Comparison of inflammatory and thrombotic profiles of patients with COVID-19 in their different outcomes: hospital discharge and death
DOI:
https://doi.org/10.33448/rsd-v11i2.25990Keywords:
COVID-19; Inflamation; Coagulation.Abstract
COVID-19 was categorized as a pandemic in March 2020 and is manifested by mild respiratory symptoms although there is a possibility of worsening and death. The causes of death have been associated with thrombotic processes and activation of coagulation with exacerbated inflammatory reaction. Thus, the present study aimed to investigate tests of the inflammatory profile, C Reactive Protein (CRP), and of the thrombotic profile, D-dimer (DD), Prothrombin Time (PT), International Normalized Ratio (INR) and Activated Partial Thromboplastin Time (TTPa), as prognostic markers in patients with COVID-19 in their different outcomes. The work consists of an analysis of tests from patients admitted with outcome discharge and death, with positive molecular test for SARS-CoV-2, between March 2020 and January 2021, belonging to the COVID-19 Data Sharing/BR repository of the Hospital Beneficência Portuguesa, using the Mann-Whitney two-tailed test and Bonferroni correction. In the death group, 97.7% of the patients had a CRP above normality and 100% had a DD above the reference. The PT, in the discharge group, was above normal in 36.21% of the patients, while in the death group, it was 82.8%. The TTPa, in the discharge outcome, was above normal in 14.8% of the patients, on the other hand, 54.54% at death. In all tests evaluated, the medians of the death group were higher than the discharge group. Although the sample was from a single hospital, important trends were observed. CRP and DD can be used as prognostic markers for COVID-19 and PT, INR and TTPa, although showing relevant results, need further investigation.
References
Asakura, H., & Ogawa, H. (2021). COVID-19-associated coagulopathy and disseminated intravascular coagulation. International Journal of Hematology, 113, 45–57, 2021. https://doi.org/10.1007/s12185-020-03029-y.
Atzrodt, C. L., Maknojia, I., McCarthy, R. D. P., Oldfield, T. M., Po, J., Ta, K. T. L., Stepp, H. E., & Clements, T. P. (2020). A Guide to COVID-19: a global pandemic caused by the novel coronavirus SARS-CoV-2. The FEBS Journal, 287, 3633–3650. https://doi.org/10.1111/febs.15375.
Deng, Y., Liu, W., Liu, K., Fang, Y-Y., Shang, J., Zhou, L., Wang, K., Leng, F., Wei, S., Chen, L., & Liu, H-G. (2020). Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study. Chinese Medical Journal, 133(11), 1261–1267. https://doi.org/10.1097/CM9.0000000000000824.
Dolhnikoff, M., Duarte‐Neto, A. N., Monteiro, R. A. A., Silva, L. F. F., Oliveira, E. P., Saldiva, P. H. N., Mauad, T., & Negri, E. M. (2020). Pathological evidence of pulmonary thrombotic phenomena in severe COVID‐19. Journal of Thrombosis and Haemostasis, 18(6), 1517–1519. https://doi.org/10.1111/jth.14844.
Eijk, L. E. van, Binkhorst, M., Bourgonje, A. R., Offringa, A. K., Mulder, D. J., Bos, E. M., Kolundzic, N., Abdulle, A. E., Voort, P. H. J. van der, Rikkert, M. G. M. O., Hoeven, J. G. van der, Dunnen, W. F. A. den, Hillebrands, J.-L., Goor, H. van (2021). COVID‐19: immunopathology, pathophysiological mechanisms, and treatment options. The Journal of Pathology, 254(4), 307–331, 2021. https://doi.org/10.1002/path.5642.
FAPESP (2020). FAPESP COVID-19 Data Sharing/BR. Recuperado de https://repositoriodatasharingfapesp.uspdigital.usp.br/, em 15 de agosto de 2021.
Fleury Medicina e Saúde (2021). Proteína C Reativa, soro. Recuperado de https://www.fleury.com.br/medico/exames/proteina-c-reativa-soro, em 31 de outubro de 2021.
Gómez-Mesa, J. E., Galindo-Coral, S., Montes, M. C., & Martin, A. J. M. (2021). Thrombosis and Coagulopathy in COVID-19. Current Problems in Cardiology, 46(3), 100742. https://doi.org/10.1016/j.cpcardiol.2020.100742.
Guan, W.-J., Ni, Z.-Y., Hu, Y., Liang, W.-H., Ou, C.-Q., He,J.-X., Liu, L., Shan, H., Lei, C.-L., Hui, D. S.C., Du, B., Li, L.-J., Zeng, G., Yuen, K.-Y., Chen, R.-C., Tang, C.-L., Wang, T., Chen, P.-Y., Xiang, J., … & Zhong, N.-S. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. The New England Journal of Medicine, 382(18), 1708–1720. https://doi.org/10.1056/NEJMoa2002032.
Hadid, T., Kafri, Z., & Al-Katib, A. (2021). Coagulation and anticoagulation in COVID-19. Blood Reviews, 47, 100761. https://doi.org/10.1016/j.blre.2020.100761.
Hu, B., Huang, S., & Yin, L. (2020). The cytokine storm and COVID‐19. Journal of Medical Virology, 93, 250–256. https://doi.org/10.1002/jmv.26232.
Iba, T., Levy, J. H., Levi, M., & Thachil, J. (2020). Coagulopathy in COVID-19. Journal of Thrombosis and Haemostasis, 18(9), 2103–2109. https://doi.org/10.1111/jth.14975.
