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Kappelmayer J, Debreceni IB, Fejes Z, Nagy B. Inflammation, Sepsis, and the Coagulation System. Hamostaseologie 2024; 44:268-276. [PMID: 38354835 DOI: 10.1055/a-2202-8544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Sepsis has been a major health problem for centuries and it is still the leading cause of hospital deaths. Several studies in the past decades have identified numerous biochemical abnormalities in severe cases, and many of these studies provide evidence of the perturbation of the hemostatic system. This can result in complications, such as disseminated intravascular coagulation that can lead to multiorgan failure. Nevertheless, large clinical studies have demonstrated that the simple approach of inhibiting the coagulation processes by any means fails to provide significant improvement in the survival of septic patients. A cause of this failure could be the fact that in sepsis the major clinical problems result not primarily from the presence of the infective agent or enhanced coagulation but from the complex dysregulated systemic host response to pathogens. If this overt reaction is not fully deciphered, appropriate interference is highly unlikely and any improvement by conventional therapeutic interventions would be limited. Cellular activation in sepsis can be targeted by novel approaches like inhibition of the heterotypic cellular interactions of blood cells by targeting surface receptors or posttranscriptional control of the hemostatic system by noncoding ribonucleic acid (RNA) molecules. Stable RNA molecules can affect the expression of several proteins. Thus, it can be anticipated that modulation of microRNA production would result in a multitude of effects that may be beneficial in septic cases. Here, we highlight some of the recent diagnostic possibilities and potential novel routes of the dysregulated host response.
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Affiliation(s)
- János Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Beke Debreceni
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Fejes
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Béla Nagy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Li Z, Zeng M, Wu T, Wang Z, Sun Y, Zhang Z, Wu F, Chen Z, Fu M, Meng F. Causal Effects of COVID-19 on the Risk of Thrombosis: A Two-Sample Mendel Randomization Study. Thromb Haemost 2024; 124:709-720. [PMID: 38325400 PMCID: PMC11259497 DOI: 10.1055/a-2263-8514] [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: 07/19/2023] [Accepted: 11/17/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) and thrombosis are linked, but the biomolecular mechanism is unclear. We aimed to investigate the causal relationship between COVID-19 and thrombotic biomarkers. METHODS We used two-sample Mendelian randomization (MR) to assess the effect of COVID-19 on 20 thrombotic biomarkers. We estimated causality using inverse variance weighting with multiplicative random effect, and performed sensitivity analysis using weighted median, MR-Egger regression and MR Pleiotropy Residual Sum and Outlier (MR-PRESSO) methods. All the results were examined by false discovery rate (FDR) with the Benjamin and Hochberg method for this correction to minimize false positives. We used R language for the analysis. RESULTS All COVID-19 classes showed lower levels of tissue factor pathway inhibitor (TFPI) and interleukin-1 receptor type 1 (IL-1R1). COVID-19 significantly reduced TFPI (odds ratio [OR] = 0.639, 95% confidence interval [CI]: 0.435-0.938) and IL-1R1 (OR = 0.603, 95% CI = 0.417-0.872), nearly doubling the odds. We also found that COVID-19 lowered multiple coagulation factor deficiency protein 2 and increased C-C motif chemokine 3. Hospitalized COVID-19 cases had less plasminogen activator, tissue type (tPA) and P-selectin glycoprotein ligand 1 (PSGL-1), while severe cases had higher mean platelet volume (MPV) and lower platelet count. These changes in TFPI, tPA, IL-1R1, MPV, and platelet count suggested a higher risk of thrombosis. Decreased PSGL-1 indicated a lower risk of thrombosis. CONCLUSION TFPI, IL-1R, and seven other indicators provide causal clues of the pathogenesis of COVID-19 and thrombosis. This study demonstrated that COVID-19 causally influences thrombosis at the biomolecular level.
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Affiliation(s)
- Zhengran Li
- The Second Clinical Medicine School, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Minghui Zeng
- Institute of Scientific Research, Southern Medical University, Guangzhou, China
| | - Tong Wu
- The First Clinical Medicine School, Southern Medical University, Guangzhou, Guangdong, China
| | - Zijin Wang
- The Second Clinical Medicine School, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuxin Sun
- The Second Clinical Medicine School, Southern Medical University, Guangzhou, Guangdong, China
| | - Ziran Zhang
- The Second Clinical Medicine School, Southern Medical University, Guangzhou, Guangdong, China
| | - Fanye Wu
- The Second Clinical Medicine School, Southern Medical University, Guangzhou, Guangdong, China
| | - Zejun Chen
- The Second Clinical Medicine School, Southern Medical University, Guangzhou, Guangdong, China
| | - Min Fu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Fanke Meng
- Emergency Department, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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Zhu Y, Cao X, Ying R, Liu K, Chai Y, Luo M, Huang Q, Gao P, Zhang C. Mapping the vast landscape of multisystem complications of COVID-19: Bibliometric analysis. Heliyon 2024; 10:e30760. [PMID: 38765136 PMCID: PMC11098853 DOI: 10.1016/j.heliyon.2024.e30760] [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: 11/01/2023] [Revised: 04/16/2024] [Accepted: 05/03/2024] [Indexed: 05/21/2024] Open
Abstract
Background With the rapid global spread of COVID-19, it has become evident that the virus can lead to multisystem complications, leading to a significant increase in related publications. Bibliometrics serves as a valuable tool for identifying highly cited literature and research hotspots within specific areas. Objective The aim of this study is to identify current research hotspots and future trends in COVID-19 complications. Methods The dataset was obtained from the Web of Science Core Collection, covering COVID-19 complications from December 8, 2019, to October 31, 2022. Various aspects, including publication general information, authors, journals, co-cited authors, co-cited references, research hotspots, and future trends, were subjected to analysis. Visual analysis was conducted using VOSviewer, The Online Analysis Platform of Literature Metrology, and Charticulator. Results There were 4597 articles in the study. The top three countries with the most published articles are the USA (n = 1350, 29.4 %), China (n = 765, 16.6 %), and Italy (n = 623, 13.6 %). USA and China have the closest collaborative relationship. The institute with the largest number of publications is Huazhong University of Science and Technology, followed by Harvard Medical School. Nevertheless, half of the top 10 institutes belong to the USA. "Rezaei, Nima" published 13 articles and ranked first, followed by "Yaghi, Shadi" with 12 articles and "Frontera, Jennifer" with 12 articles. The journal with the largest number of publications is "Journal of Clinical Medicine". The top 3 co-cited authors are "Zhou, Fei", "Guan, Wei-Jie", "Huang, Chaolin". The top 3 co-cited references addressed COVID-19's clinical features in China and noticed that COVID-19 patients had a wide range of complications. We also list four research hotspots. Conclusions This study conducted a bibliometric visual analysis of the literature on COVID-19 complications and summarized the current research hotspots. This study may provide valuable insights into the complications of COVID-19.
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Affiliation(s)
- Yi Zhu
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiyu Cao
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rongtao Ying
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ke Liu
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yilu Chai
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Maocai Luo
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qingsong Huang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Peiyang Gao
- Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chuantao Zhang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Jia M, Wang Z, Hu F. Causal relationship between physical activity and platelet traits: a Mendelian randomization study. Front Physiol 2024; 15:1371638. [PMID: 38571721 PMCID: PMC10987957 DOI: 10.3389/fphys.2024.1371638] [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: 01/16/2024] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction: The purpose of this study was to discuss the causal relationship between physical activity and platelet traits. Methods: A dataset from a large-scale European physical activity and platelet traits was collected by using Mendelian randomization of the study. For the analysis, the inverse variance weighting method, weighted median and MR-Egger were used to estimate causal effects. The sensitivity analyses were also performed using Cochran's Q test, funnel plots and Leave-one-out analysis. Results: Light DIY, other exercises, strenuous sports, walking for pleasure were significantly associated with a decrease in platelet crit. But none of the heavy /light DIY was associated with increase in platelet crit. Other exercises and strenuous sports were associated with decrease in platelet count. Conclusion: Some types of physical activity have a causal relationship with platelet crit and platelet count. However, the types of physical activity we studied have not supported a causal relationship with mean platelet volume and platelet distribution width.
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Affiliation(s)
| | - Zhiyong Wang
- Department of Physical Education, Dong-A University, Busan, Republic of Korea
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Ding L. Ferroptosis in viral infection: a potential therapeutic target. Future Microbiol 2024; 19:519-524. [PMID: 38411103 PMCID: PMC11216501 DOI: 10.2217/fmb-2023-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/16/2023] [Indexed: 02/28/2024] Open
Abstract
Ferroptosis, known as a type of programmed cell death that is iron dependent, is characterized by intracellular iron accumulation, glutathione depletion, glutathione peroxidase inactivation and lipid peroxidation. More and more research in recent years has demonstrated the tight connection between viral infections and ferroptosis. This article reviews the potential role and mechanism of ferroptosis in viral infection, and these findings will help in the prevention and treatment of the virus.
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Affiliation(s)
- Liqiong Ding
- Department of Pharmaceutics, School of Pharmacy, Hubei University of Science & Technology, Xianning, China
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Pushalkar S, Wu S, Maity S, Pressler M, Rendleman J, Vitrinel B, Jeffery L, Abdelhadi R, Chen M, Ross T, Carlock M, Choi H, Vogel C. Complex changes in serum protein levels in COVID-19 convalescents. Sci Rep 2024; 14:4479. [PMID: 38396092 PMCID: PMC10891133 DOI: 10.1038/s41598-024-54534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
The COVID-19 pandemic, triggered by severe acute respiratory syndrome coronavirus 2, has affected millions of people worldwide. Much research has been dedicated to our understanding of COVID-19 disease heterogeneity and severity, but less is known about recovery associated changes. To address this gap in knowledge, we quantified the proteome from serum samples from 29 COVID-19 convalescents and 29 age-, race-, and sex-matched healthy controls. Samples were acquired within the first months of the pandemic. Many proteins from pathways known to change during acute COVID-19 illness, such as from the complement cascade, coagulation system, inflammation and adaptive immune system, had returned to levels seen in healthy controls. In comparison, we identified 22 and 15 proteins with significantly elevated and lowered levels, respectively, amongst COVID-19 convalescents compared to healthy controls. Some of the changes were similar to those observed for the acute phase of the disease, i.e. elevated levels of proteins from hemolysis, the adaptive immune systems, and inflammation. In contrast, some alterations opposed those in the acute phase, e.g. elevated levels of CETP and APOA1 which function in lipid/cholesterol metabolism, and decreased levels of proteins from the complement cascade (e.g. C1R, C1S, and VWF), the coagulation system (e.g. THBS1 and VWF), and the regulation of the actin cytoskeleton (e.g. PFN1 and CFL1) amongst COVID-19 convalescents. We speculate that some of these shifts might originate from a transient decrease in platelet counts upon recovery from the disease. Finally, we observed race-specific changes, e.g. with respect to immunoglobulins and proteins related to cholesterol metabolism.
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Affiliation(s)
- Smruti Pushalkar
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA.
| | - Shaohuan Wu
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA
| | - Shuvadeep Maity
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA
- Birla Institute of Technology and Science-Pilani (BITS Pilani), Hyderabad, India
| | - Matthew Pressler
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA
| | - Justin Rendleman
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA
| | - Burcu Vitrinel
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA
| | - Lauren Jeffery
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA
| | - Ryah Abdelhadi
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA
| | - Mechi Chen
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA
| | - Ted Ross
- Cleveland Clinic Florida Research & Innovation Center, Port St. Lucie, FL, USA
| | - Michael Carlock
- Cleveland Clinic Florida Research & Innovation Center, Port St. Lucie, FL, USA
| | - Hyungwon Choi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christine Vogel
- Department of Biology, Center for Genomics and Systems Biology, New York University, New York, NY, USA.
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Guo J, Guo S, Lu S, Gong J, Wang L, Ding L, Chen Q, Liu W. The development of proximity labeling technology and its applications in mammals, plants, and microorganisms. Cell Commun Signal 2023; 21:269. [PMID: 37777761 PMCID: PMC10544124 DOI: 10.1186/s12964-023-01310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 10/02/2023] Open
Abstract
Protein‒protein, protein‒RNA, and protein‒DNA interaction networks form the basis of cellular regulation and signal transduction, making it crucial to explore these interaction networks to understand complex biological processes. Traditional methods such as affinity purification and yeast two-hybrid assays have been shown to have limitations, as they can only isolate high-affinity molecular interactions under nonphysiological conditions or in vitro. Moreover, these methods have shortcomings for organelle isolation and protein subcellular localization. To address these issues, proximity labeling techniques have been developed. This technology not only overcomes the limitations of traditional methods but also offers unique advantages in studying protein spatial characteristics and molecular interactions within living cells. Currently, this technique not only is indispensable in research on mammalian nucleoprotein interactions but also provides a reliable approach for studying nonmammalian cells, such as plants, parasites and viruses. Given these advantages, this article provides a detailed introduction to the principles of proximity labeling techniques and the development of labeling enzymes. The focus is on summarizing the recent applications of TurboID and miniTurbo in mammals, plants, and microorganisms. Video Abstract.
