Elevated Plasma Fibrinogen Is Associated With Excessive Inflammation and Disease Severity in COVID-19 Patients

Abstract

BackgroundThe coronavirus disease-19 (COVID-19) is characterized with intense inflammatory response, cardiac involvement, and coagulopathy. Fibrinogen, as a biomarker for inflammation, cardiovascular disease, and coagulation, has not been fully investigated yet. The aim of this study was to assess the clinical application of fibrinogen in COVID-19 patients.MethodsWe retrospectively analyzed the demographic and laboratory characteristics of 119 COVID-19 patients in the University of Alabama of Birmingham Medical Center. Correlations of fibrinogen on admission with intensive care unit (ICU) admission, disease severity, and laboratory parameters were analyzed.ResultsAmong the 119 COVID-19 patients, 77.3% (92/119) had severe disease, and 59.5% (71/119) patients were admitted to the ICU. Elevated fibrinogen was detected in 67.2% (80/119) of the patients. Fibrinogen levels were significantly associated with inflammatory markers and disease severity, but not with cardiac injury biomarker high sensitivity troponin I. Patients with severe disease had increased fibrinogen levels upon admission compared to patients with non-severe disease (P = 0.001). Fibrinogen level at 528.0 mg/dl was the optimal cutoff to predict disease severity, with a sensitivity and specificity of 66.7% and 70.3% (area undty -60er the curve [AUC] 0.72, P = 0.0006).ConclusionsFibrinogen is commonly elevated in COVID-19 patients, especially in those with severe disease. Elevated fibrinogen correlates with excessive inflammation, disease severity, and ICU admission in COVID-19 patients.

Identification of Parameters Representative of Immune Dysfunction in Patients with Severe and Fatal COVID-19 Infection: a Systematic Review and Meta-analysis

“…Beyond immunological and hematological cells, cytokines, antibodies and complements, there are some other laboratory parameters that are related to immune dysfunction and reflect the progression of COVID-19 which have been reported in previous studies [165][166][167][168]. In the current study, we simultaneously included coagulation parameters (including prothrombin time(PT), activated partial thromboplastin time(APTT), D-dimer and fibrinogen (FIB)), inflammatory parameters (containing C-reactive protein(CRP), procalcitonin(PCT), erythrocyte sedimentation rate(ESR), serum amyloid A(SAA)) and ferritin, biochemical parameters (including cardiac function related ones such as creatine kinase(CK), cardiac troponin I(cTnI), myoglobin (MYO), lactate dehydrogenase (LDH), liver function related ones such as aspartate aminotransferase(AST), alanine aminotransferase (ALT), total bilirubin(TBIL) and kidney function related ones such as creatinine(CRN), albumin(ALB), blood urea nitrogen(BUN).…”

Fibrinogen and Atherosclerotic Cardiovascular Diseases—Review of the Literature and Clinical Studies

“…Perhaps the reduction in fibrinogen concentration by statins is one of the elements of their beneficial influence on improving the prognosis of COVID-19 [ 107 , 108 ]. Moreover, the results of numerous clinical studies indicate that the assessment of fibrinogen concentration may be a useful indicator in the assessment of the prognosis of patients with COVID-19 [ 109 , 110 , 111 , 112 ].…”

Contribution of the von Willebrand factor/ADAMTS13 imbalance to COVID-19 coagulopathy

“…Modest thrombocytopenia has been observed in 70%–95% of patients with severe COVID-19 in addition to modest increases in prothrombin time ( 7 , 9 , 10 , 12 , 13 , 16 ). Patients with severe COVID-19 have modest elevations in fibrinogen levels that rapidly decline before death ( 10 , 12 , 13 , 17 – 21 ). Strikingly high levels of lactate dehydrogenase and C-reactive protein have been observed in COVID-19 nonsurvivors ( 7 ).…”