasingly used in the ICU and in anesthesia. Besides POC-devices for blood gas analysis, several devices are available for coagulation measurements. Although basic principles for thromboelastographic measurements are not novel, some promising developments were made during the last decade improving both user-friendliness and measurement reliability. For instance, POC measurements of activated clotting time (ACT) for heparin monitoring is still regarded as standard-of-care in cardiac interventions and surgery. In the field of anesthesia and intensive care medicine, POC-devices for thromboelastographic and platelet aggregation measurements are widely used. Their impact in case of bleeding and patient blood management for cardiothoracic and trauma surgery is well known. Moreover, there are promising concepts for anticoagulation monitoring including new oral anticoagulant drugs. Coagulation POC-devices may also identify patients at specific risk for thromboembolic events quickly. On the other hand, benefits of POC-devices need to be balanced against limitations, which include technical restrictions and operator related errors, mainly affecting reproducibility and interpretation of results. Therefore, it is recommendable to consider results of POC-coagulation testing in comparison to standard laboratory tests (SLT). Nevertheless, in urgent or emergency situations POC results enable fast decision making to optimize patient care.
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Affiliation(s)
- Lars Heubner
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany. -
| | - Martin Mirus
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Oliver Vicent
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Andreas Güldner
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Oliver Tiebel
- Institute of Clinical Chemistry, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jan Beyer-Westendorf
- Thrombosis Research Unit, Division of Hematology and Hemostasis, Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Dietmar Fries
- Department for General and Surgical Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Peter M Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany
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Parvizpour F, Saeedifar R, Abdulahi A, Salehi MR, Mahmoudi M, Arabpour Z, Sefat F. Comparison of laboratory parameters in patients with COVID-19 (Preprint). JMIR Form Res 2022. [DOI: 10.2196/37340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Wygrecka M, Birnhuber A, Seeliger B, Michalick L, Pak O, Schultz AS, Schramm F, Zacharias M, Gorkiewicz G, David S, Welte T, Schmidt JJ, Weissmann N, Schermuly RT, Barreto G, Schaefer L, Markart P, Brack MC, Hippenstiel S, Kurth F, Sander LE, Witzenrath M, Kuebler WM, Kwapiszewska G, Preissner KT. Altered fibrin clot structure and dysregulated fibrinolysis contribute to thrombosis risk in severe COVID-19. Blood Adv 2022; 6:1074-1087. [PMID: 34861681 PMCID: PMC8648369 DOI: 10.1182/bloodadvances.2021004816] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022] Open
Abstract
The high incidence of thrombotic events suggests a possible role of the contact system pathway in COVID-19 pathology. In this study, we determined the altered levels of factor XII (FXII) and its activation products in critically ill patients with COVID-19 in comparison with patients with severe acute respiratory distress syndrome related to the influenza virus (acute respiratory distress syndrome [ARDS]-influenza). Compatible with those data, we found rapid consumption of FXII in COVID-19 but not in ARDS-influenza plasma. Interestingly, the lag phase in fibrin formation, triggered by the FXII activator kaolin, was not prolonged in COVID-19, as opposed to that in ARDS-influenza. Confocal and electron microscopy showed that increased FXII activation rate, in conjunction with elevated fibrinogen levels, triggered formation of fibrinolysis-resistant, compact clots with thin fibers and small pores in COVID-19. Accordingly, clot lysis was markedly impaired in COVID-19 as opposed to that in ARDS-influenza. Dysregulated fibrinolytic system, as evidenced by elevated levels of thrombin-activatable fibrinolysis inhibitor, tissue-plasminogen activator, and plasminogen activator inhibitor-1 in COVID-19 potentiated this effect. Analysis of lung tissue sections revealed widespread extra- and intravascular compact fibrin deposits in patients with COVID-19. A compact fibrin network structure and dysregulated fibrinolysis may collectively contribute to a high incidence of thrombotic events in COVID-19.