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Affiliation(s)
- Jieyu Guo
- School of Basic Medical Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China
- School of Pharmacy, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China
| | - Shuang Guo
- Medicine Research Institute, Hubei Key Laboratory of Diabetes and Angiopathy, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China
| | - Siao Lu
- School of Basic Medical Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China
- School of Pharmacy, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China
| | - Jun Gong
- School of Pharmacy, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China
| | - Long Wang
- School of Basic Medical Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China
| | - Liqiong Ding
- School of Pharmacy, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China
| | - Qingjie Chen
- School of Pharmacy, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China.
| | - Wu Liu
- School of Basic Medical Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, 437000, China.
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Zhao J, Xu X, Gao Y, Yu Y, Li C. Crosstalk between Platelets and SARS-CoV-2: Implications in Thrombo-Inflammatory Complications in COVID-19. Int J Mol Sci 2023; 24:14133. [PMID: 37762435 PMCID: PMC10531760 DOI: 10.3390/ijms241814133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
The SARS-CoV-2 virus, causing the devastating COVID-19 pandemic, has been reported to affect platelets and cause increased thrombotic events, hinting at the possible bidirectional interactions between platelets and the virus. In this review, we discuss the potential mechanisms underlying the increased thrombotic events as well as altered platelet count and activity in COVID-19. Inspired by existing knowledge on platelet-pathogen interactions, we propose several potential antiviral strategies that platelets might undertake to combat SARS-CoV-2, including their abilities to internalize the virus, release bioactive molecules to interfere with viral infection, and modulate the functions of immune cells. Moreover, we discuss current and potential platelet-targeted therapeutic strategies in controlling COVID-19, including antiplatelet drugs, anticoagulants, and inflammation-targeting treatments. These strategies have shown promise in clinical settings to alleviate the severity of thrombo-inflammatory complications and reduce the mortality rate among COVID-19 patients. In conclusion, an in-depth understanding of platelet-SARS-CoV-2 interactions may uncover novel mechanisms underlying severe COVID-19 complications and could provide new therapeutic avenues for managing this disease.
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Affiliation(s)
| | | | | | - Yijing Yu
- School of Medicine, The Chinese University of Hong Kong, Shenzhen 518172, China; (J.Z.); (X.X.); (Y.G.)
| | - Conglei Li
- School of Medicine, The Chinese University of Hong Kong, Shenzhen 518172, China; (J.Z.); (X.X.); (Y.G.)
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Attia H, El Nagdy M, Abdel Halim RM. Preliminary Study of sCD14 and sCD163 as Predictors of Disease Severity and ICU Admission in COVID-19: Relation to Hematological Parameters, Blood Morphological Changes and Inflammatory Biomarkers. Mediterr J Hematol Infect Dis 2023; 15:e2023046. [PMID: 37705527 PMCID: PMC10497305 DOI: 10.4084/mjhid.2023.046] [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: 04/23/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023] Open
Abstract
Background and Objectives Research supports the role of monocyte/macrophage activation in COVID-19 immunopathology. This study aimed to evaluate sCD14 and sCD163 - the monocyte activation markers - and to investigate their relation to hematological parameters and blood morphology in COVID-19 infection. Methods This is a case-control study that included 70 COVID-19 patients. Patients were subdivided into two groups: 23 severely diseased ICU-admitted patients and another group of 47 non-ICU-admitted patients. sCD163 and sCD14 levels were determined using ELISA. Results sCD163 and sCD14 showed significantly higher levels in sera of patients compared to the control group, with significantly higher levels of sCD163 in ICU-admitted patients than non-ICU admitted patients. Receiver operating characteristic curve analysis demonstrated the usefulness of sCD163 with a cut-off value of 734 ng/mL as a potential marker to discriminate between ICU and non-ICU admitted COVID-19 patients (sensitivity of 81.16%; specificity of 96.67% and positive predictive value of 98% with area under the curve of 0.930). sCD163 levels showed a positive correlation with total white blood cells, absolute neutrophilic count, Neutrophil/Lymphocyte ratio, and a negative correlation with platelet count. sCD14 levels positively correlated with D-dimer values associated with a shift to the left and neutrophilic toxic granulations in blood morphology. Conclusion High sCD163 and sCD14 levels, hematological parameters, and blood morphology reflect monocyte activation in COVID-19 infection. sCD163 is a potential marker of disease severity. These findings support further study of therapeutics targeting macrophage activity in COVID-19 patients with high sCD163 levels.
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Affiliation(s)
- Hend Attia
- Clinical and Chemical Pathology-Haematology, School of Medicine, Newgiza University, Giza, Egypt
| | - Mona El Nagdy
- Clinical and Chemical Pathology, Kasr Alainy, Cairo University, Cairo, Egypt
| | - Radwa M Abdel Halim
- Clinical and Chemical Pathology, Kasr Alainy, Cairo University, Cairo, Egypt
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Kokkoris S, Kanavou A, Kremmydas P, Katsaros D, Karageorgiou S, Gkoufa A, Georgakopoulou VE, Spandidos DA, Giannopoulos C, Kardamitsi M, Routsi C. Temporal evolution of laboratory characteristics in patients critically ill with COVID‑19 admitted to the intensive care unit (Review). MEDICINE INTERNATIONAL 2023; 3:52. [PMID: 37810906 PMCID: PMC10557099 DOI: 10.3892/mi.2023.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023]
Abstract
In the context of coronavirus disease 2019 (COVID-19), laboratory medicine has played a crucial role in both diagnosis and severity assessment. Although the importance of baseline laboratory findings has been extensively reported, data regarding their evolution over the clinical course are limited. The aim of the present narrative review was to provide the dynamic changes of the routine laboratory variables reported in patients with severe COVID-19 over the course of their critical illness. A search was made of the literature for articles providing data on the time-course of routine laboratory tests in patients with severe COVID-19 during their stay in the intensive care unit (ICU). White blood cell, neutrophil and lymphocyte counts, neutrophil to lymphocyte ratio, platelet counts, as well as D-dimer, fibrinogen, C-reactive protein, lactate dehydrogenase and serum albumin levels were selected as disease characteristics and routine laboratory parameters. A total of 25 research articles reporting dynamic trends in the aforementioned laboratory parameters over the clinical course of severe COVID-19 were identified. During the follow-up period provided by each study, the majority of the laboratory values remained persistently abnormal in both survivors and non-survivors. Furthermore, in the majority of studies, the temporal trends of laboratory values distinctly differentiated patients between survivors and non-survivors. In conclusion, there are distinct temporal trends in selected routine laboratory parameters between survivors and non-survivors with severe COVID-19 admitted to the ICU, indicating their importance in the prognosis of clinical outcome.
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Affiliation(s)
- Stelios Kokkoris
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Angeliki Kanavou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Panagiotis Kremmydas
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Dimitrios Katsaros
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Stavros Karageorgiou
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Aikaterini Gkoufa
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
- Department of Infectious Diseases, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Charalampos Giannopoulos
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Marina Kardamitsi
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Christina Routsi
- First Department of Intensive Care, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, 10676 Athens, Greece
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Mirjanić-Azarić B, Pejić I, Mijić S, Pejčić A, Đurđević-Svraka A, Svraka D, Knežević D, Milivojac T, Bogavac-Stanojević N. The predictive role of biochemical markers on outcomes of severe COVID-19 patients admitted to intensive care unit. J Med Biochem 2023; 42:513-523. [PMID: 37790205 PMCID: PMC10545360 DOI: 10.5937/jomb0-40641] [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: 10/15/2022] [Accepted: 02/13/2023] [Indexed: 10/05/2023] Open
Abstract
Background The pandemic of severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2) is a multi-system disease caused by a diffuse systemic process involving a complex interaction of the inflammatory, immunological and coagulative cascades. This study aims to identify the most effective biomarkers to predict poor outcome in intensive care unit (ICU) patients with severe COVID-19 disease. Methods A single-centre retrospective observational study enrolled 69 deceased and 20 recovered patients treated in the ICU of the General Hospital Gradiska in the period from March 1, 2021. until April 1, 2022. We evaluated the leukocytes (WBC), lymphocytes (LYM), neutrophils (NEU), platelets (PLT), haemoglobin, neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). In addition, we evaluated the IL-6, ferritin, CRP, D-dimer, magnesium, bilirubin and lactate dehydrogenase.
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Affiliation(s)
- Bosa Mirjanić-Azarić
- University of Banja Luka, Medical Faculty, Department of Medical Biochemistry, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Ivana Pejić
- General Hospital Gradiska, Gradiska, Republic of Srpska, Bosnia and Herzegovina
| | - Smiljana Mijić
- Aqualab Laboratory, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Aleksandra Pejčić
- General Hospital Gradiska, Gradiska, Republic of Srpska, Bosnia and Herzegovina
| | | | - Dragan Svraka
- University Clinical Centre of the Republic of Srpska, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Darija Knežević
- General Hospital Gradiska, Gradiska, Republic of Srpska, Bosnia and Herzegovina
| | - Tatjana Milivojac
- University of Banja Luka, Medical Faculty, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
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Xu T, Bao Z, Zhou M, Wang W. Clinical characteristics and outcomes of COVID-19 patients with varying renal functions statuses during the Omicron pandemic in Shanghai. BMC Nephrol 2023; 24:253. [PMID: 37620784 PMCID: PMC10463636 DOI: 10.1186/s12882-023-03258-3] [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: 11/16/2022] [Accepted: 06/29/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE This study aims to provide an academic summary of the clinical characteristics, outcomes and risk factors associated with prolonged hospital stays among the patients with varying renal function statuses during the Omicron pandemic in Shanghai. METHODS Clinical data was collected from COVID-19 patients admitted to Shanghai Jiaotong University School of Medicine Ruijin Hospital Northern District. Based on their baseline eGFR, the patients were divided into three groups: Group A (eGFR > = 90ml/min/1.73m2, n = 384), Group B (15ml/min/1.73m2 < = eGFR < 90ml/min/1.73m2, n = 220), and Group C (Hemodialysis-dependent patient, n = 92). Clinical characteristics and laboratory data were compared among the three groups. The cumulative hazards of ICU admission were compared using the Kaplan-Meier method. Univariate and multivariate linear regression analyses were conducted to identify the factors influencing the duration of positive nucleic acid test. RESULTS Between March 25, 2022, and May 31, 2022, a total of 696 COVID-19 patients were included in the study. Among the dialysis patients, 92% (85) of dialysis patients had not received any COVID-19 vaccination, and 14.1%(13) of hemodialysis (HD) patients eventually progressed to severe or critical cases. A total of 13 (2.15%) patients were admitted to the ICU, with 8 (61.5%) were HD patients. The duration of nucleic acid positivity showed a negative correlation with eGFR (B: -0.048, 95%CI: -0.059~-0.037, P = 0.000), platelet counts (B: -0.011, 95%CI: -0.017~-0.005, P = 0.001) or lymphocyte counts (B: -0.658, 95%CI: -1.229~-0.086, P = 0.024). CONCLUSIONS The majority of Omicron patients have a favorable prognosis, while HD patients experience relatively poorer outcomes and higher rates of ICU admission. Decreased eGFR and low lymphocyte/platelet counts are the important risk factors associated with prolonged Omicron infection.
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Affiliation(s)
- Tian Xu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
- Institute of Nephrology, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Zhiyao Bao
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Min Zhou
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China.
| | - Weiming Wang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
- Institute of Nephrology, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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13
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Teodoro AGF, Rodrigues WF, Farnesi-de-Assunção TS, Borges AVBE, Obata MMS, Neto JRDC, da Silva DAA, Andrade-Silva LE, Desidério CS, Costa-Madeira JC, Barbosa RM, Cunha ACCH, Pereira LQ, de Vito FB, Vaz Tanaka SCS, Helmo FR, Lemes MR, Barbosa LM, Trevisan RO, Mundim FV, Oliveira-Scussel ACM, Junior PRR, Monteiro IB, Ferreira YM, Machado GH, Ferreira-Paim K, Moraes-Souza H, de Oliveira CJF, Rodrigues Júnior V, Silva MVD. Inflammatory Response and Activation of Coagulation after COVID-19 Infection. Viruses 2023; 15:v15040938. [PMID: 37112918 PMCID: PMC10145373 DOI: 10.3390/v15040938] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023] Open
Abstract
SARS-CoV-2 (COVID-19) infection is responsible for causing a disease with a wide spectrum of clinical presentations. Predisposition to thromboembolic disease due to excessive inflammation is also attributed to the disease. The objective of this study was to characterize the clinical and laboratory aspects of hospitalized patients, in addition to studying the pattern of serum cytokines, and associate them with the occurrence of thromboembolic events. METHODOLOGY A retrospective cohort study with 97 COVID-19 patients hospitalized from April to August 2020 in the Triângulo Mineiro macro-region was carried out. A review of medical records was conducted to evaluate the clinical and laboratory aspects and the frequency of thrombosis, as well as the measurement of cytokines, in the groups that presented or did not present a thrombotic event. RESULTS There were seven confirmed cases of thrombotic occurrence in the cohort. A reduction in the time of prothrombin activity was observed in the group with thrombosis. Further, 27.8% of all patients had thrombocytopenia. In the group that had thrombotic events, the levels of IL1b, IL-10, and IL2 were higher (p < 0.05). CONCLUSIONS In the studied sample, there was an increase in the inflammatory response in patients with thrombotic events, confirmed by the increase in cytokines. Furthermore, in this cohort, a link was observed between the IL-10 percentage and an increased chance of a thrombotic event.
