COVID-19 associated coagulopathy: The crowning glory of thrombo-inflammation concept

Gris, J.-C.; Pérez‐Martin, A.; Quéré, Isabelle; Sotto, Albert

doi:10.1016/j.accpm.2020.04.013

Cited by 32 publications

(29 citation statements)

References 5 publications

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“…Recently, it has been described that SARS-CoV-2 infection can be associated with coagulation dysfunction, predisposing infected individuals to venous thromboembolism in several ways (27). Pathogenic mechanisms, including endothelial dysfunction with increased levels of von Willebrand factor, systemic inflammation with Toll-like receptor activation, and a procoagulatory state via tissue factor pathway activation, are involved (28).…”

Section: Discussionmentioning

confidence: 99%

Isolated intracranial hypertension associated with COVID-19

et al. 2020

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Background Headache is a frequent complaint in COVID-19 patients. However, no detailed information on headache characteristics is provided in these reports. Our objective is to describe the characteristics of headache and the cerebrospinal fluid (CSF) profile in COVID-19 patients, highlighting the cases of isolated intracranial hypertension. Methods In this cross-sectional study, we selected COVID-19 patients who underwent lumbar puncture due to neurological complaints from April to May 2020. We reviewed clinical, imaging, and laboratory data of patients with refractory headache in the absence of other encephalitic or meningitic features. CSF opening pressures higher than 250 mmH2O were considered elevated, and from 200 to 250 mmH2O equivocal. Results Fifty-six COVID-19 patients underwent lumbar puncture for different neurological conditions. A new, persistent headache that prompted a CSF analysis was diagnosed in 13 (23.2%). The pain was throbbing, holocranial or bilateral in the majority of patients. All patients had normal CSF analysis and RT-qPCR for SARS-CoV-2 was negative in all samples. Opening pressure >200 mmH2O was present in 11 patients and, in six of these, > 250 mmH2O. 6/13 patients had complete improvement of the pain, five had partial improvement, and two were left with a daily persistent headache. Conclusions In a significant proportion of COVID-19 patients, headache was associated to intracranial hypertension in the absence of meningitic or encephalitic features. Coagulopathy associated with COVID-19 could be an explanation, but further studies including post-mortem analysis of areas of production and CSF absorption (choroid plexuses and arachnoid granulations) are necessary to clarify this issue.

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Section: Discussionmentioning

confidence: 99%

Isolated intracranial hypertension associated with COVID-19

et al. 2020

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“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen of coronavirus disease 2019 (COVID-19), which is clinically characterized by fever, myalgia, diarrhea, and respiratory illness ( Huang et al, 2020 , Mao et al, 2020 ), has been associated with neurological syndromes, such as meningoencephalitis, ischemic stroke, encephalopathy, Guillain-Barré syndrome (GBS), acute necrotizing encephalopathy, and acute disseminated encephalomyelitis (ADEM) ( Helms et al, 2020 , Moriguchi et al, 2020 , Oxley et al, 2020 , Parsons et al, 2020 , Poyiadji et al, 2020 , Toscano et al, 2020 ). Possible mechanisms implicated in these neurological conditions are neuronal injury associated with direct virus infection, hyperinflammation syndrome associated with cytokines storm, a para- or post-infectious inflammatory disease, an immune-mediated disease, or a secondary process due to severe effects of a systemic disorder (sepsis, hyperpyrexia, hypoxia, hypercoagulability, critical illness) ( Gris et al, 2020 , Mehta et al, 2020b , Zubair et al, 2020 ). Several biomarkers for COVID-19 severity have been identified in blood, including C-reactive protein, D-dimer, lactate dehydrogenase, interleukin-6, and ferritin ( Ciaccio and Agnello 2020 ), but less evidences are available for cerebrospinal fluid (CSF) biomarkers.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid findings in neurological diseases associated with COVID-19 and insights into mechanisms of disease development

Espíndola

Brandão

Gomes

et al. 2021

International Journal of Infectious Diseases

104

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Highlights Patients with COVID-19 and neurological manifestations have diverse CSF profiles. Detection of SARS-CoV-2 RNA in the cerebrospinal fluid is infrequent. Oligoclonal bands are found in CSF of COVID-19 patients with neurological diseases. CNS inflammation promotes neuronal injury in patients with COVID-19. CSF levels of NfL is elevated in inflammatory neurological diseases in COVID-19. SARS-CoV-2 replication in CNS may trigger the infiltration by immune cells.

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“…Activation of the coagulation cascade in early stages of disease appears to be due to a thromboin ammatory response and direct viral effects on pulmonary tissue, which is counter-balanced by brinolytic activity and manifests as an increase in brin degradation products. In later stages of disease, this balance is lost and a pro-coagulant state ensues (5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

COVID-19: What Can Iodine Maps From Perfusion CT Teach US? A Prospective Cohort Study.

Santamarina

Riscal

Beddings

et al. 2020

Preprint

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Background: Subtraction CT angiography (sCTA) is a technique used to evaluate pulmonary perfusion based on iodine distribution maps. The aim of this study is to assess lung perfusion changes with sCTA seen in patients with COVID-19 pneumonia, and correlate them with clinical outcomes.Material and Methods: A prospective cohort study was carried out with 45 RT-PCR-confirmed COVID-19 patients that required hospitalization at three different hospitals, between April and May 2020. In all cases, a basic clinical and demographic profile was obtained. Lung perfusion was assessed using sCTA. Evaluated imaging features included: Predominant type of perfusion abnormality (increased perfusion or hypoperfusion), perfusion abnormality distribution (focal or diffuse), extension of perfusion abnormalities (mild, moderate and severe involvement), presence of vascular dilatation and vascular tortuosity. All participants were followed-up until hospital discharge searching for the development of any of the study endpoints. These endpoints included intensive-care unit (ICU) admission, initiation of invasive mechanical ventilation (IMV) and death.Results: Forty-one patients (55.2 +/- 16.5 years, 22 men ) with RT-PCR-confirmed SARS-CoV-2 infection and an interpretable iodine map were included. Patients with perfusion anomalies on sCTA in morphologically normal lung parenchyma showed lower Pa/Fi values (294 ± 111.3 vs. 397 ± 37.7, p=0.035), and higher D-dimer levels (1156 ± 1018 vs. 378 ± 60.2, p<0.01). The patterns seen on lung CT were ground-glass opacities, mixed pattern and alveolar consolidation in 51.2%, 41.6% and 7.3%, respectively. Perfusion abnormalities were common (36 patients, 87.8%), mainly hypoperfusion in areas of apparently healthy lung . Patients with severe hypoperfusion in areas of apparently healthy lung parenchyma had an increased probability of being admitted to ICU and to initiate IMV (HR of 11.9% and HR 7.8%, respectively).Conclusion: Perfusion abnormalities evidenced in iodine maps obtained by sCTA are associated with increased admission to ICU and initiation of IMV in COVID-19 patients.

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COVID-19 associated coagulopathy: The crowning glory of thrombo-inflammation concept

Cited by 32 publications

References 5 publications

Isolated intracranial hypertension associated with COVID-19

Isolated intracranial hypertension associated with COVID-19

Cerebrospinal fluid findings in neurological diseases associated with COVID-19 and insights into mechanisms of disease development

COVID-19: What Can Iodine Maps From Perfusion CT Teach US? A Prospective Cohort Study.

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