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Affiliation(s)
- Malgorzata Wygrecka
- Center for Infection and Genomics of the Lung (CIGL), Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Anna Birnhuber
- Ludwig Boltzmann Institute for Lung Vascular Research, Medical University of Graz, Graz, Austria
| | - Benjamin Seeliger
- Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany
| | - Laura Michalick
- Institute of Physiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Oleg Pak
- Excellence Cluster Cardiopulmonary Institute, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Astrid-Solveig Schultz
- Center for Infection and Genomics of the Lung (CIGL), Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Fabian Schramm
- Center for Infection and Genomics of the Lung (CIGL), Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Martin Zacharias
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - Gregor Gorkiewicz
- Diagnostic and Research Institute of Pathology, Medical University Graz, Graz, Austria
| | - Sascha David
- Institute of Intensive Care, University Hospital Zurich, Zurich, Switzerland
| | - Tobias Welte
- Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany
| | - Julius J. Schmidt
- Department of Nephrology and Hypertension, Hanover Medical School, Hanover, Germany
| | - Norbert Weissmann
- Excellence Cluster Cardiopulmonary Institute, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Ralph T. Schermuly
- Excellence Cluster Cardiopulmonary Institute, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Guillermo Barreto
- Paris-Est Creteil University, Gly-Croissance, Réparation et Régénération Tissulaires (CRRET), Creteil, France
- Laboratoire Ingénierie Moléculaire et Physiopathologie Articulaire (IMoP), Unité Mixte de Recherche (UMR) 7365, Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Biopôle de l'Université de Lorraine, Campus Biologie-Santé, Faculté de Médecine, Vandœuvre-lès-Nancy Cedex, France
| | - Liliana Schaefer
- Institute of Pharmacology and Toxicology, Goethe University, Frankfurt am Main, Germany
| | - Philipp Markart
- Department of Pulmonary Medicine, Fulda Hospital, University Medicine Marburg, Campus Fulda, Fulda, Germany
| | - Markus C. Brack
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; and
| | - Stefan Hippenstiel
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; and
| | - Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; and
| | - Leif E. Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; and
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; and
| | | | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Medical University of Graz, Graz, Austria
| | - Klaus T. Preissner
- Department of Cardiology, Kerckhoff Heart Research Institute, Justus-Liebig-University, Giessen, Germany
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Pavoni V, Gianesello L, Pazzi M, Dattolo P, Prisco D. Questions about COVID-19 associated coagulopathy: possible answers from the viscoelastic tests. J Clin Monit Comput 2022; 36:55-69. [PMID: 34264472 PMCID: PMC8280589 DOI: 10.1007/s10877-021-00744-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/09/2021] [Indexed: 12/30/2022]
Abstract
Abnormal coagulation parameters are often observed in patients with coronavirus disease 2019 (COVID-19) and the severity of derangement has been associated with a poor prognosis. The COVID-19 associated coagulopathy (CAC) displays unique features that include a high risk of developing thromboembolic complications. Viscoelastic tests (VETs), such as thromboelastometry (ROTEM), thromboelastography (TEG) and Quantra Hemostasis Analyzer (Quantra), provide "dynamic" data on clot formation and dissolution; they are used in different critical care settings, both in hemorrhagic and in thrombotic conditions. In patients with severe COVID-19 infection VETs can supply to clinicians more information about the CAC, identifying the presence of hypercoagulable and hypofibrinolysis states. In the last year, many studies have proposed to explain the underlying characteristics of CAC; however, there remain many unanswered questions. We tried to address some of the important queries about CAC through VETs analysis.
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Affiliation(s)
- Vittorio Pavoni
- Emergency Department and Critical Care Area, Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Lara Gianesello
- Department of Anesthesia and Intensive Care, Orthopedic Anesthesia, University-Hospital Careggi, Largo Palagi, 1, 50139, Florence, Italy.
| | - Maddalena Pazzi
- Emergency Department and Critical Care Area, Anesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Pietro Dattolo
- Nephrology Unit Florence 1, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Is it hyperfibrinolysis or fibrinolytic shutdown in severe COVID-19? Thromb Res 2022; 210:1-3. [PMID: 34953317 PMCID: PMC8686202 DOI: 10.1016/j.thromres.2021.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/15/2022]
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Aires RB, Soares AADSM, Gomides APM, Nicola AM, Teixeira-Carvalho A, da Silva DLM, de Gois ET, Xavier FD, Martins FP, Santos GPJ, Schulte HL, Luz IS, Espindola LS, do Amaral LR, Felicori LF, Naves LA, de Carvalho MRM, Gomes MDS, Nóbrega OT, Albuquerque P, Fontes W, Gomes CM, Kurizky PS, Albuquerque CP, Martins-Filho OA, da Mota LMH. Thromboelastometry demonstrates endogenous coagulation activation in nonsevere and severe COVID-19 patients and has applicability as a decision algorithm for intervention. PLoS One 2022; 17:e0262600. [PMID: 35030224 PMCID: PMC8759688 DOI: 10.1371/journal.pone.0262600] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/28/2021] [Indexed: 12/17/2022] Open
Abstract
In patients with severe forms of COVID-19, thromboelastometry has been reported to display a hypercoagulant pattern. However, an algorithm to differentiate severe COVID-19 patients from nonsevere patients and healthy controls based on thromboelastometry parameters has not been developed. Forty-one patients over 18 years of age with positive qRT-PCR for SARS-CoV-2 were classified according to the severity of the disease: nonsevere (NS, n = 20) or severe (S, n = 21). A healthy control (HC, n = 9) group was also examined. Blood samples from all participants were tested by extrinsic (EXTEM), intrinsic (INTEM), non-activated (NATEM) and functional assessment of fibrinogen (FIBTEM) assays of thromboelastometry. The thrombodynamic potential index (TPI) was also calculated. Severe COVID-19 patients exhibited a thromboelastometry profile with clear hypercoagulability, which was significantly different from the NS and HC groups. Nonsevere COVID-19 cases showed a trend to thrombotic pole. The NATEM test suggested that nonsevere and severe COVID-19 patients presented endogenous coagulation activation (reduced clotting time and clot formation time). TPI data were significantly different between the NS and S groups. The maximum clot firmness profile obtained by FIBTEM showed moderate/elevated accuracy to differentiate severe patients from NS and HC. A decision tree algorithm based on the FIBTEM-MCF profile was proposed to differentiate S from HC and NS. Thromboelastometric parameters are a useful tool to differentiate the coagulation profile of nonsevere and severe COVID-19 patients for therapeutic intervention purposes.
