Analysis of coagulation parameters in patients with COVID-19 in Shanghai, China

Zou, Ying; Guo, Huimin; Zhang, Yuyi; Zhang, Zhengguo; Liu, Yu; Wang, Jiefei; Lu, Hongzhou; Qian, Zhiping

doi:10.5582/bst.2020.03086

Cited by 104 publications

(118 citation statements)

References 14 publications

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“…Bleeding as well as thrombotic events often occur in subjects with multiple weak risk factors which interact to produce the symptoms [109]. Both bleeding, thrombocytopenia and thrombotic pathologies have been reported in COVID-19 patients and are significant accompaniments to acute respiratory distress syndrome and lung complications [3][4][5][6]12,155,156]. Therefore, fibrin(ogen) levels, D-dimer, VWF and P-selectin could all be valuable biomarkers that might provide clinicians with the correct clinical diagnosis and might assist in deciding the method of treatment.…”

Section: Discussionmentioning

confidence: 99%

Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes

Grobler

Grobbelaar

Maphumulo

et al. 2020

IJMS

164

154

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Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), also known as coronavirus disease 2019 (COVID-19)-induced infection, is strongly associated with various coagulopathies that may result in either bleeding and thrombocytopenia or hypercoagulation and thrombosis. Thrombotic and bleeding or thrombotic pathologies are significant accompaniments to acute respiratory syndrome and lung complications in COVID-19. Thrombotic events and bleeding often occur in subjects with weak constitutions, multiple risk factors and comorbidities. Of particular interest are the various circulating inflammatory coagulation biomarkers involved directly in clotting, with specific focus on fibrin(ogen), D-dimer, P-selectin and von Willebrand Factor (VWF). Central to the activity of these biomarkers are their receptors and signalling pathways on endothelial cells, platelets and erythrocytes. In this review, we discuss vascular implications of COVID-19 and relate this to circulating biomarker, endothelial, erythrocyte and platelet dysfunction. During the progression of the disease, these markers may either be within healthy levels, upregulated or eventually depleted. Most significant is that patients need to be treated early in the disease progression, when high levels of VWF, P-selectin and fibrinogen are present, with normal or slightly increased levels of D-dimer (however, D-dimer levels will rapidly increase as the disease progresses). Progression to VWF and fibrinogen depletion with high D-dimer levels and even higher P-selectin levels, followed by the cytokine storm, will be indicative of a poor prognosis. We conclude by looking at point-of-care devices and methodologies in COVID-19 management and suggest that a personalized medicine approach should be considered in the treatment of patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes

Grobler

Grobbelaar

Maphumulo

et al. 2020

IJMS

164

154

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“…Furthermore, as lung‐centric coagulopathy can also play an important role in the pathophysiology in the severe COVID‐19 patients, 98 IL‐6 may contribute to this pathology by inducing coagulation cascades 99 . However, hypercoagulability, together with high levels of D‐dimers, fibrinogen, and CRP, in COVID‐19 patients is distinct from the disseminated intravascular coagulation described in more severe inflammatory conditions 100,101 . Further, the levels of IL‐6 can vary in COVID‐19 patients relative to severity of disease 11,102 .…”

Section: Characteristics Of Leukocyte Changes and Cytokine Release Dumentioning

confidence: 99%

Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: Review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts

Wang

Jiang

Chen

et al. 2020

Journal of Leukocyte Biology

663

607

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Clinical evidence indicates that the fatal outcome observed with severe acute respiratory syndrome‐coronavirus‐2 infection often results from alveolar injury that impedes airway capacity and multi‐organ failure—both of which are associated with the hyperproduction of cytokines, also known as a cytokine storm or cytokine release syndrome. Clinical reports show that both mild and severe forms of disease result in changes in circulating leukocyte subsets and cytokine secretion, particularly IL‐6, IL‐1β, IL‐10, TNF, GM‐CSF, IP‐10 (IFN‐induced protein 10), IL‐17, MCP‐3, and IL‐1ra. Not surprising, therapies that target the immune response and curtail the cytokine storm in coronavirus 2019 (COVID‐19) patients have become a focus of recent clinical trials. Here we review reports on leukocyte and cytokine data associated with COVID‐19 disease in 3939 patients in China and describe emerging data on immunopathology. With an emphasis on immune modulation, we also look at ongoing clinical studies aimed at blocking proinflammatory cytokines; transfer of immunosuppressive mesenchymal stem cells; use of convalescent plasma transfusion; as well as immunoregulatory therapy and traditional Chinese medicine regimes. In examining leukocyte and cytokine activity in COVID‐19, we focus in particular on how these levels are altered as the disease progresses (neutrophil NETosis, macrophage, T cell response, etc.) and proposed consequences to organ pathology (coagulopathy, etc.). Viral and host interactions are described to gain further insight into leukocyte biology and how dysregulated cytokine responses lead to disease and/or organ damage. By better understanding the mechanisms that drive the intensity of a cytokine storm, we can tailor treatment strategies at specific disease stages and improve our response to this worldwide public health threat.

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“…Several studies have reported that pregnant women with viral respiratory illnesses are at higher risk than non-pregnant women of developing various complications, including critical ARDS and perinatal adverse outcomes, possibly due to changes in the immune system [ 1 , 2 ]. Previous studies have reported that fibrinogen and D-dimer elevation are associated with the severity of COVID-19 [ 18 ]. Moreover, it was reported that the fibrin level was elevated in the lungs of the COVID-19 patients, and excessive fibrin accumulation in the alveoli led to acute inflammation and pulmonary fibrosis [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Severe COVID-19 Pneumonia in a 30-Year-Old Woman in the 36th Week of Pregnancy Treated with Postpartum Extracorporeal Membrane Oxygenation

et al. 2020

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Analysis of coagulation parameters in patients with COVID-19 in Shanghai, China

Cited by 104 publications

References 14 publications

Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes

Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes

Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: Review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts

Severe COVID-19 Pneumonia in a 30-Year-Old Woman in the 36th Week of Pregnancy Treated with Postpartum Extracorporeal Membrane Oxygenation

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