<p>Coagulopathy of Patients with COVID-19 is Associated with Infectious and Inflammatory Markers</p>

Abstract

Background: SARS-CoV-2 infection activates coagulation and stimulates innate immune system. Little is known about coagulopathy and response of inflammation and infection in ICU patients with COVID-19. Derangement of coagulation and markers of infection and inflammation induced by SARS-CoV-2 infection, as well as their correlations were elucidated. Methods: One hundred eight ICU patients with COVID-19 (28 survivors and 80 nonsurvivors) in Tongji hospital and Wuhan Jinyintan hospital, in Wuhan, China were included. Coagulation parameters, infectious and inflammatory markers were dynamically analysed. The correlation between coagulopathy of patients and infectious and inflammatory markers was verified. Results: SARS-CoV-2-associated coagulopathy occurred in most cases of critical illness. Raised values of d-dimer and FDP were measured in all patients, especially in non-survivors, who had longer PT, APTT, INR, as well as TT, and lower PTA and AT compared to survivors. SIC and DIC mostly occurred in non-survivors. CRP, ESR, serum ferritin, IL-8, and IL-2R increased in all patients, and were much higher in non-survivors who had significantly higher levels of IL-6 and IL-10. D-dimer was positively associated with CRP, serum ferritin (p = 0.02), PCT (p < 0.001), and IL-2R (p = 0.007). SIC scores were positively correlated with CRP (p = 0.006), PCT (p = 0.0007), IL-1β (p = 0.048), and IL-6 (p = 0.009). DIC scores were positively associated with CRP (p < 0.0001), ESR (p = 0.02), PCT (p < 0.0001), serum ferritin (p < 0.0001), IL-10 (p = 0.02), and IL-2R (p = 0.0005). Conclusion: Prothrombotic state, SIC, and DIC are the characteristics of coagulation in ICU patients with COVID-19. CRP, ESR, serum ferritin, IL-8, IL-2R, IL-6, and PCT were stimulated by SARS-CoV-2 infection. CRP, PCT, serum ferritin, and IL-2R indicate the coagulopathy severity of patients with COVID-19.

Potential Immune Indicators for Predicting the Prognosis of COVID-19 and Trauma: Similarities and Disparities

“…Higher CRP levels at admission have been reported in COVID-19 patients with more severe symptoms (24,31). Also, a positive correlation between serum levels of it at admission and chest CT progression has been detected in recent studies (24,(32)(33)(34). Han et al have indicated the optimal cut-off point of CRP at admission is 3.38 mg/L, which may be applicable to predict COVID-19 outcomes (33).…”

“…Moreover, an increase in serum concentration of this cytokine at days 4 to 6 after the onset of disease symptoms, which decreases over the next few days, is associated with good prognosis (88). It appears a high expression of IFN-g at admission, which continues for 3 to 4 weeks, could cause negative consequences due to over-activity in the immune (30,32,33,37,80), PCT (30,33,38,(51)(52)(53)55), ferritin (33,68) and SAA (73,75,76,78) system, inducing ACE2 expression (the binding site for SARS-CoV-2) and promoting virus replication (87). Anti-IFN-I autoantibodies have recently been detected in COVID-19 and are associated with poor prognosis of the disease.…”

Purinergic signaling elements are correlated with coagulation players in peripheral blood and leukocyte samples from COVID-19 patients

“…Within days after the viral infection, the severely ill patients develop pneumonia that usually progresses to acute respiratory distress syndrome (ARDS), requiring admission to the intensive unit care (ICU) and supplementation with exogenous oxygen [14]. The ICU patients have alterations in blood biomarkers associated with the severity and progression of the disease, such as elevated levels of circulating D-dimer (> 1 µg/mL) [15][16][17], prolonged prothrombin time [18], elevated levels of pro-inflammatory cytokines, and chemokines [15,19], especially IL-6, IL-1β and TNF-α [15,[20][21][22][23], C-reactive protein (CRP), lactate dehydrogenase (LDH), and the activation of the NLRP3 inflammasome [24].…”

Mesenchymal Stem Cell-Derived Extracellular Vesicles Carrying miRNA as a Potential Multi Target Therapy to COVID-19: an In Silico Analysis

“…A major part of COVID-19 cases are asymptomatic, although around 20% of patients are severely or critically unwell [13,14]. In those individuals, who present symptoms, common clinical manifestations of COVID-19 include fever, cough, fatigue, sputum production, shortness of breath, sore throat, headache, loss of taste and smell, pneumonia and more advanced cases progress to Acute Respiratory Distress Syndrome (ARDS), coagulation disturbs [15], multiple organ failure, septic shock and death [16]. The patients who progressed to ARDS are evaluate following the Berlin definition [17].…”