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Affiliation(s)
- Rodrigo B. Aires
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Serviço de Anestesiologia, Hospital Santa Lúcia Sul, Brasília, Distrito Federal, Brazil
- * E-mail: (RBA); (PSK)
| | - Alexandre A. de S. M. Soares
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Ana Paula M. Gomides
- Faculdade de Ciências da Saúde, Centro Universitário de Brasília, Brasília, Distrito Federal, Brazil
| | - André M. Nicola
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Andréa Teixeira-Carvalho
- Grupo Integrado de Pesquisa em Biomarcadores, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Dayde Lane M. da Silva
- Departamento de Farmácia, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Eliana T. de Gois
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Unidade de Clínica Médica, Hospital Regional do Gama (HRG), Brasília, Distrito Federal, Brazil
| | - Flávia D. Xavier
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Francielle P. Martins
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Núcleo de Gestão Interna de Leitos, Hospital Regional da Asa Norte (HRAN), Brasília, Distrito Federal, Brazil
| | - Gabriela P. J. Santos
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Unidade de Medicina Interna, Hospital Regional de Taguatinga, Brasília, Distrito Federal, Brazil
| | - Heidi Luise Schulte
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Isabelle S. Luz
- Laboratório de Bioquímica e Química de Proteínas, Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Laila S. Espindola
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Laboratório de Farmacognosia, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Laurence R. do Amaral
- Laboratório de Bioinformática e Análises Moleculares, Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia (RMPCT), Universidade Federal de Uberlândia, Patos de Minas, Minas Gerais, Brazil
| | - Liza F. Felicori
- Laboratório de Biologia Sintética e Biomiméticos, Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Luciana A. Naves
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Serviço de Endocrinologia, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Maíra R. M. de Carvalho
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Unidade de Medicina Interna, Hospital Regional da Asa Norte (HRAN), Brasília, Distrito Federal, Brazil
| | - Matheus de S. Gomes
- Laboratório de Bioinformática e Análises Moleculares, Rede Multidisciplinar de Pesquisa, Ciência e Tecnologia (RMPCT), Universidade Federal de Uberlândia, Patos de Minas, Minas Gerais, Brazil
| | - Otávio T. Nóbrega
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Patrícia Albuquerque
- Faculdade UnB Ceilândia, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Wagner Fontes
- Laboratório de Bioquímica e Química de Proteínas, Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Ciro M. Gomes
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Serviço de Dermatologia, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Patricia S. Kurizky
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Serviço de Dermatologia, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- * E-mail: (RBA); (PSK)
| | - Cleandro P. Albuquerque
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Serviço de Reumatologia, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
| | - Olindo A. Martins-Filho
- Grupo Integrado de Pesquisa em Biomarcadores, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Licia Maria H. da Mota
- Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
- Serviço de Reumatologia, Hospital Universitário de Brasília, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brazil
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Fattorutto M, Bouckaert Y, Brauner J, Franck S, Bouton F, Heuse D, Bouckaert C, Bruyneel A. Pragmatic study of a thromboprophylaxis algorithm in critically ill patients with SARS-COV-2 infection. J Thromb Thrombolysis 2022; 53:58-66. [PMID: 34173169 PMCID: PMC8233177 DOI: 10.1007/s11239-021-02514-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 01/08/2023]
Abstract
The optimal thromboprophylactic strategy for patients affected by Coronavirus disease 2019 (COVID-19) has been debated among experts. This study evaluated the safety and efficacy of a thromboprophylaxis algorithm. This was a retrospective, single-center study in critically ill patients admitted to the intensive care unit (University affiliated Hospital) for acute respiratory failure due to Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). From March 16 to April 9, 2020, thromboprophylaxis was adjusted according to weight (control group, n = 19) and after this date, thromboprophylaxis depended on an algorithm based on thrombotic and hemorrhagic risk factors (protocol group, n = 13). With regard to safety (number of major bleeding events and blood transfusions), the groups were not significantly different. With regard to efficacy, the number of thrombotic events decreased from 37 to 0%, p = 0.025 after implementation of the algorithm. Also, peak fibrinogen dropped from 8.6 (7.2-9.3) to 6.5 (4.6-8.4) g/L, p = 0.041 and D-dimers from 2194 (1464-3763) to 1486 (900-2582) ng/mL, p = 0.0001. In addition, length of stay declined from 19 (10-31) to 5 (3-19) days, p = 0.009. In conclusion, a tailored thromboprophylaxis algorithm (risk stratification based on clinical parameters and biological markers) reduce thrombotic phenomena in critically ill COVID-19 patients without increasing major bleeding.