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Affiliation(s)
- Anna Glória Fonseca Teodoro
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Wellington Francisco Rodrigues
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | | | - Anna V Bernardes E Borges
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Malu Mateus Santos Obata
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - José Rodrigues do Carmo Neto
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Djalma A Alves da Silva
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Leonardo E Andrade-Silva
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Chamberttan S Desidério
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Juliana C Costa-Madeira
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Rafaela M Barbosa
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Andrezza C C Hortolani Cunha
- Postgraduate Program in Physiological Sciences, Federal University of Triângulo Mineiro, Uberaba 38025-200, Brazil
| | - Loren Q Pereira
- Laboratory of Hematological Research of the Federal University of Triângulo Mineiro and Regional Blood Center of Uberaba-Hemominas Foundation, Uberaba 38025-440, Brazil
| | - Fernanda Bernadelli de Vito
- Laboratory of Hematological Research of the Federal University of Triângulo Mineiro and Regional Blood Center of Uberaba-Hemominas Foundation, Uberaba 38025-440, Brazil
| | - Sarah Cristina Sato Vaz Tanaka
- Laboratory of Hematological Research of the Federal University of Triângulo Mineiro and Regional Blood Center of Uberaba-Hemominas Foundation, Uberaba 38025-440, Brazil
| | - Fernanda R Helmo
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Marcela Rezende Lemes
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Laís M Barbosa
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Rafael O Trevisan
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Fabiano V Mundim
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | | | - Paulo Roberto Resende Junior
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Ivan B Monteiro
- UNIMED São Domingos Hospital, Uberaba 38025-110, Brazil
- José Alencar Gomes da Silva Regional Hospital, Uberaba 38060-200, Brazil
| | - Yulsef M Ferreira
- José Alencar Gomes da Silva Regional Hospital, Uberaba 38060-200, Brazil
| | | | - Kennio Ferreira-Paim
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Hélio Moraes-Souza
- Laboratory of Hematological Research of the Federal University of Triângulo Mineiro and Regional Blood Center of Uberaba-Hemominas Foundation, Uberaba 38025-440, Brazil
| | - Carlo José Freire de Oliveira
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Virmondes Rodrigues Júnior
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
| | - Marcos Vinicius da Silva
- Department of Immunology, Microbiology and Parasitology, Federal University of Triângulo Mineiro, Uberaba 38025-350, Brazil
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Zhang C, Shang X, Yuan Y, Li Y. Platelet‑related parameters as potential biomarkers for the prognosis of sepsis. Exp Ther Med 2023; 25:133. [PMID: 36845958 PMCID: PMC9947577 DOI: 10.3892/etm.2023.11832] [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: 08/17/2022] [Accepted: 01/11/2023] [Indexed: 02/12/2023] Open
Abstract
Early diagnosis and accurate prognosis are key for reducing the fatality rate and medical expenses associated with sepsis. Platelets are involved in the delayed tissue injury that occurs during sepsis. Therefore, the aim of the present study was to investigate the usefulness of platelets and associated parameters as prognostic markers of sepsis. The present study collected patient samples based on The Third International Consensus Definitions for Sepsis and Septic Shock criteria. Platelet-associated parameters were detected by flow cytometry and their correlation with clinical scores and prognoses was analyzed. Considering the association between endothelial cells and platelet activation, levels of plasma tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and angiopoietin-2 (Ang-2) were analyzed by ELISA. The results showed significant differences in platelet P-selectin expression and phosphatidylserine exposure, mitochondrial membrane potential (Mmp)-Index values and plasma levels of TWEAK and Ang-2 between patients and healthy controls (P<0.05). Except for P-selectin and TWEAK levels, all parameters were correlated with clinical scores (acute physiology and chronic health evaluation II and sequential/sepsis-related organ failure assessment). Additionally, platelet Mmp-Index between admission and the end of therapy was only different in non-survivors (P<0.001) and platelet phosphatidylserine exposure was significantly lower in survivors (P=0.006). Therefore, of the parameters tested, the dynamic monitoring of phosphatidylserine exposure, platelet Mmp-Index values and plasma Ang-2 levels had the most potential for the assessment of disease severity and clinical outcomes.
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Affiliation(s)
- Chao Zhang
- Hebei Key Laboratory of Nerve Injury and Repair, Institute of Basic Medicine, Chengde Medical University, Chengde, Hebei 067000, P.R. China
| | - Xueyi Shang
- Department of Critical Care Medicine, The Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100071, P.R. China
| | - Yuan Yuan
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing 100071, P.R. China,Correspondence to: Dr Yuan Yuan, State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 20 Dongdajie Street, Fengtai, Beijing 100071, P.R. China
| | - Yan Li
- Department of Critical Care Medicine, The Fifth Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100071, P.R. China,Respiratory Department, Hebei Hua'Ao Hospital, Zhangjiakou, Hebei 075000, P.R. China,Correspondence to: Dr Yuan Yuan, State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 20 Dongdajie Street, Fengtai, Beijing 100071, P.R. China
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15
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Parameters to Predict the Outcome of Severe and Critical COVID-19 Patients when Admitted to the Hospital. J Clin Med 2023; 12:jcm12041323. [PMID: 36835858 PMCID: PMC9959673 DOI: 10.3390/jcm12041323] [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: 12/05/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Manifestations of COVID-19 are diverse and range from asymptomatic to severe, critical illness and death. Cases requiring hospital care (in severe and critical illnesses) are associated with comorbidities and hyperactivation of the immune system. Therefore, in this exploratory observational study, we analyzed which parameters are associated with mortality. We evaluated: demographic characteristics (age, sex and comorbidities), laboratory data (albumin, leukocytes, lymphocytes, platelets, ferritin), days of hospital stay, interleukins (IL-2, IL-6, IL-7, IL-10, IL-17) and sP-selectin in 40 Mexican patients admitted to medical emergencies with a confirmed diagnosis of COVID-19, a complete clinical record, and who signed the informed consent. Twenty severe (they required intermediate care with non-invasive ventilation) and twenty critically ill patients (they required mechanical ventilation) were classified, and these were subsequently compared with healthy and recovered subjects. A significant difference was found between the hospitalized groups in the parameters of age, ferritin, days of hospital stay and death with p values = 0.0145, p = 0.0441, p = 0.0001 and p = 0.0001, respectively. In the determination of cytokines and P-selectin, a significant difference was found between the following groups: recovered patients and healthy volunteers compared with hospitalized patients in severe and critical condition. Importantly, IL-7 remained elevated one year later in recovered patients. Taken together, these values determined at the time of hospital admission could be useful to monitor patients closely and evaluate in-hospital progress, hospital discharge, and out-of-hospital progress.
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16
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Naorungroj T, Viarasilpa T, Tongyoo S, Detkaew A, Pinpak T, Wimolwattanaphan R, Ratanarat R, Promsin P, Thamrongpiroj P, Phumpichet A, Permpikul C. Characteristics, outcomes, and risk factors for in-hospital mortality of COVID-19 patients: A retrospective study in Thailand. Front Med (Lausanne) 2023; 9:1061955. [PMID: 36687414 PMCID: PMC9846200 DOI: 10.3389/fmed.2022.1061955] [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: 10/05/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Data on the characteristics and outcomes of patients hospitalized for Coronavirus Disease 2019 (COVID-19) in Thailand are limited. Objective To determine characteristics and outcomes and identify risk factors for hospital mortality for hospitalized patients with COVID-19. Methods We retrospectively reviewed the medical records of patients who had COVID-19 infection and were admitted to the cohort ward or ICUs at Siriraj Hospital between January 2020 and December 2021. Results Of the 2,430 patients included in this study, 229 (9.4%) died; the mean age was 54 years, 40% were men, 81% had at least one comorbidity, and 13% required intensive care unit (ICU). Favipiravir (86%) was the main antiviral treatment. Corticosteroids and rescue anti-inflammatory therapy were used in 74 and 6%, respectively. Admission to the ICU was the only factor associated with reduced mortality [odds ratio (OR) 0.01, 95% confidence interval (CI) 0.01-0.05, P < 0.001], whereas older age (OR 14.3, 95%CI 5.76-35.54, P < 0.001), high flow nasal cannula (HFNC; OR 9.2, 95% CI 3.9-21.6, P < 0.001), mechanical ventilation (OR 269.39, 95%CI 3.6-2173.63, P < 0.001), septic shock (OR 7.79, 95%CI, 2.01-30.18, P = 0.003), and hydrocortisone treatment (OR 27.01, 95%CI 5.29-138.31, P < 0.001) were factors associated with in-hospital mortality. Conclusion The overall mortality of hospitalized patients with COVID-19 was 9%. The only factor associated with reduced mortality was admission to the ICU. Therefore, appropriate selection of patients for admission to the ICU, strategies to limit disease progression and prevent intubation, and early detection and prompt treatment of nosocomial infection can improve survival in these patients.
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17
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Siegenthaler AG, Ghelani G, Brady A, Loon T, Madhira BR. Hematologic Abnormalities After COVID-19 Infection: A Case of Coombs-Negative Hemolytic Anemia and Thrombocytopenia. J Investig Med High Impact Case Rep 2023; 11:23247096231207687. [PMID: 37882166 PMCID: PMC10604495 DOI: 10.1177/23247096231207687] [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: 08/18/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023] Open
Abstract
The occurrence of hemolytic anemia in patients with active SARS-CoV-2 infection has been documented in medical literature. While relatively uncommon, there have been instances where this condition presents as a Coombs-negative hemolytic anemia. In this research study, we report a distinctive case of Coombs-negative hemolytic anemia and thrombocytopenia in a patient with a known history of COVID-19 infection. The patient demonstrated a favorable response to treatment involving the administration of steroids and intravenous immunoglobulin (IVIG) therapy. This case adds to the existing body of evidence regarding the hematological manifestations of SARS-CoV-2 infection, highlighting the importance of considering and managing hematological complications in patients with COVID-19.
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Affiliation(s)
| | - Ghanshyam Ghelani
- State University of New York Upstate Medical University, Syracuse, USA
| | - Amy Brady
- State University of New York Upstate Medical University, Syracuse, USA
| | - Taylor Loon
- State University of New York Upstate Medical University, Syracuse, USA
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18
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Yu T, Dong J, Qi Q, Lv Q, Li J, Huang C, Cai X. A Nomogram for Predicting Delayed Viral Shedding in Non-Severe SARS-CoV-2 Omicron Infection. Infect Drug Resist 2023; 16:2487-2500. [PMID: 37138833 PMCID: PMC10150765 DOI: 10.2147/idr.s407620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
Purpose The Omicron variant of SARS-CoV-2 has emerged as a significant global concern, characterized by its rapid transmission and resistance to existing treatments and vaccines. However, the specific hematological and biochemical factors that may impact the clearance of Omicron variant infection remain unclear. The present study aimed to identify easily accessible laboratory markers that are associated with prolonged virus shedding in non-severe patients with COVID-19 caused by the Omicron variant. Patients and Methods A retrospective cohort study was conducted on 882 non-severe COVID-19 patients who were diagnosed with the Omicron variant in Shanghai between March and June 2022. The least absolute shrinkage and selection operator regression model was used for feature selection and dimensional reduction, and multivariate logistic regression analysis was performed to construct a nomogram for predicting the risk of prolonged SARS-CoV-2 RNA positivity lasting for more than 7 days. The receiver operating characteristic (ROC) curve and calibration curves were used to assess predictive discrimination and accuracy, with bootstrap validation. Results Patients were randomly divided into derivation (70%, n = 618) and validation (30%, n = 264) cohorts. Optimal independent markers for prolonged viral shedding time (VST) over 7 days were identified as Age, C-reactive protein (CRP), platelet count, leukocyte count, lymphocyte count, and eosinophil count. These factors were subsequently incorporated into the nomogram utilizing bootstrap validation. The area under the curve (AUC) in the derivation (0.761) and validation (0.756) cohorts indicated good discriminative ability. The calibration curve showed good agreement between the nomogram-predicted and actual patients with VST over 7 days. Conclusion Our study confirmed six factors associated with delayed VST in non-severe SARS-CoV-2 Omicron infection and constructed a Nomogram which may assist non-severely affected patients to better estimate the appropriate length of self-isolation and optimize their self-management strategies.
