Admission Levels of Serum P-Selectin and IL-6 Can Predict Development of Deep Venous Thrombosis in Hospitalized Covid-19 Patients

Abstract

Background and Aim Deep venous thrombosis (DVT) of the lower extremities is common in Covid-19 patients. Interleukin (IL)-6 and P-selectin were found to be elevated in Covid-19 patients. The current study aimed to evaluate P-selectin and IL6 in Covid-19 patients with DVT and to explore its relation to clinical and laboratory parameters in those patients. Patients and methods The present retrospective study included 150 hospitalized COVID-19 patients diagnosed on the basis of a positive result of reverse-transcriptase polymerase chain reaction (RT-PCR) test. Laboratory assessments were included for IL-6 and P selectin assessments via enzyme-linked immunosorbent assay. The primary outcome of the present study was the development of DVT detected by Doppler ultrasound (DU) evaluation of the lower extremities during the admission. Results The present study included 150 hospitalized Covid-19 patients. DVT was developed in 59 patients (39.3%). DVP patients had significantly higher levels of P selectin [76.0 (63.0–87.0) versus 63.0 (54.3–75.0), p < 0.001] and IL-6 [37.0 (27.0–49.0) versus 18.5 (13.5–31.5), p < 0.001]. ROC curve analysis revealed good performance of P selectin [AUC (95% CI): 0.72 (0.64–0.81)] and IL-6 [AUC (95% CI): 0.79 (0.71–0.86)] in identification of DVT. Logistic regression analysis identified the presence of severe disease [OR (95% CI): 9.016 (3.61–22.49), p < 0.001], elevated P selectin [OR (95% CI): 1.032 (1.005–1.059), p = 0.018] and elevated IL-6 [OR (95% CI): 1.062 (1.033–1.091), p < 0.001] as significant predictors of DVT development in multivariate analysis. Conclusion The present study identified a probable role of elevated P-selectin and IL-6 levels in the DVT development in hospitalized Covid-19 patients.

Biomarkers of endothelial dysfunction are associated with poor outcome in COVID‐19 patients: A systematic review and meta‐analysis

“…showed higher P‐selectin levels in severe COVID‐19 patients and non‐survivors and stated that P‐selectin concentrations increases with disease severity 36 . Several studies have related high levels of P‐selectin to hypercoagulopathy observed in COVID‐19 patients 10,11,77 . Fenyves et al.…”

“…Ten studies 9,11,29,41,45,[71][72][73][74][75] for E-selectin and 11 studies for Pselectin 10,11,32,36,45,52,71,72,[76][77][78] were reviewed with a total of 896 (351 with poor outcome vs. 545 with good outcome) and 1042 patients (353 with poor outcome vs. 689 with good outcome) for Eselectin and P-selectin respectively. The pooled standard mean difference among the two groups showed a significant increase in Eselectin and P-selectin levels among patients with poor outcome relative to those with good outcome (SMD: 1.09 (0.55, 1.63), p < 0.0001 for E-selectin and SMD: 0.59 (0.24, 0.94), p = 0.001 for Pselectin) (Figure 5, panel A and B respectively).…”

“…36 Several studies have related high levels of P-selectin to hypercoagulopathy observed in COVID-19 patients. 10,11,77 Production of E-selectin is restricted to ECs, and proinflammatory cytokines such as TNF-α can induce its production by ECs. 11 Higher levels of E-selectin in COVID-19 patients have been reported by several studies.…”

A Clinical Prediction Rule for Thrombosis in Critically Ill COVID-19 Patients: Step 1 Results of the Thromcco Study

“…However, the relationships between thrombosis and IL6 and CRP, which were included in the score, have been previously explored. For instance, Farouk et al reported that IL6 levels at admission were related to DVT [ 19 ]. Similarly, Smilowitz found that the association between CRP levels and adverse outcomes was consistent in patients with low and high D-dimer levels [ 20 ].…”

Mechanisms of COVID-19 Associated Pulmonary Thrombosis: A Narrative Review

“…In a prospective multicenter cohort study including 1240 hospitalized COVID-19 patients who performed a CT pulmonary angiography, only 11.7% of 103 patients diagnosed with pulmonary thrombosis had DVT [ 157 ]. DVT was found in 59 patients (39.3%) when Doppler ultrasound was used systematically for evaluation of the lower extremities during hospital admission for COVID-19 patients [ 158 ]. In another study, none of the patients with pulmonary thrombosis had clinical evidence of DVT [ 152 ].…”