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Affiliation(s)
- Maurizio Fattorutto
- Department of Anesthesiology, Centre Hospitalier Universitaire Tivoli, Avenue Max Buset 34, 7100, La Louvière, Belgium.
| | - Yves Bouckaert
- Intensive Care Unit, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | - Jonathan Brauner
- Department of Clinical Biology/Blood Bank, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | - Stéphane Franck
- Intensive Care Unit, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | - Fabrice Bouton
- Intensive Care Unit, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | - Danielle Heuse
- Intensive Care Unit, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | | | - Arnaud Bruyneel
- Intensive Care Unit, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
- School of Public Health, Université Libre Bruxelles, Brussels, Belgium
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Vuimo TS, Tsarenko SV, Filimonova EV, Seregina EA, Karamzin SS. Correction of Anticoagulant Therapy in Patients with Severe COVID-19 Virus Infection Using a Thrombodynamics Coagulation Assay. Clin Appl Thromb Hemost 2022; 28:10760296221142862. [PMID: 36560917 PMCID: PMC9793037 DOI: 10.1177/10760296221142862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The average frequency of thrombosis in patients with COVID-19 is still high despite low molecular weight heparin (LMWH) prophylactic. Global hemostasis assays, particularly thrombodynamics (TD), known to be sensitive to both hypercoagulation and heparin effects, could potentially be useful for individual management of anticoagulant therapy. METHODS A total of 74 patients with lung involvement >50% were randomized into two groups: Group A (44 patients) received weight-based dosing of LMWH, and Group B (30 patients) received the first LMWH dose by a weight-based dosing protocol and then received an adjusted dose based on TD daily results. The endpoints of the study were thrombosis and bleeding as well as discharge or death of the patient. RESULTS The incidence of thrombosis was 3 times lower in Group B under TD control compared to Group A without TD control: 7% versus 23 respectively (p = .05). The relative risk of thrombosis if the average clot growth rate V in TD exceeded the threshold value of 25 μm/min was 14.3 (p = .0005, 95% confidence interval 3.2-63.7). There were no clinically significant bleeding episodes in Group B while there were 7% in unregulated Group A. Mortality in Group B under TD control was lower than that in Group A without control: 27% versus 36%, respectively (p = .13). CONCLUSIONS The dosing LMWH under thrombodynamics control in severe patients with COVID-19 allows for a significant reduction in thrombotic complications. Long-term hypercoagulation revealed by thrombodynamics (3 and more days) is a strong predictor of thrombosis (AUC = 0.83).
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Affiliation(s)
- Tatiana S. Vuimo
- Center for Theoretical Problems of
Physicochemical Pharmacology RAS, Moscow, Russia
- Dmitry Rogachev National Medical Research
Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Sergey V. Tsarenko
- City Clinical Hospital №52 of Moscow Health care Department, Moscow,
Russia
- Faculty of Fundamental Medicine, Moscow State University, Moscow, Russia
| | | | - Elena A. Seregina
- Center for Theoretical Problems of
Physicochemical Pharmacology RAS, Moscow, Russia
- Dmitry Rogachev National Medical Research
Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Sergey S. Karamzin
- Center for Theoretical Problems of
Physicochemical Pharmacology RAS, Moscow, Russia
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COVID-19 and Panax ginseng: Targeting platelet aggregation, thrombosis and the coagulation pathway. J Ginseng Res 2022; 46:175-182. [PMID: 35068944 PMCID: PMC8767971 DOI: 10.1016/j.jgr.2022.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) not only targets the respiratory system but also triggers a cytokine storm and a series of complications, such as gastrointestinal problems, acute kidney injury, and myocardial ischemia. The use of natural products has been utilized to ease the symptoms of COVID-19, and in some cases, to strengthen the immune system against COVID-19. Natural products are readily available and have been regularly consumed for various health benefits. COVID-19 has been reported to be associated with the risk of thromboembolism and deep vein thrombosis. These thrombotic complications often affects mortality and morbidity. Panax ginseng, which has been widely consumed for its various health benefits has also been reported for its therapeutic effects against cardiovascular disease, thrombosis and platelet aggregation. In this review, we propose that P. ginseng can be consumed as a supplementation against the various associated complications of COVID-19, especially against thrombosis. We utilized the network pharmacology approach to validate the potential therapeutic properties of P. ginseng against COVID-19 mediated thrombosis, the coagulation pathway and platelet aggregation. Additionally, we aimed to investigate the roles of P. ginseng against COVID-19 with the involvement of platelet-leukocyte aggregates in relation to immunity-related responses in COVID-19.