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Affiliation(s)
- Tianyu Yu
- Department of General Surgery, Gongli Hospital of Shanghai Pudong New Area, Shanghai, 200135, People’s Republic of China
| | - Jiangnan Dong
- Department of General Surgery, Gongli Hospital of Shanghai Pudong New Area, Shanghai, 200135, People’s Republic of China
| | - Qi Qi
- Department of General Surgery, Gongli Hospital of Shanghai Pudong New Area, Shanghai, 200135, People’s Republic of China
| | - Qiang Lv
- Department of General Surgery, Gongli Hospital of Shanghai Pudong New Area, Shanghai, 200135, People’s Republic of China
| | - Jun Li
- Department of General Surgery, Gongli Hospital of Shanghai Pudong New Area, Shanghai, 200135, People’s Republic of China
| | - Chaojun Huang
- Department of General Surgery, Gongli Hospital of Shanghai Pudong New Area, Shanghai, 200135, People’s Republic of China
| | - Xiaoyan Cai
- Department of General Surgery, Gongli Hospital of Shanghai Pudong New Area, Shanghai, 200135, People’s Republic of China
- Correspondence: Xiaoyan Cai, Department of General Surgery, Gongli Hospital of Shanghai Pudong New Area, Shanghai, 200135, People’s Republic of China, Tel/Fax +86-21-58858730, Email
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Kaiafa G, Savopoulos C, Karlafti E, Pantazi K, Paramythiotis D, Thomaidou E, Daios S, Ztriva E, Gionis M, Fyntanidou V, Argiriadou H, Didangelos T. Coagulation Profile of COVID-19 Patients. Life (Basel) 2022; 12:1658. [PMID: 36295093 PMCID: PMC9604860 DOI: 10.3390/life12101658] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 12/09/2023] Open
Abstract
Coronavirus disease is a viral infection that can affect multiple systems and be expressed with many-or no-symptoms. The viral infection begins when the virus binds to the host's receptor and from that point on, it is transmitted to the rest of the body, where it causes inflammatory reactions. Among other tissues and systems, SARS-CoV-2 impacts the coagulation system, where it triggers the immunothrombotic response. Its effects are rather intense and can lead to many complications. COVID-19-associated coagulopathy is frequently observed in hospitalized patients, especially ICU patients, and can be proven detrimental. It is usually accompanied by other complications, such as sepsis-induced coagulopathy, disseminated intravascular coagulation and venous thromboembolism. Since all these conditions lead to poor prognosis for severely ill patients, thromboprophylaxis and coagulopathy prognosis are just as important as the therapeutic handling of these patients. Since the beginning of the pandemic, many biomarkers have been considered useful when trying to assess the thrombotic risk of hospitalized patients or evaluate the severity of their situation. At the same time, many drugs have already been tested-while others are still being trialed-in order to find the optimal therapy for each urgent situation.
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Affiliation(s)
- Georgia Kaiafa
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Eleni Karlafti
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Konstantina Pantazi
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgery Department, AHEPA General University Hospital, 54621 Thessaloniki, Greece
| | - Evanthia Thomaidou
- Department of Anesthesia and Intensive Care, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Stylianos Daios
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Eleftheria Ztriva
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Michalis Gionis
- Vascular Surgery Department, General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Varvara Fyntanidou
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Helena Argiriadou
- Department of Anesthesia and Intensive Care, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Triantafyllos Didangelos
- 1st Propaedeutic Department of Internal Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
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Velichko A, Huyut MT, Belyaev M, Izotov Y, Korzun D. Machine Learning Sensors for Diagnosis of COVID-19 Disease Using Routine Blood Values for Internet of Things Application. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22207886. [PMID: 36298235 PMCID: PMC9610709 DOI: 10.3390/s22207886] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 05/16/2023]
Abstract
Healthcare digitalization requires effective applications of human sensors, when various parameters of the human body are instantly monitored in everyday life due to the Internet of Things (IoT). In particular, machine learning (ML) sensors for the prompt diagnosis of COVID-19 are an important option for IoT application in healthcare and ambient assisted living (AAL). Determining a COVID-19 infected status with various diagnostic tests and imaging results is costly and time-consuming. This study provides a fast, reliable and cost-effective alternative tool for the diagnosis of COVID-19 based on the routine blood values (RBVs) measured at admission. The dataset of the study consists of a total of 5296 patients with the same number of negative and positive COVID-19 test results and 51 routine blood values. In this study, 13 popular classifier machine learning models and the LogNNet neural network model were exanimated. The most successful classifier model in terms of time and accuracy in the detection of the disease was the histogram-based gradient boosting (HGB) (accuracy: 100%, time: 6.39 sec). The HGB classifier identified the 11 most important features (LDL, cholesterol, HDL-C, MCHC, triglyceride, amylase, UA, LDH, CK-MB, ALP and MCH) to detect the disease with 100% accuracy. In addition, the importance of single, double and triple combinations of these features in the diagnosis of the disease was discussed. We propose to use these 11 features and their binary combinations as important biomarkers for ML sensors in the diagnosis of the disease, supporting edge computing on Arduino and cloud IoT service.
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Affiliation(s)
- Andrei Velichko
- Institute of Physics and Technology, Petrozavodsk State University, 33 Lenin Ave., 185910 Petrozavodsk, Russia
- Correspondence: (A.V.); (M.T.H.)
| | - Mehmet Tahir Huyut
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Erzincan Binali Yıldırım University, 24000 Erzincan, Türkiye
- Correspondence: (A.V.); (M.T.H.)
| | - Maksim Belyaev
- Institute of Physics and Technology, Petrozavodsk State University, 33 Lenin Ave., 185910 Petrozavodsk, Russia
| | - Yuriy Izotov
- Institute of Physics and Technology, Petrozavodsk State University, 33 Lenin Ave., 185910 Petrozavodsk, Russia
| | - Dmitry Korzun
- Department of Computer Science, Institute of Mathematics and Information Technology, Petrozavodsk State University, 33 Lenin Ave., 185910 Petrozavodsk, Russia
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21
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Kasielska-Trojan A, Manning JT, Jabłkowski M, Białkowska-Warzecha J, Kwasniewska O, Hirschberg AL, Antoszewski B. Right-left digit ratios, a novel form of asymmetry: Patterns of instability in children and relationships to platelet counts and hospitalization in adults with COVID-19. Front Public Health 2022; 10:995025. [PMID: 36311570 PMCID: PMC9615030 DOI: 10.3389/fpubh.2022.995025] [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] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023] Open
Abstract
High right minus left (R-L) asymmetry of digit ratios has been reported to be linked to hospitalization for COVID-19. Here we examined the developmental patterns of this novel form of asymmetry in children and further explored their relationships to platelet counts and hospitalization for COVID-19 in adult patients. We considered ratios calculated from four digits (2D, 3D, 4D, 5D) in: (i) a sample of healthy participants aged 2 years to 18 years (n = 680, 340 males) and (ii) 96 adult patients (42 males) hospitalized for COVID-19 and 100 controls (53 males). The protocol for (ii) included a questionnaire and laboratory test results. In sample (i) of the six unsigned digit ratio asymmetries, those which included 5D had the highest mean asymmetry with the greatest between-individual variation and they were unstable over the age range of 2 years to 18 years. In sample (ii) patients showed higher asymmetries than controls in four ratios (2D:4D, 2D:5D, 3D:5D, 4D:5D) and a sum of asymmetries of the two independent ratios (2D:4D+3D:5D) correlated positively with platelet counts and hospitalization. Conclusion: Means and SDs of digit ratio asymmetry that include the 5th digit are high and age-unstable. Digit ratio asymmetry, particularly 5th digit ratio asymmetry and a composite measure of 2D:4D + 3D:5D asymmetry, may be positively linked to high platelet counts in COVID-19 patients and to an elevated risk of hospitalization.
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Affiliation(s)
- Anna Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland,*Correspondence: Anna Kasielska-Trojan
| | - John T. Manning
- Applied Sports, Technology, Exercise, and Medicine (A-STEM), Swansea University, Swansea, United Kingdom
| | - Maciej Jabłkowski
- Department of Infectious and Liver Diseases, Medical University of Lodz, Lodz, Poland
| | | | | | - Angelica L. Hirschberg
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden,Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Bogusław Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, Lodz, Poland
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22
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Jankauskaite L, Malinauskas M, Snipaitiene A. Effect of stimulated platelets in COVID-19 thrombosis: Role of alpha7 nicotinic acetylcholine receptor. Front Cardiovasc Med 2022; 9:1037369. [PMID: 36312286 PMCID: PMC9614055 DOI: 10.3389/fcvm.2022.1037369] [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: 09/05/2022] [Accepted: 09/26/2022] [Indexed: 01/08/2023] Open
Abstract
Since early 2020, SARS-CoV-2-induced infection resulted in global pandemics with high morbidity, especially in the adult population. COVID-19 is a highly prothrombotic condition associated with subsequent multiorgan failure and lethal outcomes. The exact mechanism of the prothrombotic state is not well understood and might be multifactorial. Nevertheless, platelets are attributed to play a crucial role in COVID-19-associated thrombosis. To date, platelets' role was defined primarily in thrombosis and homeostasis. Currently, more focus has been set on their part in inflammation and immunity. Moreover, their ability to release various soluble factors under activation as well as internalize and degrade specific pathogens has been highly addressed in viral research. This review article will discuss platelet role in COVID-19-associated thrombosis and their role in the cholinergic anti-inflammatory pathway. Multiple studies confirmed that platelets display a hyperactivated phenotype in COVID-19 patients. Critically ill patients demonstrate increased platelet activation markers such as P-selectin, PF4, or serotonin. In addition, platelets contain acetylcholine and express α7 nicotinic acetylcholine receptors (α7nAchR). Thus, acetylcholine can be released under activation, and α7nAchR can be stimulated in an autocrine manner and support platelet function. α7 receptor is one of the most important mediators of the anti-inflammatory properties as it is associated with humoral and intrinsic immunity and was demonstrated to contribute to better outcomes in COVID-19 patients when under stimulation. Hematopoietic α7nAchR deficiency increases platelet activation and, in experimental studies, α7nAchR stimulation can diminish the pro-inflammatory state and modulate platelet reactiveness via increased levels of NO. NO has been described to inhibit platelet adhesion, activation, and aggregation. In addition, acetylcholine has been demonstrated to decrease platelet aggregation possibly by blocking the e p-38 pathway. SARS-CoV-2 proteins have been found to be similar to neurotoxins which can bind to nAChR and prevent the action of acetylcholine. Concluding, the platelet role in COVID-19 thrombotic events could be explained by their active function in the cholinergic anti-inflammatory pathway.
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Affiliation(s)
- Lina Jankauskaite
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania,Department of Pediatrics, Medical Faculty, Lithuanian University of Health Sciences, Kaunas, Lithuania,*Correspondence: Lina Jankauskaite
| | - Mantas Malinauskas
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ausra Snipaitiene
- Department of Pediatrics, Medical Faculty, Lithuanian University of Health Sciences, Kaunas, Lithuania
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23
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Wifi MN, Morad MA, El Sheemy R, Abdeen N, Afify S, Abdalgaber M, Abdellatef A, Zaghloul M, Alboraie M, El-Kassas M. Hemostatic system and COVID-19 crosstalk: A review of the available evidence. World J Methodol 2022; 12:331-349. [PMID: 36186748 PMCID: PMC9516549 DOI: 10.5662/wjm.v12.i5.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/17/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023] Open
Abstract
Since the discovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant coronavirus disease 2019 (COVID-19) pandemic, respiratory manifestations have been the mainstay of clinical diagnosis, laboratory evaluations, and radiological investigations. As time passed, other pathological aspects of SARS-CoV-2 have been revealed. Various hemostatic abnormalities have been reported since the rise of the pandemic, which was sometimes superficial, transient, or fatal. Mild thrombocytopenia, thrombocytosis, venous, arterial thromboembolism, and disseminated intravascular coagulation are among the many hemostatic events associated with COVID-19. Venous thromboembolism necessitating therapeutic doses of anticoagulants is more frequently seen in severe cases of COVID-19, especially in patients admitted to intensive care units. Hemorrhagic complications rarely arise in COVID-19 patients either due to a hemostatic imbalance resulting from severe disease or as a complication of over anticoagulation. Although the pathogenesis of coagulation disturbance in SARS-CoV-2 infection is not yet understood, professional societies recommend prophylactic antithrombotic therapy in severe cases, especially in the presence of abnormal coagulation indices. The review article discusses the various available evidence on coagulation disorders, management strategies, outcomes, and prognosis associated with COVID-19 coagulopathy, which raises awareness about the importance of anticoagulation therapy for COVID-19 patients to guard against possible thromboembolic events.
