Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study

Ozoliņa, Agnese; Šarkele, Marina; Sabeļņikovs, Oļegs; Šķesters, Andrejs; Jaunalksne, Inta; Serova, Jeļena; Bjertnæs, Lars J.; Vanags, Indulis

doi:10.37247/pamed2ed.2.2020.12

Cited by 8 publications

(11 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, non-survivors had significantly lower platelet counts than survivors, suggesting that low platelet counts are associated with poor prognosis in ARDS. This finding is also supported by several studies showing that platelet count is an independent predictor of mortality in ARDS patients [38,40,41]. Furthermore, our findings are consistent with the study by Wang et al [42] that thrombocytopenia accelerate the progression of ARDS and increase mortality in critically ill patients.…”

Section: Discussionsupporting

confidence: 93%

“…Coagulation dysfunction in patients with ARDS is mainly due to the exposure and interaction of tissue factor (TF) with neutrophil elastase, resulting in the activation of coagulation cascade [25,37]. In the prospective study by Ozolina et al [40], patients who developed ARDS had significantly higher plasma TF than patients who did not develop ARDS. Therefore, neutrophil elastase inhibitors have been reported to improve the prognosis of ARDS associated with sever sepsis [45] and are also recommended for management of ARDS with coagulopathy caused by COVID-19 [46].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic value of neutrophils to lymphocytes and platelets ratio for 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study

et al. 2022

View full text Add to dashboard Cite

Background Acute respiratory distress syndrome (ARDS) is a rapidly progressive and fatal respiratory failure disease that often occurs in critically ill patients. Since ARDS is associated with immune dysregulation and coagulation abnormalities, it is necessary to identify an appropriate predictor that can accurately predict ARDS mortality based on its pathophysiology. Therefore, this study aimed to evaluate the clinical value of neutrophils to lymphocytes and platelets ratio (N/LPR) in predicting 28-day mortality in ARDS patients. Methods From July 2018 to October 2021, the medical records of ARDS patients were retrospective reviewed. Neutrophil count, lymphocyte count, and platelet count were collected, and the neutrophil-to-lymphocyte ratio (NLR) and N/LPR were calculated. Multivariate logistic regression analyses were performed to identify independent predictors of 28-day mortality in ARDS. Receiver operating characteristic (ROC) curve with the area under curve (AUC) was used to evaluate optimal cut-off values for 28-day mortality in ARDS. Kaplan–Meier analysis was used to estimate the 28-day survival probabilities stratified by optimal cut-off values of N/LPR and NLR. Results A total of 136 ARDS patients were included in this study and were further divided into survivors (n = 69) and non-survivors (n = 67) groups according to their survival status on day 28. There were no significant differences between the two groups in age, sex, history of smoking and drinking, comorbidities, and reasons of admission (P > 0.05). Non-survivors had significantly higher neutrophil counts, NLR and N/LPR and had significantly lower platelet counts than survivors (P < 0.05). Multivariate regression analysis revealed that N/LPR, NLR and platelet counts were independent predictors for 28-day mortality in ARDS (P < 0.05). The ROC analyses showed that N/LPR with optimal cut-off value of 10.57 (sensitivity: 74.6%; specificity: 72.5%) is a more reliable predictor for 28-day mortality in ARDS than NLR and platelet count (AUC: 0.785 vs. 0.679 vs. 0.326). Further subgroup analysis confirmed that ARDS patients with N/LPR < 10.57 had significantly lower 28-day mortality than patients with N/LPR ≥ 10.57 (P < 0.001). Kaplan–Meier analysis also confirmed that ARDS patients with N/LPR < 10.57 had significantly longer survival. Conclusion N/LPR is an independent risk factor associated with 28-day mortality in ARDS patients and shows better performance in predicting mortality rate than NLR.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Prognostic value of neutrophils to lymphocytes and platelets ratio for 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…83 This concept is supported by evidence of increased PAI-1 activity that is common in patients with ARDS, and which cumulatively contributes to a declining clinical status by inhibiting fibrinolysis, thus worsening the thrombotic burden. 84,85 As noted above, PAI-1 levels have been reported to be elevated in patients with severe COVID-19. 50 On the contrary, elevated levels of bradykinin likely occur due to the inflammatory response to the virus, which may in turn induce the release of tPA from endothelium.…”

Section: Derangement Of Fibrinolysismentioning

confidence: 84%

Coronavirus Disease 2019–Associated Coagulopathy

Lippi

Sanchís-Gomar

Favaloro

et al. 2021

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Patients with the severe form of coronavirus disease 2019 (COVID-19) have been frequently found to suffer from both arterial and venous thrombotic events due to the perpetuation of a hypercoagulable state. This phenomenon, termed COVID-19-associated coagulopathy (CC), is now considered a major component of the pathophysiology of this novel infectious disease, leading to widespread thrombosis. While at first, the vascular insults may be limited to the pulmonary microvasculature, as the disease progresses, systemic involvement occurs, culminating in distant organ thrombosis and multi-organ dysfunction syndrome. In this review article, we discuss recent insights into the pathophysiologic mechanisms of CC and review the clinical, histopathologic, and laboratory evidence, which leads us to conclude that COVID-19 is both a pulmonary and vascular disorder.

show abstract

“…It has been shown that the median plasma concentrations of tissue factor and plasminogen activator inhibitor-1 were significantly higher at day seven in patients with ARDS, as compared to non-ARDS (Ozolina et al, 2016). Coagulopathy arises from thrombin generation mediated by localized tissue factor, and depression of fibrinolysis mediated by plasminogen activator in the lungs, in accordance with an increase in plasminogen activator inhibitor-1 (PAI-1) (Ozolina et al, 2016;Glas et al, 2013). This again points towards how heparin might be helpful in fighting this coagulopathy.…”

Section: Coagulation Disorder: Is Heparin the Answer?mentioning

confidence: 99%

COVID-19: Review on latest available drugs and therapies against SARS-CoV-2. Coagulation and inflammation cross-talking

2020

View full text Add to dashboard Cite

SARS-CoV-2 is the agent responsible for COVID-19. The infection can be dived into three phases: mild infection, the pulmonary phase and the inflammatory phase. Treatment options for the pulmonary phase include: Hydroxychloroquine, Remdesivir, Lopinavir/Ritonavir. The inflammatory phase includes therapeutic options like Tocilizumab, Anakinra, Baricitinib, Eculizumab, Emapalumab and Heparin. Human clinical trials are starting to show some results, in some cases like that of Remdesivir and corticosteroids these are controversial. Coagulopathy is a common complication in severe cases, inflammation and coagulation are intertwined and cross-talking between these two responses is known to happen. A possible amplification of this cross-talking is suggested to be implicated in the severe cases that show both a cytokine storm and coagulopathy.

show abstract

Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study

Cited by 8 publications

References 21 publications

Prognostic value of neutrophils to lymphocytes and platelets ratio for 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study

Prognostic value of neutrophils to lymphocytes and platelets ratio for 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study

Coronavirus Disease 2019–Associated Coagulopathy

COVID-19: Review on latest available drugs and therapies against SARS-CoV-2. Coagulation and inflammation cross-talking

Contact Info

Product

Resources

About