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López-Jaime FJ, Fernández-Bello I, Martín-Téllez S, Doblas-Márquez A, Tesfay Y, Márquez-Gómez I, Reguera-Iglesias JM, Muñoz-Pérez MI, Montaño A. Clot Stiffness Measured By Seer Sonorheometry As a Marker Of Poor Prognosis In Hospitalized COVID-19 Patients. Clin Appl Thromb Hemost 2022; 28:10760296221112085. [PMID: 35903939 PMCID: PMC9340415 DOI: 10.1177/10760296221112085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
A high risk of thrombotic complications has been observed among severely ill COVID-19 patients. Viscoelastic tests (VET) have shown a hypercoagulable profile in these patients, although so far there is no clear evidence on the use of these tools as predictors of risk in the clinical course of patients. In this study we aimed to evaluate the association between Quantra® sonorheometry VET parameters, standard coagulation tests and inflammatory markers in 69 patients with COVID-19 on hospital admission with disease severity and outcome. Inflammatory markers were elevated in a high percentage of patients, as were coagulation-related parameters such as fibrinogen and D-dimer levels. Quantra® sonorheometry analysis revealed increased clot stiffness (CS), especially due to increased fibrinogen contribution (FCS) in 63.7%. Analysis of clot stability to lysis (CSL) on the Quantra showed a value of 100%, suggesting hypofibrinolysis, in 32.4%. Age > 65 years, elevated values of fibrinogen, D-dimer, LDH, increased CS and CSL were significantly associated with worsening disease. The combination of elevated FCS and D-dimer values showed a particularly high prognostic value in distinguishing patients with severe symptomatology. In conclusion, FCS measured by Quantra® system and its combination with D-dimer could be established as a powerful tool to identify poor prognosis in COVID-19 patients on hospital admission.
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Affiliation(s)
| | - Ihosvany Fernández-Bello
- Unidad de Hemostasia y Trombosis, Hospital Universitario Regional de
Málaga, IBIMA, Málaga, Spain
| | - Sandra Martín-Téllez
- Unidad de Hemostasia y Trombosis, Hospital Universitario Regional de
Málaga, IBIMA, Málaga, Spain
| | - Alberto Doblas-Márquez
- Unidad de Hemostasia y Trombosis, Hospital Universitario Regional de
Málaga, IBIMA, Málaga, Spain
| | | | - Ignacio Márquez-Gómez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Regional de
Málaga, Málaga, Spain
| | | | | | - Adrián Montaño
- Unidad de Hemostasia y Trombosis, Hospital Universitario Regional de
Málaga, IBIMA, Málaga, Spain
- Universidad de Salamanca, Salamanca, Spain
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Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population. Crit Care Res Pract 2021; 2021:3935098. [PMID: 34956676 PMCID: PMC8694947 DOI: 10.1155/2021/3935098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/23/2021] [Indexed: 01/21/2023] Open
Abstract
Introduction The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood and is an indicator of the overall real-time coagulopathic state of the patient. Methods A single-centre, prospective, observational cohort study was conducted in South Africa, analysing the coagulation patterns of 41 patients with hypoxia related to SARS-CoV-2 using serial thromboelastography (TEG) on admission, after 48 hours, and at resolution of hypoxia/day 10. Results: Two-thirds (n = 26) were women. The median age was 61 (IQR 50–67), and the majority (88%) were Black patients. Almost half (22) of the patients were critically ill and ventilated, with median SOFA and SAPS2 scores of 3 and 22 (IQR2-4 and 18–30), respectively. The prevalence of hypercoagulability was 0.54 (95% CI 0.46–0.62), whilst 29/41 (0.71, CI 0.64–0.78)) met the definition of hypofibrinolysis. Differences between the hypercoagulable (HC) and non-hypercoagulable groups remained apparent at 48 hours after anticoagulation. At this time point, the K time was significantly lower (p ˂ 0,01), and the α-angle (p ˂ 0,01) and maximum amplitude (MA) (p ˂ 0,01) were significantly higher in the HC cohort. At resolution of hypoxia, or day 10, only MA was significantly higher in the hypercoagulable group compared to the non-hypercoagulable group (p = 0.01). The initial impairment in fibrinolysis (Ly30), α angle, and MA were significantly associated with mortality, with p values of 0.006, 0.031, and 0.04, respectively. Conclusions In this South African population, hypercoagulability was a highly prevalent phenomenon in COVID-19 disease. It was typified by hypofibrinolysis and a persistently elevated MA, despite anticoagulation therapy.
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Neethling C, Calligaro G, Miller M, Opie JJS. The evolution of clot strength in critically-ill COVID-19 patients: a prospective observational thromboelastography study. Thromb J 2021; 19:83. [PMID: 34742307 PMCID: PMC8572064 DOI: 10.1186/s12959-021-00331-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Few studies detail the evolution of COVID-19 associated coagulopathy. We performed serial thromboelastography (TEG) and laboratory coagulation studies in 40 critically-ill, mechanically ventilated COVID-19 patients over a 14-day period and analysed differences between 30-day survivors and non-survivors. METHODS Single-center prospective, observational study including 40 patients with severe COVID-19 pneumonia admitted to the intensive care unit (ICU) for mechanical ventilation. TEG analysis was performed on days 1, 7 and 14 of ICU admission and laboratory coagulation studies were performed on days 1 and 14. Coagulation variables were evaluated for change over the 14-day observation period. Differences between survivors and non-survivors at 30-days were analysed and compared. RESULTS On admission, TEG maximum amplitude (MA) with heparinase correction was above the upper limit of the reference range in 32 (80%) patients while 33 (82.5%) presented with absent clot lysis at 30 min. The functional fibrinogen MA was also elevated above the upper limit of the reference range in 37 (92.5%) patients. All patients had elevated D-dimer and fibrinogen levels, mildly prolonged prothrombin times (PT), normal platelet counts and normal activated partial thromboplastin times (aPTT). The heparinase MA decreased significantly with time and normalised after 14 days (p = < 0.001) while the increased fibrin contribution to clot strength persisted with time (p = 0.113). No significant differences in TEG analysis were noted between 30-day survivors and non-survivors at all time points. No patients developed disseminated intravascular coagulopathy (DIC) after 14-days, however thrombosis and bleeding were each reported in 3 (7.5%) patients. CONCLUSION Critically-ill patients with COVID-19 present in a hypercoagulable state characterised by an increased clot strength. This state normalises after 14 days despite a persistently increased fibrin contribution to clot strength. We were unable to demonstrate any significant differences in TEG parameters between 30-day survivors and non-survivors at all time points.