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Affiliation(s)
- Mohamed-Naguib Wifi
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mohamed Abdelkader Morad
- Clinical Hematology Unit, Department of Internal Medicine, Kasr Al-Ainy, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Reem El Sheemy
- Department of Tropical Medicine, Minia Faculty of Medicine, Minia University, Minia 61511, Egypt
| | - Nermeen Abdeen
- Department of Tropical Medicine, Faculty of Medicine, Alexandria University, Alexandria 21523, Egypt
| | - Shimaa Afify
- Department of Gastroenterology, National Hepatology and Tropical Medicine, National Hepatology and Tropical Medicine Research Institute, Cairo 11451, Egypt
| | - Mohammad Abdalgaber
- Department of Gastroenterology and Hepatology, Police Authority Hospital, Agoza, Giza 12511, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Hepatogastro- enterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh 33511, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Helwan 11731, Egypt
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24
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Araújo DC, Veloso AA, Borges KBG, Carvalho MDG. Prognosing the risk of COVID-19 death through a machine learning-based routine blood panel: A retrospective study in Brazil. Int J Med Inform 2022; 165:104835. [PMID: 35908372 PMCID: PMC9327247 DOI: 10.1016/j.ijmedinf.2022.104835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 01/08/2023]
Abstract
Background: Despite an extensive network of primary care availability, Brazil has suffered profoundly during the COVID-19 pandemic, experiencing the greatest sanitary collapse in its history. Thus, it is important to understand phenotype risk factors for SARS-CoV-2 infection severity in the Brazilian population in order to provide novel insights into the pathogenesis of the disease. Objective: This study proposes to predict the risk of COVID-19 death through machine learning, using blood biomarkers data from patients admitted to two large hospitals in Brazil. Methods: We retrospectively collected blood biomarkers data in a 24-h time window from 6,979 patients with COVID-19 confirmed by positive RT-PCR admitted to two large hospitals in Brazil, of whom 291 (4.2%) died and 6,688 (95.8%) were discharged. We then developed a large-scale exploration of risk models to predict the probability of COVID-19 severity, finally choosing the best performing model regarding the average AUROC. To improve generalizability, for each model five different testing scenarios were conducted, including two external validations. Results: We developed a machine learning-based panel composed of parameters extracted from the complete blood count (lymphocytes, MCV, platelets and RDW), in addition to C-Reactive Protein, which yielded an average AUROC of 0.91 ± 0.01 to predict death by COVID-19 confirmed by positive RT-PCR within a 24-h window. Conclusion: Our study suggests that routine laboratory variables could be useful to identify COVID-19 patients under higher risk of death using machine learning. Further studies are needed for validating the model in other populations and contexts, since the natural history of SARS-CoV-2 infection and its consequences on the hematopoietic system and other organs is still quite recent.
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Affiliation(s)
- Daniella Castro Araújo
- Huna, São Paulo, SP, Brazil; Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Adriano Alonso Veloso
- Departamento de Ciência da Computação, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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25
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Inflammatory and thrombotic parameters associated with the COVID-19 course in Poland (SARSTer study). Adv Med Sci 2022; 67:291-297. [PMID: 35932632 PMCID: PMC9296792 DOI: 10.1016/j.advms.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/16/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
Purpose The aim of the study was to assess the coagulation and inflammatory markers connected with severe course of COVID-19 and no clinical improvement. Material and methods The study population included 2590 adult patients, diagnosed with COVID-19, selected from the SARSTer national database - an ongoing project led by the Polish Association of Epidemiologists and Infectiologists and supported by the Medical Research Agency. Clinical and laboratory parameters, such as C-reactive protein (CRP), white blood cells (WBCs), neutrophil and lymphocyte count, procalcitonin, ferritin, interleukin-6 (IL-6), D-dimer concentration and platelet (PLT) count were analyzed before and after treatment (remdesivir, tocilizumab, dexamethasone, anticoagulants). Results Significant differences between patients with mild and severe course of the disease were observed in all examined parameters before treatment (p < 0.05). After treatment only ferritin concentration did not differ significantly. In patients with pulmonary embolism, CRP concentration, neutrophil count, D-dimer and IL-6 concentration were significantly higher than in patients without embolism (p < 0.05). The significant differences between the groups with and without fatal outcome were observed within all analyzed parameters. Significant differences in all examined parameters before treatment were observed between patients with and without clinical improvement (p < 0.05). Multivariate logistic regression showed that no clinical improvement was associated with: IL-6>100 pg/ml (OR-2.14), D-dimer concentration over 1000 ng/ml (OR-1.62) and PLT count below 150,000/μl (OR-1.57). Conclusions Severe course of the disease is associated with lower PLT and lymphocyte count, higher D-dimer, CRP, neutrophil count and IL-6 concentration. The best predictors of no clinical improvement in COVID-19 are: IL-6>100 pg/ml, D-dimer>1000 ng/ml and PLT<150,000/μl.
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26
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Diagnosis and Prognosis of COVID-19 Disease Using Routine Blood Values and LogNNet Neural Network. SENSORS 2022; 22:s22134820. [PMID: 35808317 PMCID: PMC9269123 DOI: 10.3390/s22134820] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 01/08/2023]
Abstract
Since February 2020, the world has been engaged in an intense struggle with the COVID-19 disease, and health systems have come under tragic pressure as the disease turned into a pandemic. The aim of this study is to obtain the most effective routine blood values (RBV) in the diagnosis and prognosis of COVID-19 using a backward feature elimination algorithm for the LogNNet reservoir neural network. The first dataset in the study consists of a total of 5296 patients with the same number of negative and positive COVID-19 tests. The LogNNet-model achieved the accuracy rate of 99.5% in the diagnosis of the disease with 46 features and the accuracy of 99.17% with only mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, and activated partial prothrombin time. The second dataset consists of a total of 3899 patients with a diagnosis of COVID-19 who were treated in hospital, of which 203 were severe patients and 3696 were mild patients. The model reached the accuracy rate of 94.4% in determining the prognosis of the disease with 48 features and the accuracy of 82.7% with only erythrocyte sedimentation rate, neutrophil count, and C reactive protein features. Our method will reduce the negative pressures on the health sector and help doctors to understand the pathogenesis of COVID-19 using the key features. The method is promising to create mobile health monitoring systems in the Internet of Things.
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27
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Cheung CL, Ho SC, Krishnamoorthy S, Li GHY. COVID-19 and platelet traits: A bidirectional Mendelian randomization study. J Med Virol 2022; 94:4735-4743. [PMID: 35676178 PMCID: PMC9348324 DOI: 10.1002/jmv.27920] [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: 04/16/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 01/08/2023]
Abstract
This study aimed to evaluate the host genetic liability of coronavirus disease 2019 (covid‐19) with platelet traits using the Mendelian randomization (MR) approach. We conducted a bidirectional two‐sample MR using summary statistics from the largest genome‐wide association study of three variables, covid‐19 severity (severe acute respiratory syndrome coronavirus 2 [SARS‐CoV‐2] infection, covid‐19 hospitalization, and severe covid‐19, N = ~1 059 456–1 557 411) and four platelet traits (mean platelet volume [MPV], plateletcrit, platelet distribution width, and platelet count; N = 408 112). Inverse‐variance weighted (IVW), median weighted, MR‐Egger, and contamination mixture methods were used to estimate the causal association. Null and inconsistent associations in the IVW and sensitivity analyses were observed for SARS‐CoV‐2 infection and covid‐19 hospitalization with platelet traits. For severe covid‐19, significant associations with MPV and platelet count were observed in the IVW and sensitivity analyses, with the betaIVW of 0.01 (95% confidence interval [CI]: 0.005–0.016, p = 3.51 × 10−4) and −0.009 (95% CI: −0.015 to −0.002, p = 0.008) per doubling in odds of severe covid‐19, respectively. Conversely, null associations were observed for platelet traits with covid‐19 traits. In conclusion, host genetic liability to severe covid‐19 was causally associated with increased MPV and reduced platelet count, which may provide insights into evaluating hypercoagulability and thromboembolic events in covid‐19 patients.
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Affiliation(s)
- Ching-Lung Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong
| | - Shun-Cheong Ho
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Suhas Krishnamoorthy
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Gloria H-Y Li
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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28
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de Andrade SA, de Souza DA, Torres AL, de Lima CFG, Ebram MC, Celano RMG, Schattner M, Chudzinski-Tavassi AM. Pathophysiology of COVID-19: Critical Role of Hemostasis. Front Cell Infect Microbiol 2022; 12:896972. [PMID: 35719336 PMCID: PMC9205169 DOI: 10.3389/fcimb.2022.896972] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/05/2022] [Indexed: 12/18/2022] Open
Abstract
The COVID-19 pandemic, caused by SARS-CoV-2, had its first cases identified in late 2019 and was considered a clinical pandemic in March 2020. In March 2022, more than 500 million people were infected and 6,2 million died as a result of this disease, increasingly associated with changes in human hemostasis, such as hypercoagulation. Numerous factors contribute to the hypercoagulable state, and endothelial dysfunction is the main one, since the activation of these cells can strongly activate platelets and the coagulation system. In addition, there is a dysregulation of the renin-angiotensin system due to the SARS-CoV-2 takeover of the angiotensin converting enzyme 2, resulting in a strong immune response that could further damage the endothelium. Thrombus formation in the pulmonary microvasculature structure in patients with COVID-19 is an important factor to determine the severity of the clinical picture and the outcome of this disease. This review describes the hemostatic changes that occur in SARS-CoV-2 infection, to further improve our understanding of pathogenic mechanisms and the interaction between endothelium dysfunction, kallikrein-kinins, renin angiotensin, and the Coagulation/fibrinolysis systems as underlying COVID-19 effectors. This knowledge is crucial for the development of new effective therapeutic approaches, attenuating the severity of SARS-CoV-2’s infection and to reduce the deaths.
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Affiliation(s)
| | | | | | | | | | | | - Mirta Schattner
- Laboratory of Experimental Thrombosis. Instituto de Medicina Experimental – CONICET -Academia Nacional de Medicina, Buenos Aires, Argentina
- *Correspondence: Ana Marisa Chudzinski-Tavassi, ; Mirta Schattner,
| | - Ana Marisa Chudzinski-Tavassi
- Center of Excellence in New Target Discovery (CENTD), Instituto Butantan, São Paulo, Brazil
- Innovation and Development Laboratory, Instituto Butantan, São Paulo, São Paulo, Brazil
- *Correspondence: Ana Marisa Chudzinski-Tavassi, ; Mirta Schattner,
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29
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Li J, Li R, Jin X, Ren J, Du L, Zhang J, Gao Y, Liu X, Hou Y, Zhang L, Song Z, Song J, Wang X, Wang G. Association of platelet count with mortality in patients with infectious diseases in intensive care unit: a multicenter retrospective cohort study. Platelets 2022; 33:1168-1174. [PMID: 35485162 DOI: 10.1080/09537104.2022.2066646] [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: 10/18/2022]
Abstract
Platelets play important roles in thrombosis, hemostasis, inflammation, and infection. We aimed to evaluate the association between platelet count and its variation trend and prognosis of patient with infectious diseases in intensive care units (ICUs). This retrospective cohort study extracted 4,251 critically ill adult patients with infectious diseases from the eICU Collaborative Research Database, whose platelet counts were measured daily during the first 7 days after admission. In the survivors, platelet counts decreased in the first days after admission, reached a nadir on day 3, and then returned and continued to rise above the admission value. In non-survivors, the platelet counts decreased after admission, without a subsequent upturn. We defined three subgroups according to the nadir platelet counts within 7 days: ≤50, 50-130, and ≥130 × 109/L, corresponding to high, intermediate, and low ICU mortality. A decreased platelet count was associated with increased ICU mortality (intermediate vs. low: 1.676 [1.285-2.187]; high vs. low: 3.632 [2.611-5.052]). In conclusion, during the first 7 days, platelet counts decreased after ICU admission, while increased subsequently in the survivors but not in the non-survivors. ICU mortality risk increased as nadir platelet count decreased below 130 × 109/L, and further boosted when it reached below 50 × 109/L.
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Affiliation(s)
- Jiamei Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruohan Li
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuting Jin
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiajia Ren
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linyun Du
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingjing Zhang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ya Gao
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiu Liu
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanli Hou
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Zhang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhenju Song
- Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingchun Song
- Department of Critical Care Medicine, The 908th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanchang, China
| | - Xiaochuang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Gang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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30
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Tahir Huyut M, Huyut Z, İlkbahar F, Mertoğlu C. What is the impact and efficacy of routine immunological, biochemical and hematological biomarkers as predictors of COVID-19 mortality? Int Immunopharmacol 2022; 105:108542. [PMID: 35063753 PMCID: PMC8761578 DOI: 10.1016/j.intimp.2022.108542] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/27/2021] [Accepted: 01/11/2022] [Indexed: 01/08/2023]
Abstract
It remains important to investigate the changing and impact of routine blood values (RBVs) in order to predict mortality and follow an appropriate treatment in COVID-19 patients. In the study, the importance of RBVs in the mortality of patients with COVID-19 was investigated. The changes in the biochemical, hematological, and immunological parameters of patients who recovered (n = 4364) and died (n = 233) from COVID-19 over time and their relationship with the mortality of the disease were evaluated retrospectively. Odds ratios of the parameters affecting one-month mortality were calculated by running multiple-logistic-regression analysis. The cut off values and diagnostic efficiencies of the parameters that posed a risk for mortality were obtained via receiver operating curve analysis. It was determined that the C-reactive protein (CRP), D-dimer, procalcitonin, erythrocyte-sedimentation-rate (ESR), troponin values were at abnormal levels until death occurred in the patients who died. In addition, the procalcitonin levels were consistently high in patients who died. The patients who died generally had a sustained increase in their leukocyte and neutrophil levels and biochemical variables, and an ongoing decrease in lymphopenia and eosinopenia levels. Although significant changes were observed in liver function tests, cardiac troponin, hemogram values, kidney function tests and parameters related to inflammation in deceased patients, high ESR, international-normalized-ratio (INR), prothrombin-time (PT), CRP, D-dimer, ferritin and red-cell-distribution width (RDW) values, respectively, were the most effective predictive mortality risk biomarkers of COVID-19. In addition, neutrophilia, leukocytosis, thrombocytopenia, erythrocytopenia were other risk predictors of mortality. Indicators was found in this study can be successfully used to predict mortality from COVID-19.