Jin, X., Duan, Y., Bao, T., Gu, J., Chen, Y., Li, Y., Mao, S., Chen, Y., & Xie, W. (2020). The values of coagulation function in COVID-19 patients. PLos One, 15(10), e0241329. https://doi.org/10.1371/journal.pone.0241329.
Kadam, S. B., Sukhramani, G. S., Bishnoi, P., Pable, A. A., & Barvkar, V. T. (2021). SARS-CoV-2, the pandemic coronavirus: Molecular and structural insights. Journal of Basic Microbiology, 61(3), 180–202. https://doi.org/10.1002/jobm.202000537.
Kumar, A., Prasoon, P., Kumari, C., Pareek, V., Faiq, M. A., Narayan, R. K., Kulandhasamy, M., & Kant, K. (2021). SARS-CoV-2-specific virulence factors in COVID-19. Journal of Medical Virology, 93(3), 1343–1350. https://doi.org/10.1002/jmv.26615.
Liu, F., Li, L., Xu, M., Wu, J., Luo, D., Zhu, Y., Li, B., Song, X., & Zhou, X. (2020). Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. Journal of Clinical Virology, 127, 104370. https://doi.org/10.1016/j.jcv.2020.104370.
Ministério da Saúde. (2016). Manual de Diagnóstico Laboratorial das Coagulopatias Hereditárias e Plaquetopatias. Ministério da Saúde, Secretaria de Atenção à Saúde. Brasília, DF. Recuperado de https://bvsms.saude.gov.br/bvs/publicacoes/manual_diagnostico_coagulopatias_hereditarias_plaqueopatias.pdf, em 31 de outubro de 2021.
Orsi, F. A., Paula, E. V. de, Santos, F. O., Teruchkin, M. M., Campêlo, D. H. C., Mello, T. T., Chindamo, M. C. Macedo, A. V. S., Rocha, A T., Ramacciotti, E., Nascimento, A. C. K., Annichino-Bizzacchi, J., Lourenco, D. M., Guerra, J. C. de C., Rezende, S. M., & Cavalheiro, C., Fº. (2020). Guidance on diagnosis, prevention and treatment of thromboembolic complications in COVID-19: a position paper of the Brazilian Society of Thrombosis and Hemostasis and the Thrombosis and Hemostasis Committee of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy. Hematology, Transfusion and Cell Therapy, 42(4), 300–308, 2020. https://doi.org/10.1016/j.htct.2020.06.001.
Ozen, M., Yilmaz, A. Cakmak, V., Beyoglu, R., Oskay, A., Seyit, M., & Senol, H. (2021). D-Dimer as a potential biomarker for disease severity in COVID-19. The American Journal of Emergency Medicine, 40, 55–59. https://doi.org/10.1016/j.ajem.2020.12.023.
Pollard, C. A., Morran, M. P., & Nestor-Kalinosk, A. L. (2020). The COVID-19 pandemic: a global health crisis. Physiol Genomics, 52, 549–557. https://doi.org/10.1152/physiolgenomics.00089.2020.
Rostami, M., & Mansouritorghabeh, H. (2020). D-dimer level in COVID-19 infection: a systematic review. Expert Review of Hematology, 13(11), 1265–1275, 2020. https://doi.org/10.1080/17474086.2020.1831383.
Smilowitz, N. R., Kunichoff, D., Garshick, M., Shah, B., Pillinger, M., Hochman, J. S., & Berger, J. S. (2021). C-reactive protein and clinical outcomes in patients with COVID-19. European Heart Journal, 42(23), 2270–2279. https://doi.org/10.1093/eurheartj/ehaa1103.
Tang, N., Li, D., Wang, X., & Sun, Z. (2020a). Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis, 18(4), 844–847. https://doi.org/10.1111/jth.14768.
Tang, N., Bai, H., Chen, X., Gong, J., Li, D., & Sun, Z. (2020b). Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of Thrombosis and Haemostasis, 18(5), 1094–1099. https://doi.org/10.1111/jth.14817.
Williamson, E. J., Walker, A. J., Bhaskaran, K., Bacon, S., Bates, C., Morton, C. E., Curtis, H. J., Mehrkar, A., Evans, D., Inglesby, P., Cockburn, J., McDonald, H. I., MacKenna, B., Tomlinson, L., Douglas, I. J., Rentsch, C. T., Mathur, R., Wong, A. Y. S., Grieve, R., & Goldacre, B. (2020). Factors associated with COVID-19-related death using OpenSAFELY. Nature, 584(7821), 430–436. https://doi.org/10.1038/s41586-020-2521-4.
Wool, G. D., & Miller, J. L. (2021) The Impact of COVID-19 Disease on Platelets and Coagulation. Pathobiology, 88(1), 15–27. https://doi.org/10.1159/000512007.
World Health Organization (2022). Who Coronavirus (COVID-19) Dashboard. Recuperado de covid19.who.int, em 19 de janeiro de 2022.
Yesudhas, D., Srivastava, A., & Gromiha, M. M. (2020). COVID-19 outbreak: history, mechanism, transmission, structural studies and therapeutics. Springer Link, 49, 199–213. https://doi.org/10.1007/s15010-020-01516-2.
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Copyright (c) 2022 Monike Aparecida Matos de Oliveira; Izabella Brito de Souza; Juan Andrade Silva; Carolina Heitmann Mares Azevedo Ribeiro; Ana Cristina Lo Prete
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