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Affiliation(s)
- Colette Neethling
- Department of Anaesthesia & Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Anzio Drive, Observatory, Cape Town, 7925, South Africa.
| | - Gregory Calligaro
- Division of Pulmonology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Malcolm Miller
- Department of Anaesthesia & Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Anzio Drive, Observatory, Cape Town, 7925, South Africa
| | - Jessica J S Opie
- Division of Haematology, Department of Pathology, University of Cape Town & National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
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Bahraini M, Dorgalaleh A. The Impact of SARS-CoV-2 Infection on Blood Coagulation and Fibrinolytic Pathways: A Review of Prothrombotic Changes Caused by COVID-19. Semin Thromb Hemost 2021; 48:19-30. [PMID: 34695858 DOI: 10.1055/s-0041-1736166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The cardinal pathology of coronavirus disease 2019 (COVID-19) is a primary infection of pulmonary tract cells by severe acute respiratory syndrome coronavirus 2, provoking a local inflammatory response, often accompanied by cytokine storm and acute respiratory distress syndrome, especially in patients with severe disease. Systemic propagation of the disease may associate with thrombotic events, including deep vein thrombosis, pulmonary embolism, and thrombotic microangiopathy, which are important causes of morbidity and mortality in patients with COVID-19. This narrative review describes current knowledge of the pathophysiological mechanisms of COVID-19-associated coagulopathy, with focus on prothrombotic changes in hemostatic mediators, including plasma levels of clotting factors, natural anticoagulants, components of fibrinolytic system, and platelets. It will also highlight the central role of endothelial cells in COVID-19-associated coagulopathy. This narrative review discusses also potential therapeutic strategies for managing thrombotic complications. Awareness by medical experts of contributors to the pathogenesis of thrombotic events in COVID-19 is imperative to develop therapeutics not limited to regular anticoagulants. Instituting cooperation among medical personnel and researchers may lessen this novel virus' impact now, and in the event of recurrence.
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Affiliation(s)
- Mehran Bahraini
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Akbar Dorgalaleh
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
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Polo Friz H, Gelfi E, Orenti A, Motto E, Primitz L, Donzelli T, Intotero M, Scarpazza P, Vighi G, Cimminiello C, Boracchi P. Acute pulmonary embolism in patients presenting pulmonary deterioration after hospitalisation for non-critical COVID-19. Intern Med J 2021; 51:1236-1242. [PMID: 33834578 PMCID: PMC8251288 DOI: 10.1111/imj.15307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Emerging evidence suggests an association between COVID-19 and acute pulmonary embolism (APE). AIMS To assess the prevalence of APE in patients hospitalised for non-critical COVID-19 who presented clinical deterioration, and to investigate the association of clinical and biochemical variables with a confirmed diagnosis of APE in these subjects. METHODS All consecutive patients admitted to the internal medicine department of a general hospital with a diagnosis of non-critical COVID-19, who performed a computer tomography pulmonary angiography (CTPA) for respiratory deterioration in April 2020, were included in this retrospective cohort study. RESULTS Study populations: 41 subjects, median (interquartile range) age: 71.7 (63-76) years, CPTA confirmed APE = 8 (19.51%, 95% confidence interval (CI): 8.82-34.87%). Among patients with and without APE, no significant differences were found with regards symptoms, comorbidities, treatment, Wells score and outcomes. The optimal cut-off value of d-dimer for predicting APE was 2454 ng/mL, sensitivity (95% CI): 63 (24-91), specificity: 73 (54-87), positive predictive value: 36 (13-65), negative predictive value: 89 (71-98) and AUC: 0.62 (0.38-0.85). The standard and age-adjusted d-dimer cut-offs, and the Wells score ≥2 did not associate with confirmed APE, albeit a cut-off value of d-dimer = 2454 ng/mL showed an relative risk: 3.21; 95% CI: 0.92-13.97; P = 0.073. Heparin at anticoagulant doses was used in 70.73% of patients before performing CTPA. CONCLUSION Among patients presenting pulmonary deterioration after hospitalisation for non-critical COVID-19, the prevalence of APE is high. Traditional diagnostic tools to identify high APE pre-test probability patients do not seem to be clinically useful. These results support the use of a high index of suspicion for performing CTPA to exclude or confirm APE as the most appropriate diagnostic approach in this clinical setting.