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Affiliation(s)
- Mehmet Tahir Huyut
- Erzincan Binali Yıldırım Unversıty, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Erzincan, Türkiye.
| | - Zübeyir Huyut
- Van Yuzuncu Yıl University, Faculty of Medicine, Department of Biochemistry, Van, Türkiye
| | - Fatih İlkbahar
- Duzce Unıversıty, Department of Management Informatıon Systems, Düzce, Türkiye
| | - Cuma Mertoğlu
- Erzincan Binali Yıldırım Unversıty, Faculty of Medicine, Department of Clinical Biochemistry, Erzincan, Türkiye; Inonu University, Faculty of Medicine, Department of Clinical Biochemistry, Malatya, Türkiye
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31
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Amara U, Rashid S, Mahmood K, Nawaz MH, Hayat A, Hassan M. Insight into prognostics, diagnostics, and management strategies for SARS CoV-2. RSC Adv 2022; 12:8059-8094. [PMID: 35424750 PMCID: PMC8982343 DOI: 10.1039/d1ra07988c] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/04/2022] [Indexed: 01/08/2023] Open
Abstract
The foremost challenge in countering infectious diseases is the shortage of effective therapeutics. The emergence of coronavirus disease (COVID-19) outbreak has posed a great menace to the public health system globally, prompting unprecedented endeavors to contain the virus. Many countries have organized research programs for therapeutics and management development. However, the longstanding process has forced authorities to implement widespread infrastructures for detailed prognostic and diagnostics study of severe acute respiratory syndrome (SARS CoV-2). This review discussed nearly all the globally developed diagnostic methodologies reported for SARS CoV-2 detection. We have highlighted in detail the approaches for evaluating COVID-19 biomarkers along with the most employed nucleic acid- and protein-based detection methodologies and the causes of their severe downfall and rejection. As the variable variants of SARS CoV-2 came into the picture, we captured the breadth of newly integrated digital sensing prototypes comprised of plasmonic and field-effect transistor-based sensors along with commercially available food and drug administration (FDA) approved detection kits. However, more efforts are required to exploit the available resources to manufacture cheap and robust diagnostic methodologies. Likewise, the visualization and characterization tools along with the current challenges associated with waste-water surveillance, food security, contact tracing, and their role during this intense period of the pandemic have also been discussed. We expect that the integrated data will be supportive and aid in the evaluation of sensing technologies not only in current but also future pandemics.
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Affiliation(s)
- Umay Amara
- Institute of Chemical Sciences, Bahauddin Zakariya University Multan 608000 Pakistan
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS University Islamabad Lahore Campus 54000 Pakistan
| | - Sidra Rashid
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS University Islamabad Lahore Campus 54000 Pakistan
| | - Khalid Mahmood
- Institute of Chemical Sciences, Bahauddin Zakariya University Multan 608000 Pakistan
| | - Mian Hasnain Nawaz
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS University Islamabad Lahore Campus 54000 Pakistan
| | - Akhtar Hayat
- Interdisciplinary Research Centre in Biomedical Materials (IRCBM), COMSATS University Islamabad Lahore Campus 54000 Pakistan
| | - Maria Hassan
- Institute of Chemical Sciences, Bahauddin Zakariya University Multan 608000 Pakistan
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Ahmadi E, Bagherpour Z, Zarei E, Omidkhoda A. Pathological effects of SARS-CoV-2 on hematological and immunological cells: Alterations in count, morphology, and function. Pathol Res Pract 2022; 231:153782. [PMID: 35121363 PMCID: PMC8800420 DOI: 10.1016/j.prp.2022.153782] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 01/08/2023]
Abstract
The novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19 outbreak, spread rapidly and infected more than 140 million people with more than three million victims worldwide. The SARS-CoV-2 causes destructive changes in the immunological and hematological system of the host. These alterations appear to play a critical role in disease pathology and the emerging of clinical manifestations. In this review, we aimed to discuss the effect of COVID-19 on the count, function and morphology of immune and blood cells and the role of these changes in the pathophysiology of the disease. Knowledge of these changes may help with better management and treatment of COVID-19 patients.
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Affiliation(s)
- Ehsan Ahmadi
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Bagherpour
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elmira Zarei
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Omidkhoda
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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Vincent JL, Levi M, Hunt BJ. Prevention and management of thrombosis in hospitalised patients with COVID-19 pneumonia. THE LANCET. RESPIRATORY MEDICINE 2022; 10:214-220. [PMID: 34838161 PMCID: PMC8616572 DOI: 10.1016/s2213-2600(21)00455-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 12/13/2022]
Abstract
A proportion of people infected with SARS-CoV-2 develop moderate or severe COVID-19, with an increased risk of thromboembolic complications. The inflammatory response to SARS-CoV-2 infection can cause an acute-phase response and endothelial dysfunction, which contribute to COVID-19-associated coagulopathy, the clinical and laboratory features of which differ in some respects from those of classic disseminated intravascular coagulation. Understanding of the pathophysiology of thrombosis in COVID-19 is needed to develop approaches to management and prevention, with implications for short-term and long-term health outcomes. Evidence is emerging to support treatment decisions in patients with COVID-19, but many questions remain about the optimum approach to management. In this Viewpoint, we provide a summary of the pathophysiology of thrombosis and associated laboratory and clinical findings, and highlight key considerations in the management of coagulopathy in hospitalised patients with severe COVID-19, including coagulation assessment, identification of thromboembolic complications, and use of antithrombotic prophylaxis and therapeutic anticoagulation. We await the results of trials that are underway to establish the safety and benefits of prolonged thromboprophylaxis after hospital discharge.
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Affiliation(s)
- Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Marcel Levi
- Department of Medicine and Cardiometabolic Programme-National Institute for Health Research UCLH/UCL Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK; Department of Vascular Medicine, Amsterdam University Medical Center (location Academic Medical Center), Amsterdam, Netherlands
| | - Beverley J Hunt
- Kings Healthcare Partners and Thrombosis & Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Heber S, Pereyra D, Schrottmaier WC, Kammerer K, Santol J, Rumpf B, Pawelka E, Hanna M, Scholz A, Liu M, Hell A, Heiplik K, Lickefett B, Havervall S, Traugott MT, Neuböck MJ, Schörgenhofer C, Seitz T, Firbas C, Karolyi M, Weiss G, Jilma B, Thålin C, Bellmann-Weiler R, Salzer HJF, Szepannek G, Fischer MJM, Zoufaly A, Gleiss A, Assinger A. A Model Predicting Mortality of Hospitalized Covid-19 Patients Four Days After Admission: Development, Internal and Temporal-External Validation. Front Cell Infect Microbiol 2022; 11:795026. [PMID: 35141170 PMCID: PMC8819729 DOI: 10.3389/fcimb.2021.795026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To develop and validate a prognostic model for in-hospital mortality after four days based on age, fever at admission and five haematological parameters routinely measured in hospitalized Covid-19 patients during the first four days after admission. Methods Haematological parameters measured during the first 4 days after admission were subjected to a linear mixed model to obtain patient-specific intercepts and slopes for each parameter. A prediction model was built using logistic regression with variable selection and shrinkage factor estimation supported by bootstrapping. Model development was based on 481 survivors and 97 non-survivors, hospitalized before the occurrence of mutations. Internal validation was done by 10-fold cross-validation. The model was temporally-externally validated in 299 survivors and 42 non-survivors hospitalized when the Alpha variant (B.1.1.7) was prevalent. Results The final model included age, fever on admission as well as the slope or intercept of lactate dehydrogenase, platelet count, C-reactive protein, and creatinine. Tenfold cross validation resulted in a mean area under the receiver operating characteristic curve (AUROC) of 0.92, a mean calibration slope of 1.0023 and a Brier score of 0.076. At temporal-external validation, application of the previously developed model showed an AUROC of 0.88, a calibration slope of 0.95 and a Brier score of 0.073. Regarding the relative importance of the variables, the (apparent) variation in mortality explained by the six variables deduced from the haematological parameters measured during the first four days is higher (explained variation 0.295) than that of age (0.210). Conclusions The presented model requires only variables routinely acquired in hospitals, which allows immediate and wide-spread use as a decision support for earlier discharge of low-risk patients to reduce the burden on the health care system. Clinical Trial Registration Austrian Coronavirus Adaptive Clinical Trial (ACOVACT); ClinicalTrials.gov, identifier NCT04351724.
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Affiliation(s)
- Stefan Heber
- Institute of Physiology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - David Pereyra
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Waltraud C. Schrottmaier
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Kerstin Kammerer
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Jonas Santol
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Benedikt Rumpf
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Erich Pawelka
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Markus Hanna
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alexander Scholz
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Markus Liu
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Agnes Hell
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Klara Heiplik
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Benno Lickefett
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Sebastian Havervall
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | | | - Matthias J. Neuböck
- Department of Pulmonology, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - Christian Schörgenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Christa Firbas
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Mario Karolyi
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria
| | - Charlotte Thålin
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut J. F. Salzer
- Department of Pulmonology, Kepler University Hospital and Johannes Kepler University, Linz, Austria
| | - Gero Szepannek
- Institute of Applied Computer Science, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Michael J. M. Fischer
- Institute of Physiology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alexander Zoufaly
- Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Andreas Gleiss
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Alice Assinger
- Department of Vascular Biology and Thrombosis Research, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
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Jeon JP, Lee SJ, Kim C. Impact of Dementia on Mortality Due to Coronavirus Disease 2019: Propensity-Score-Matching Study. J Clin Neurol 2022; 18:79-86. [PMID: 35021280 PMCID: PMC8762493 DOI: 10.3988/jcn.2022.18.1.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with dementia are particularly vulnerable to coronavirus disease 2019 (COVID-19) because they tend to be older and often have concomitant diseases. Previous studies have investigated the impact of dementia on COVID-19 outcomes, but the evidence is not robust for Asian populations. We aimed to determine the relationship between dementia and COVID-19 outcomes using data from a large-scale nationwide public database. METHODS Data on patients with COVID-19 who were released from quarantine between January 1, 2020 and April 30, 2020, published by the Korea Disease Control and Prevention Agency, were divided into two groups based on the dementia status. Propensity-score matching was used to adjust for multiple confounders between the dementia and no-dementia groups. Binary, ordinal logistic regression and multivariate Cox proportional-hazards models were used to compare mortality, quarantine duration, and clinical deterioration according to the dementia status in the two groups. RESULTS Males and older individuals (age ≥60 years) constituted 41.5% and 32.9%, respectively, of the 5,299 patients. The prevalence of dementia was 4.2%, and 4.5% of the participants died during hospitalization. In multivariate analysis, dementia was significantly associated with increased mortality (odds ratio [OR]=2.80, 95% confidence interval [CI]=1.60-4.60), longer duration of quarantine (hazard ratio=1.69, 95% CI=1.16-2.45), and larger shift to a worse clinical severity (common OR=1.74, 95% CI=1.18-2.61). CONCLUSIONS After adjusting for important clinical predictors, dementia was associated with increased in-hospital mortality, duration of quarantine, and clinical deterioration during hospitalization in COVID-19 patients.
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Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Su Jung Lee
- School of Nursing, Hallym University, Chuncheon, Korea
| | - Chulho Kim
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
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Barale C, Melchionda E, Morotti A, Russo I. Prothrombotic Phenotype in COVID-19: Focus on Platelets. Int J Mol Sci 2021; 22:ijms222413638. [PMID: 34948438 PMCID: PMC8705811 DOI: 10.3390/ijms222413638] [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: 11/26/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 infection is associated with a broad spectrum of presentations, but alveolar capillary microthrombi have been described as a common finding in COVID-19 patients, appearing as a consequence of a severe endothelial injury with endothelial cell membrane disruption. These observations clearly point to the identification of a COVID-19-associated coagulopathy, which may contribute to thrombosis, multi-organ damage, and cause of severity and fatality. One significant finding that emerges in prothrombotic abnormalities observed in COVID-19 patients is that the coagulation alterations are mainly mediated by the activation of platelets and intrinsically related to viral-mediated endothelial inflammation. Beyond the well-known role in hemostasis, the ability of platelets to also release various potent cytokines and chemokines has elevated these small cells from simple cell fragments to crucial modulators in the blood, including their inflammatory functions, that have a large influence on the immune response during infectious disease. Indeed, platelets are involved in the pathogenesis of acute lung injury also by promoting NET formation and affecting vascular permeability. Specifically, the deposition by activated platelets of the chemokine platelet factor 4 at sites of inflammation promotes adhesion of neutrophils on endothelial cells and thrombogenesis, and it seems deeply involved in the phenomenon of vaccine-induced thrombocytopenia and thrombosis. Importantly, the hyperactivated platelet phenotype along with evidence of cytokine storm, high levels of P-selectin, D-dimer, and, on the other hand, decreased levels of fibrinogen, von Willebrand factor, and thrombocytopenia may be considered suitable biomarkers that distinguish the late stage of COVID-19 progression in critically ill patients.