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Affiliation(s)
- Hernan Polo Friz
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Elia Gelfi
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Annalisa Orenti
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics Epidemiology and Biometry 'G. A. Maccacaro', University of Milan, Milan, Italy
| | - Elena Motto
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Laura Primitz
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Tino Donzelli
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Marcello Intotero
- Radiology, Diagnostic Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy
| | - Paolo Scarpazza
- Pulmonology, Medical Department, Vimercate Hospital, ASST Vimercate, Vimercate, Italy
| | - Giuseppe Vighi
- Internal Medicine, Medical Department, Vimercate Hospital, ASST di Vimercate, Vimercate, Italy
| | - Claudio Cimminiello
- Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia ePatologia Vascolare, SIAPAV), Milan, Italy
| | - Patrizia Boracchi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics Epidemiology and Biometry 'G. A. Maccacaro', University of Milan, Milan, Italy
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Yanushevish OO, Dukhovskaya HE, Vavilova TP, Ostrovskiy YA, Kurbanova ZT, Ostrovskaya YA. Saliva as new analytical object for D-dimer level determination. Klin Lab Diagn 2021; 66:407-410. [PMID: 34292682 DOI: 10.51620/0869-2084-2021-66-7-407-410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The amount of D-dimer in the mixed saliva of healthy individuals and patients with comorbidities has been investigated. It has been established that the level of D-dimer in saliva increases with age regardless of pathology. The highest values were found in patients with erosive gastritis.
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Affiliation(s)
- O O Yanushevish
- A.I. Evdokimov Moscow State University of Medicine and Dentistry Ministry of Health of the Russian Federation
| | - H E Dukhovskaya
- A.I. Evdokimov Moscow State University of Medicine and Dentistry Ministry of Health of the Russian Federation
| | - T P Vavilova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry Ministry of Health of the Russian Federation
| | - Y A Ostrovskiy
- A.I. Evdokimov Moscow State University of Medicine and Dentistry Ministry of Health of the Russian Federation
| | - Z T Kurbanova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry Ministry of Health of the Russian Federation
| | - Yu A Ostrovskaya
- A.I. Evdokimov Moscow State University of Medicine and Dentistry Ministry of Health of the Russian Federation
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The Prothrombotic State Associated with SARS-CoV-2 Infection: Pathophysiological Aspects. Mediterr J Hematol Infect Dis 2021; 13:e2021045. [PMID: 34276914 PMCID: PMC8265369 DOI: 10.4084/mjhid.2021.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/08/2021] [Indexed: 01/08/2023] Open
Abstract
Severe coronavirus disease-2019 (COVID-19) is frequently associated with microvascular thrombosis, especially in the lung, or macrovascular thrombosis, mainly venous thromboembolism, which significantly contributes to the disease mortality burden. COVID-19 patients also exhibit distinctive laboratory abnormalities that are compatible with a prothrombotic state. The key event underlying COVID-19-associated thrombotic complications is an excessive host inflammatory response to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection generating multiple inflammatory mediators, mainly cytokines and complement activation products. The latter, along with the virus itself, the increased levels of angiotensin II and hypoxia, drive the major cellular changes promoting thrombosis, which include: (1) aberrant expression of tissue factor by activated alveolar epithelial cells, monocytes-macrophages and neutrophils, and production of other prothrombotic factors by activated endothelial cells (ECs) and platelets; (2) reduced expression of physiological anticoagulants by dysfunctional ECs, and (3) suppression of fibrinolysis by the endothelial overproduction of plasminogen activator inhibitor-1 and, likely, by heightened thrombin-mediated activation of thrombin-activatable fibrinolysis inhibitor. Moreover, upon activation or death, neutrophils and other cells release nuclear materials that are endowed with potent prothrombotic properties. The ensuing thrombosis significantly contributes to lung injury and, in most severe COVID-19 patients, to multiple organ dysfunction. Insights into the pathogenesis of COVID-19-associated thrombosis may have implications for the development of new diagnostic and therapeutic tools.
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Iliadi V, Konstantinidou I, Aftzoglou K, Iliadis S, Konstantinidis TG, Tsigalou C. The Emerging Role of Neutrophils in the Pathogenesis of Thrombosis in COVID-19. Int J Mol Sci 2021; 22:5368. [PMID: 34065210 PMCID: PMC8161034 DOI: 10.3390/ijms22105368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Previous studies have shown that COVID-19 leads to thrombotic complications, which have been associated with high morbidity and mortality rates. Neutrophils are the largest population of white blood cells and play a pivotal role in innate immunity. During an infection, neutrophils migrate from circulation to the infection site, contributing to killing pathogens. This mechanism is regulated by chemokines such as IL-8. Moreover, it was shown that neutrophils play an important role in thromboinflammation. Through a diverse repertoire of mechanisms, neutrophils, apart from directly killing pathogens, are able to activate the formation of thrombi. In COVID-19 patients, neutrophil activation promotes neutrophil extracellular trap (NET) formation, platelet aggregation, and cell damage. Furthermore, neutrophils participate in the pathogenesis of endothelitis. Overall, this review summarizes recent progress in research on the pathogenesis of COVID-19, highlighting the role of the prothrombotic action of neutrophils in NET formation.
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Affiliation(s)
- Valeria Iliadi
- Medical School, Izhevsk State Medical Academy, Kommunarov Street 281, 426034 Izhevsk, Russia; (V.I.); (S.I.)
| | | | | | - Sergios Iliadis
- Medical School, Izhevsk State Medical Academy, Kommunarov Street 281, 426034 Izhevsk, Russia; (V.I.); (S.I.)
| | - Theocharis G. Konstantinidis
- Blood Transfusion Center, University General Hospital of Alexandroupolis Dragana Campus, 68100 Alexandroupolis, Greece
| | - Christina Tsigalou
- Laboratory of Microbiology, Democritus University of Thrace, Dragana Campus, 68100 Alexandroupolis, Greece;
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49
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Aribawa IGNM, Hidayat L, Dewi PU, Ryalino C. Progressive COVID-19-Associated Coagulopathy Despite Treatment with Therapeutic Anticoagulation and Thrombolysis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930667. [PMID: 33967265 PMCID: PMC8126589 DOI: 10.12659/ajcr.930667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) has been associated with a hypercoagulability state. Clinical presentation can range from asymptomatic to severe illness and mortality. Thrombotic complications in COVID-19 have been associated with mortality. The incidence of systemic hypercoagulation in COVID-19 is associated with the process of severe inflammation. The majority of severely ill patients have developed coagulopathy, and this condition is associated with poor outcomes. CASE REPORT A 72-year-old man presented with respiratory symptoms and was diagnosed with a COVID-19 infection. He presented with tachypnea, tachycardia, increased blood pressure, and 74% peripheral oxygen saturation under 15 L/min oxygen per non-rebreather mask. Initial laboratory test results showed severe hypoxemia as per blood gas analysis (pH 7.42, pCO₂ 23 mmHg, pO₂ 43 mmHg, HCO₃ 15 mmol/L, base deficit -9 mmol/L), with increased procalcitonin, high-sensitivity C-reactive protein, D-dimer, fibrinogen, creatine kinase myocardial band, and Troponin I. He subsequently developed thrombosis of the pulmonary arteries and multiple branches of the pulmonary vein despite therapeutic anticoagulation. We initiated heparin therapy (average dose 25 191 units per day, mean activated partial thromboplastin time, 64.35 seconds). Radiological investigations revealed multiple thromboses on pulmonary arteries and pulmonary veins, as well as multiple locations of brain infarction. Rescue thrombolytic therapy was given, but unfortunately, the patient died due to multiple end-organ failures. CONCLUSIONS Controlling coagulopathy, and thrombolytic therapy type and timing, are critical issues, and new strategies must be sought to lower its morbidity and mortality rates further.
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Affiliation(s)
- I Gusti Ngurah M Aribawa
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University/Udayana University Hospital, Denpasar, Bali, Indonesia
| | - Leonard Hidayat
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University/Udayana University Hospital, Denpasar, Bali, Indonesia
| | - Putu Utami Dewi
- Department of Radiology, Faculty of Medicine, Udayana University/Udayana University Hospital, Denpasar, Bali, Indonesia
| | - Christopher Ryalino
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University/Udayana University Hospital, Denpasar, Bali, Indonesia
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50
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Moonla C, Sosothikul D, Chiasakul T, Rojnuckarin P, Uaprasert N. Anticoagulation and In-Hospital Mortality From Coronavirus Disease 2019: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2021; 27:10760296211008999. [PMID: 33874753 PMCID: PMC8060743 DOI: 10.1177/10760296211008999] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hypercoagulability in coronavirus disease 2019 (COVID-19) may aggravate disease severity during hospitalization but the reported survival benefits from anticoagulation (AC) vary among studies. We performed a literature research to estimate pooled odds ratios (ORs) of in-hospital mortality and major bleeding comparing among intermediate-to-therapeutic dose AC, prophylactic dose AC, and no AC. Until October 22, 2020, PubMed, EMBASE, and Cochrane Library Database were searched for studies reporting AC utilization and mortality in COVID-19. Studies with suspected risk of bias were excluded before the synthesis of pooled ORs with 95% confidence intervals (CIs) using random-effects models. Of 37 identified studies (N = 19,510), 17 (N = 17,833) were aggregated in the meta-analysis. The overall mortality rate was 23.1% (95% CI 18.7-28.2). The pooled odds of mortality comparing anticoagulated to non-anticoagulated patients were similar, but lower in prophylactic dose AC group (OR 0.83; 95% CI 0.73-0.95). Notably, intermediate-to-therapeutic dose AC increased mortality (OR 1.60; 95% CI 1.11-2.31) and major bleeding compared to prophylactic dose AC (OR 3.33; 95% CI 2.34-4.72). Our findings support the optimal efficacy and safety profiles of prophylactic dose AC in hospitalized COVID-19 patients.
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Affiliation(s)
- Chatphatai Moonla
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Darintr Sosothikul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Clinical Research for Holistic Management in Pediatric Hematology and Oncology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thita Chiasakul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Ponlapat Rojnuckarin
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Noppacharn Uaprasert
- Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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