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Affiliation(s)
| | | | | | - Isabella Russo
- Correspondence: ; Tel.: +39-011-6705447; Fax: +39-011-9038639
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Mizurini DM, Hottz ED, Bozza PT, Monteiro RQ. Fundamentals in Covid-19-Associated Thrombosis: Molecular and Cellular Aspects. Front Cardiovasc Med 2021; 8:785738. [PMID: 34977191 PMCID: PMC8718518 DOI: 10.3389/fcvm.2021.785738] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease (COVID-19) is associated with a high incidence of coagulopathy and venous thromboembolism that may contribute to the worsening of the clinical outcome in affected patients. Marked increased D-dimer levels are the most common laboratory finding and have been repeatedly reported in critically ill COVID-19 patients. The infection caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is followed by a massive release of pro-inflammatory cytokines, which mediate the activation of endothelial cells, platelets, monocytes, and neutrophils in the vasculature. In this context, COVID-19-associated thrombosis is a complex process that seems to engage vascular cells along with soluble plasma factors, including the coagulation cascade, and complement system that contribute to the establishment of the prothrombotic state. In this review, we summarize the main findings concerning the cellular mechanisms proposed for the establishment of COVID-19-associated thrombosis.
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Affiliation(s)
- Daniella M. Mizurini
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Eugenio D. Hottz
- Oswaldo Cruz Foundation, Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
- Laboratory of Immunothrombosis, Department of Biochemistry, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Patrícia T. Bozza
- Oswaldo Cruz Foundation, Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Robson Q. Monteiro
- Institute of Medical Biochemistry Leopoldo de Meis, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Bayram M, Yildirim O, S Ozmen R, Soylu B, Dundar AS, Koksal AR, Ekinci I, Akarsu M, Tabak O. Prognostic Nutritional Index and CRP, age, platelet count, albumin level score in predicting mortality and intensive care unit admission for COVID-19. Biomark Med 2021; 15:1733-1740. [PMID: 34784756 PMCID: PMC8597666 DOI: 10.2217/bmm-2021-0337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/06/2021] [Indexed: 01/27/2023] Open
Abstract
Aim: In our study, we investigated the efficiency of the prognostic nutritional index (PNI) score and the CRP, age, platelet count, albumin level (CAPA) score predicting mortality and intensive care unit (ICU) admission in COVID-19 disease. Materials & methods: PNI and CAPA score of patients confirmed with COVID-19 calculated by using the complete blood count and biochemical parameters at admission to the hospital, in predicting the COVID-19-associated mortality and ICU admission were analyzed. Results: PNI and CAPA scores in predicting mortality were detected as AUC: 0.67 (p < 0.001), AUC: 0.71 (p < 0.001), respectively. For predicting ICU admission AUC was 0.66 (p < 0.001), AUC was 0.77 (p < 0.001), respectively. Conclusion: PNI and CAPA scores are effective scores in COVID-19, with CAPA score being better in predicting mortality and ICU admission.
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Affiliation(s)
- Mehmet Bayram
- Department of Gastroenterology, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Ozgur Yildirim
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Raye S Ozmen
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Beyza Soylu
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Ahmet S Dundar
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Ali R Koksal
- Department of Gastroenterology & Hepatology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Iskender Ekinci
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Murat Akarsu
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
| | - Omur Tabak
- Department of Internal Medicine, Health Sciences University Kanuni Sultan Süleyman Training & Research Hospital, İstanbul, 34303, Turkey
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Barrett TJ, Bilaloglu S, Cornwell M, Burgess HM, Virginio VW, Drenkova K, Ibrahim H, Yuriditsky E, Aphinyanaphongs Y, Lifshitz M, Xia Liang F, Alejo J, Smith G, Pittaluga S, Rapkiewicz AV, Wang J, Iancu-Rubin C, Mohr I, Ruggles K, Stapleford KA, Hochman J, Berger JS. Platelets contribute to disease severity in COVID-19. J Thromb Haemost 2021; 19:3139-3153. [PMID: 34538015 PMCID: PMC8646651 DOI: 10.1111/jth.15534] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Heightened inflammation, dysregulated immunity, and thrombotic events are characteristic of hospitalized COVID-19 patients. Given that platelets are key regulators of thrombosis, inflammation, and immunity they represent prime candidates as mediators of COVID-19-associated pathogenesis. The objective of this study was to understand the contribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the platelet phenotype via phenotypic (activation, aggregation) and transcriptomic characterization. APPROACH AND RESULTS In a cohort of 3915 hospitalized COVID-19 patients, we analyzed blood platelet indices collected at hospital admission. Following adjustment for demographics, clinical risk factors, medication, and biomarkers of inflammation and thrombosis, we find platelet count, size, and immaturity are associated with increased critical illness and all-cause mortality. Bone marrow, lung tissue, and blood from COVID-19 patients revealed the presence of SARS-CoV-2 virions in megakaryocytes and platelets. Characterization of COVID-19 platelets found them to be hyperreactive (increased aggregation, and expression of P-selectin and CD40) and to have a distinct transcriptomic profile characteristic of prothrombotic large and immature platelets. In vitro mechanistic studies highlight that the interaction of SARS-CoV-2 with megakaryocytes alters the platelet transcriptome, and its effects are distinct from the coronavirus responsible for the common cold (CoV-OC43). CONCLUSIONS Platelet count, size, and maturity associate with increased critical illness and all-cause mortality among hospitalized COVID-19 patients. Profiling tissues and blood from COVID-19 patients revealed that SARS-CoV-2 virions enter megakaryocytes and platelets and associate with alterations to the platelet transcriptome and activation profile.
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Affiliation(s)
- Tessa J Barrett
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Seda Bilaloglu
- Department of Population Health, New York University Langone Health, New York, New York, USA
| | - Macintosh Cornwell
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Hannah M Burgess
- Department of Microbiology, New York University Langone Health, New York, New York, USA
| | - Vitor W Virginio
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Kamelia Drenkova
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Homam Ibrahim
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Eugene Yuriditsky
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Yin Aphinyanaphongs
- Department of Population Health, New York University Langone Health, New York, New York, USA
| | - Mark Lifshitz
- Department of Pathology, New York University Langone Health, New York, New York, USA
| | - Feng Xia Liang
- DART Microscopy Laboratory, New York University Langone Health, New York, New York, USA
| | - Julie Alejo
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Grace Smith
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stefania Pittaluga
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy V Rapkiewicz
- Department of Pathology, NYU Winthrop Hospital, New York University Langone Health, Mineola, New York, USA
| | - Jun Wang
- Department of Pathology, New York University Langone Health, New York, New York, USA
| | - Camelia Iancu-Rubin
- Department of Pathology, Molecular and Cell-Based Medicine, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ian Mohr
- Department of Microbiology, New York University Langone Health, New York, New York, USA
| | - Kelly Ruggles
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Kenneth A Stapleford
- Department of Microbiology, New York University Langone Health, New York, New York, USA
| | - Judith Hochman
- Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Jeffrey S Berger
- Department of Medicine, New York University Langone Health, New York, New York, USA
- Department of Surgery, New York University Langone Health, New York, New York, USA
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Zyani A, Elyachioui K, Treyi C, Aabdi M, Sbai H. A rare case of intracerebral hemorrhage complicating heparin-induced thrombocytopenia in a COVID-19 patient. Ann Med Surg (Lond) 2021; 72:103070. [PMID: 34840776 PMCID: PMC8605820 DOI: 10.1016/j.amsu.2021.103070] [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: 09/27/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Heparin-induced thrombocytopenia is a rare complication of heparin therapy associated with thrombocytopenia and mainly thrombotic complications. Case report we herein describe a case of a woman hospitalized for management of a severe case of COVID-19 treated with low molecular weight heparin, who developed heparin-induced thrombocytopenia complicated by intracerebral hemorrhage with no thrombotic complications. Conclusion Discontinuation of heparin was effective without the use of other non-heparin anticoagulants, platelet transfusion or plasmapheresis. HIT is a rare complication of LMWH, it is associated with thrombocytopenia and mainly thrombotic complications. In this paper we will report a rare complication of HIT : ICH in a 63 years old woman admitted for covid 19-infection. Discontinuation of heparin was effective without the use of other non-heparin anticoagulants, platelet transfusion or plasmapheresis.
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Affiliation(s)
- A Zyani
- Anesthesiology and Intensive Care Unit, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
| | - K Elyachioui
- Anesthesiology and Intensive Care Unit, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
| | - C Treyi
- Anesthesiology and Intensive Care Unit, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
| | - M Aabdi
- Anesthesiology and Intensive Care Unit, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
| | - H Sbai
- Anesthesiology and Intensive Care Unit, Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tangier, Morocco
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Brain D, Plant-Hately A, Heaton B, Arshad U, David C, Hedrich C, Owen A, Liptrott NJ. Drug delivery systems as immunomodulators for therapy of infectious disease: Relevance to COVID-19. Adv Drug Deliv Rev 2021; 178:113848. [PMID: 34182016 PMCID: PMC8233062 DOI: 10.1016/j.addr.2021.113848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
The emergence of SARS-CoV-2, and the ensuing global pandemic, has resulted in an unprecedented response to identify therapies that can limit uncontrolled inflammation observed in patients with moderate to severe COVID-19. The immune pathology behind COVID-19 is complex and involves the activation and interaction of multiple systems including, but not limited to, complement, inflammasomes, endothelial as well as innate and adaptive immune cells to bring about a convoluted profile of inflammation, coagulation and tissue damage. To date, therapeutic approaches have focussed on inhibition of coagulation, untargeted immune suppression and/or cytokine-directed blocking agents. Regardless of recently achieved improvements in individual patient outcomes and survival rates, improved and focussed approaches targeting individual systems involved is needed to further improve prognosis and wellbeing. This review summarizes the current understanding of molecular and cellular systems involved in the pathophysiology of COVID-19, and their contribution to pathogen clearance and damage to then discuss possible therapeutic options involving immunomodulatory drug delivery systems as well as summarising the complex interplay between them.
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Affiliation(s)
- Danielle Brain
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK,Centre of Excellence for Long-acting Therapeutics (CELT), Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alex Plant-Hately
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK,Centre of Excellence for Long-acting Therapeutics (CELT), Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Bethany Heaton
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK,Centre of Excellence for Long-acting Therapeutics (CELT), Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Usman Arshad
- Centre of Excellence for Long-acting Therapeutics (CELT), Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Christopher David
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK,Centre of Excellence for Long-acting Therapeutics (CELT), Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Christian Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK,Department of Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Andrew Owen
- Centre of Excellence for Long-acting Therapeutics (CELT), Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Neill J. Liptrott
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK,Centre of Excellence for Long-acting Therapeutics (CELT), Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK,Corresponding author at: Materials Innovation Factory, University of Liverpool, Liverpool, UK
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Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2. Over the past year, COVID-19 has posed a significant threat to global health. Although the infection is associated with mild symptoms in many patients, a significant proportion of patients develop a prothrombotic state due to a combination of alterations in coagulation and immune cell function. The purpose of this review is to discuss the pathophysiological characteristics of COVID-19 that contribute to the immunothrombosis. RECENT FINDINGS Endotheliopathy during COVID-19 results in increased multimeric von Willebrand factor release and the potential for increased platelet adhesion to the endothelium. In addition, decreased anticoagulant proteins on the surface of endothelial cells further alters the hemostatic balance. Soluble coagulation markers are also markedly dysregulated, including plasminogen activator inhibitor-1 and tissue factor, leading to COVID-19 induced coagulopathy. Platelet hyperreactivity results in increased platelet-neutrophil and -monocyte aggregates further exacerbating the coagulopathy observed during COVID-19. Finally, the COVID-19-induced cytokine storm primes neutrophils to release neutrophil extracellular traps, which trap platelets and prothrombotic proteins contributing to pulmonary thrombotic complications. SUMMARY Immunothrombosis significantly contributes to the pathophysiology of COVID-19. Understanding the mechanisms behind COVID-19-induced coagulopathy will lead to future therapies for patients.
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Affiliation(s)
- Irina Portier
- University of Utah Molecular Medicine Program, Salt Lake City, Utah, 84112
| | - Robert A. Campbell
- University of Utah Molecular Medicine Program, Salt Lake City, Utah, 84112
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, 84132
| | - Frederik Denorme
- University of Utah Molecular Medicine Program, Salt Lake City, Utah, 84112
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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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44
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Khot R, Kumbhalkar SD, Juneja R, Joshi PP. The Development of Ecchymosis after Administration of Convalescent Serum in a Patient with COVID-19 Associated with Thrombocytosis. Eur J Case Rep Intern Med 2021; 8:002782. [PMID: 34671574 DOI: 10.12890/2021_002782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
COVID-19 can have an unpredictable and severe course, leading to many hypotheses regarding its pathophysiology and clinical manifestations. Haematological manifestations are a significant predictor of disease severity. The most common observation is lymphopenia with an increased neutrophil:lymphocyte ratio. Platelets have been implicated in thrombogenic events, but the most frequently reported abnormality is mild thrombocytopenia. Here we present an interesting case of a patient with moderate COVID-19 who presented with cutaneous ecchymoses and thrombocytosis, and discuss this paradox. LEARNING POINTS Bleeding manifestations such as ecchymoses can occur as an idiosyncratic reaction to the administration of convalescent plasma therapy in COVID-19.Thrombocytosis can occur in COVID-19 and could be a contributory factor to disease vasculopathy.
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Affiliation(s)
- Rajashree Khot
- Department of General Medicine, AIIMS, Nagpur, Maharashtra, India
| | | | - Richa Juneja
- Department of Pathology (Haematology), AIIMS, Nagpur, Maharashtra, India
| | - Prashant P Joshi
- Department of General Medicine, AIIMS, Nagpur, Maharashtra, India
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45
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Endothelial Activation and Stress Index (EASIX) as an Early Predictor for Mortality and Overall Survival in Hematological and Non-Hematological Patients with COVID-19: Multicenter Cohort Study. J Clin Med 2021; 10:jcm10194373. [PMID: 34640390 PMCID: PMC8509351 DOI: 10.3390/jcm10194373] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022] Open
Abstract
COVID-19, as a disease involving the endothelium of multiple organs, is characterized by high mortality rates among hospitalized patients. Patients with hematological malignancies are particularly at risk of an unfavorable course of COVID-19. The endothelial activation and stress index (EASIX) score has been used as a simple predictor of overall survival (OS) in specific groups of hematological cancer patients. EASIX, as a biomarker of endothelial dysfunction, might play a prognostic role in patients with COVID-19. Here, we performed a comprehensive retrospective analysis of the EASIX score in 523 hospitalized COVID-19 patients with or without coexisting hematological cancer. Hematological cancer COVID-19 patients had higher EASIX scores compared to the overall population with COVID-19. In hematological patients, EASIX was a strong predictor of the occurrence of sepsis during COVID-19. Our findings demonstrated EASIX as a strong predictor of intensive care unit admission, in-hospital mortality, the occurrence of acute renal failure and the need for hemodialysis, both in hematological and non-hematological COVID-19 patients. Patients with a high EASIX score on COVID-19 diagnosis had significantly inferior OS compared to patients with low EASIX. We showed for the first time that EASIX might serve as a simple, universal prognostic tool of OS in both hematological and non-hematological COVID-19 patients.
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46
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YILDIRIM Ö, BAYRAM M, ÖZMEN RS, SOYLU B, DÜNDAR AS, KÖKSAL AR, EKİNCİ I, AKARSU M, TABAK Ö. Evaluation of hematological indices in terms of COVID-19 related mortality and ICU admission. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.949299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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47
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Hossein Kazemi M, Kuhestani Dehaghi B, Roshandel E, Bonakchi H, Parkhideh S, Mehdizadeh M, Hajifathali A. Association of HScore Parameters with Severe COVID-19: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:322-338. [PMID: 34539007 PMCID: PMC8438337 DOI: 10.30476/ijms.2021.88404.1910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/20/2020] [Accepted: 01/23/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Several reports have associated the severe Coronavirus disease-2019 (sCOVID-19) with secondary-hemophagocytic lymphohistiocytosis (sHLH) and proposed utilizing the hemophagocytic syndrome diagnostic score (HScore) for sCOVID-19 patients. We conducted a systematic review and meta-analysis to find the possible association of HScore parameters with severity in COVID-19 patients. METHODS A systematic search was performed in Medline via PubMed, EMBASE, and Cochrane databases using all HScore and COVID-19 keywords. The studies were all from 2020, and the study language was limited to English. The records were screened based on inclusion/exclusion criteria. Random/fixed-effect models were employed for meta-analysis, based on the I2 index of parameters. The pooled mean differences were estimated for continuous parameters. The pooled odds-ratio was estimated for fever. The level of significance was set at 0.05. RESULTS Eighteen studies (comprising 2459 patients) out of 26151 screened studies were included in this meta-analysis. The results showed that the level of leukocyte, neutrophil, aspartate transaminase (AST), ferritin, and fibrinogen were significantly higher in sCOVID-19 patients than in non-severe ones. Significant lower levels of lymphocyte, platelet, and hemoglobin were also found in sCOVID-19 patients than non-severe patients. Fever was nearly associated with two times increased odds of sCOVID-19 (P=0.051). CONCLUSION Lymphopenia, thrombocytopenia, hypohemoglobinemia, hyperferritinemia, high levels of AST, and fever are common features of both sCOVID-19 and HLH. However, the leukocytosis, neutrophilia, and hyperfibrinogenemia found in sCOVID-19 are in contrast with HScore. Conclusively, HScore parameters could be risk factors for sCOVID-19. However, some parameters' roles are contradictory, suggesting the need for further investigation and a new way of HScore interpretation in sCOVID-19 patients.A preprint of this study was published at https://www.researchsquare.com/article/rs-54490/v2.
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Affiliation(s)
- Mohammad Hossein Kazemi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bentolhoda Kuhestani Dehaghi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Roshandel
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Bonakchi
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayeh Parkhideh
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Mehdizadeh
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Hajifathali
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Huyut MT, İlkbahar F. The effectiveness of blood routine parameters and some biomarkers as a potential diagnostic tool in the diagnosis and prognosis of Covid-19 disease. Int Immunopharmacol 2021; 98:107838. [PMID: 34303274 PMCID: PMC8169318 DOI: 10.1016/j.intimp.2021.107838] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/29/2021] [Accepted: 05/29/2021] [Indexed: 01/08/2023]
Abstract
Since February-2020, the world has been battling a tragic public-health crisis with the emergence and spread of 2019-nCoV. Due to the lack of information about the pathogenesis-specific treatment of Covid-19, early diagnosis and timely treatment are important. However, there is still a lack of information about routine-blood-parameteres (RBP) findings and effects in the disease process. Although the literature includes various interventions, existing studies need to be generalized and their reliability improved. In this study, the efficacy of routine blood values used in the diagnosis and prognosis of Covid-19 and independent biomarkers obtained from them were evaluated retrospectively in a large patient group. Low lymphocyte (LYM) and white-blood-cell (WBC), high CRP and Ferritin were effective in the diagnosis of the disease. The (d-CWL) = CRPWBC∗LYM and (d-CFL) = CRP∗FerritinLYM biomarkers derived from them were the most important risk factors in diagnosing the disease and were more successful than direct RBP values. High d-CWL and d-CFL values largely confirmed the Covid-19 diagnosis. The most effective RBP in the prognosis of the disease was CRP. (d-CIT) = CRP*INR*Troponin; (d-CT) = CRP*Troponin; (d-PPT) = PT*Troponin*Procalcitonin biomarkers were found to be more successful than direct RBP values and biomarkers used in previous studies in the prognosis of the disease. In this study, biomarkers derived from RBP were found to be more successful in both diagnosis and prognosis of Covid-19 than previously used direct RBP and biomarkers.
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Affiliation(s)
- Mehmet Tahir Huyut
- Erzincan Binali Yıldırım Unversıty, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Erzincan, Turkey.
| | - Fatih İlkbahar
- Duzce University, Department of Management Information Systems, Düzce, Turkey
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Fard MB, Fard SB, Ramazi S, Atashi A, Eslamifar Z. Thrombosis in COVID-19 infection: Role of platelet activation-mediated immunity. Thromb J 2021; 19:59. [PMID: 34425822 PMCID: PMC8380864 DOI: 10.1186/s12959-021-00311-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023] Open
Abstract
Background Thrombosis plays an important role in the Coronavrus Disease 2019 (COVID-19) infection-related complications such as acute respiratory distress syndrome and myocardial infarction. Multiple factors such as oxygen demand injuries, endothelial cells injury related to infection, and plaque formation. Main body Platelets obtained from the patients may have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, showing that the increased activation potential recommends platelet can be hyper-activated in severely ill SARS-CoV-2 cases. Platelets contain multiple receptors that interact with specific ligands. Pathogen’s receptors such as Toll-like receptors (TLRs), NOD-like receptor, C-type lectin receptor family, glycoprotein (GP) such as GPαIIbβ3 and GPIbα which allow pathogens to interact with platelets. Platelet TLRs and NOD2 are involved in platelet activation and thrombosis. Accordingly, TLRs are critical receptors that could recognize various endogenous damage-associated molecular patterns and exogenous pathogen-associated molecular patterns (PAMPs). TLRs are considered as important components in the activation of innate immunity response against pathogenic and non-pathogenic components like damaged tissues. TLRs-1,-2,-4,-6,-7 expression on or within platelets has been reported previously. Various PAMPs were indicated to be capable of binding to platelet-TLRs and inducing both the activation and promotion of downstream proinflammatory signaling cascade. Conclusion It is possible that the increased TLRs expression and TLR-mediated platelets activation during COVID-19 may enhance vascular and coronary thrombosis. It may be hypothesized using TLRs antagonist and monoclonal antibody against P-selectin, as the marker of leukocyte recruitment and platelet activation, besides viral therapy provide therapeutic advances in fighting against the thrombosis related complications in COVID-19.
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Affiliation(s)
| | | | - Shahin Ramazi
- Department of biophysics, faculty of biological sciences, Tarbiat Modares University, Tehran, Iran
| | - Amir Atashi
- Stem cell and tissue engineering research center, Shahroud university of medical sciences, Shahroud, Iran
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50
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Salva O, Alasino R, Giller C, Borello J, Doresky A, Karayan G, Beltramo D. Nebulization with alkaline hipertonic ibuprofen induces a rapid increase in platelets circulating in COVID-19 patients but not in healthy subjects. Platelets 2021; 33:471-478. [PMID: 34423724 DOI: 10.1080/09537104.2021.1967918] [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: 10/20/2022]
Abstract
We analyze changes in circulating platelets in COVID-19 positive patients who received conventional treatment Dexamethasone and Enoxaparin (Dexa-Enoxa) compared to patients treated with conventional therapy plus nebulization with alkaline hypertonic ibuprofenate (AHI). Results show that after 24 h of nebulization with AHI, circulating platelets shows an increase about 40% at 24 h and reach 65% at 96 h. In patients with platelets content below 200,000 by microliter the increase was 49% and 79% at 24 and 96 h respectively. In patients with platelets above 200,000 by microliter the increase was 24% and 31% at 24 and 96 h, respectively. The increase of platelets via AHI was similar in both, men and women.To evaluate whether this action of AHI was related to platelets from COVID-19 positive patients or also for healthy people, two controls were included: one of them with 10 healthy volunteers and another one with COVID-19 positive patients hospitalized and treated only with Dexa-Enoxa. Results show that, in healthy volunteers, the number of circulating platelets remains unchanged even after 7 days of treatment with AHI. In COVID-19 positive patients treated only with Dexa-Enoxa for 4 days, platelets increased only 16%.
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Affiliation(s)
- Oscar Salva
- Departamento de Clínica Médica, Clínica Independencia, Ciudad de Munro, Provincia de Buenos Aires, Argentina
| | - Roxana Alasino
- Programa de Biociencias, Centro De Excelencias En Productos Y Procesos (CEPROCOR), Ministerio de Ciencia y Tecnología de la Provincia de Córdoba, Cordoba, Argentina.,Consejo Nacional de Investigaciones Científicas (CONICET), Ministerio de Ciencia Tecnología e Innovación de la República Argentina, Provincia de Buenos Aires, Argentina
| | - Celia Giller
- Departamento de Clínica Médica, Clínica Independencia, Ciudad de Munro, Provincia de Buenos Aires, Argentina
| | - Julieta Borello
- Programa de Biociencias, Centro De Excelencias En Productos Y Procesos (CEPROCOR), Ministerio de Ciencia y Tecnología de la Provincia de Córdoba, Cordoba, Argentina
| | - Alexis Doresky
- Departamento de Investiagación Clinica, Fundación Respirar, Ciudad Autónoma de Buenos Aires, Provincia de Buenos Aires, Argentina
| | - Galia Karayan
- Departamento de Investiagación Clinica, Fundación Respirar, Ciudad Autónoma de Buenos Aires, Provincia de Buenos Aires, Argentina
| | - Dante Beltramo
- Programa de Biociencias, Centro De Excelencias En Productos Y Procesos (CEPROCOR), Ministerio de Ciencia y Tecnología de la Provincia de Córdoba, Cordoba, Argentina.,Consejo Nacional de Investigaciones Científicas (CONICET), Ministerio de Ciencia Tecnología e Innovación de la República Argentina, Provincia de Buenos Aires, Argentina
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