SARS-CoV-2 induced thrombocytopenia as an important biomarker significantly correlated with abnormal coagulation function, increased intravascular blood clot risk and mortality in COVID-19 patients

Bao, Chunde; Tao, Xiandong; Cui, Wei; Yi, Bin; Pan, Tiewen; Young, Ken H.; Qian, W.

doi:10.1186/s40164-020-00172-4

Cited by 93 publications

(99 citation statements)

References 20 publications

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“…Han et al [5] also reported that there was no significant difference in PT between patients with different levels of severity of COVID-19 and healthy controls. However, more studies reported that severe patients had significantly prolonged PT compared with non-severe patients [16][17][18]. In addition, two studies on COVID-19 indicated that non-survivors had higher PT levels than survivors [6,12].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of coagulation alteration in patients with COVID-19

Luo

You

et al. 2020

Ann Hematol

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Abnormal blood coagulation often occurs in critically ill patients, which seriously affects their prognosis. This retrospective study investigated the implications of changes in blood coagulation in patients with coronavirus disease 2019 (COVID-19). Records were reviewed for patients admitted with COVID-19 between February 4 and 16, 2020. The primary outcome was in-hospital death. A total of 85 patients were included, of whom 12 died in the hospital. The admission prothrombin time (PT), international normalized ratio (INR), and levels of D-dimer and fibrin/fibrinogen degradation products (FDP) were significantly higher in nonsurvivors than in survivors, while the reverse was true for prothrombin time activity (PT-act) and PaO 2 /FiO 2. Multivariate logistic regression showed that PT-act < 75% was independently associated with mortality. The area under the receiver operating characteristic curves for PT-act, D-dimer, and FDP at admission could significantly predict mortality. The AUCs for PT-act were larger than those for D-dimer and FDP; however, there was no significant difference. After 2 weeks of treatment, the coagulation parameters of the surviving patients improved. COVID-19 is often accompanied by abnormal coagulation. PT-act at admission is able to predict mortality in patients with COVID-19 as can D-dimer and FDP levels. PT-act < 75% is independently associated with mortality.

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Section: Discussionmentioning

confidence: 99%

Characteristics of coagulation alteration in patients with COVID-19

Luo

You

et al. 2020

Ann Hematol

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“…COVID-19 may predispose to not only venous but also arterial thromboembolic disease because of the effects of comprehensive factors including excessive inflammation, platelet activation, endothelial dysfunction, and stasis [ 7 , 14 ]. Platelet is the initiating factor in arterial thrombosis; however, thrombocytopenia is reportedly more common in patients with severe COVID-19 [ 2 , 3 , 13 , 15 , 16 ]. Thrombocytopenia is attributed to abnormal hemostasis and DIC, and is associated with severe disease manifestation and increased mortality in patients with COVID-19 [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU

et al. 2021

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Background Coronavirus disease 2019 (COVID-19) is associated with coagulation abnormalities which are indicators of higher mortality especially in severe cases. Methods We studied patients with proven COVID-19 disease in the intensive care unit of Jinyintan Hospital, Wuhan, China from 30 to 2019 to 31 March 2020. Results Of 180 patients, 89 (49.44 %) had died, 85 (47.22 %) had been discharged alive, and 6 (3.33 %) were still hospitalised by the end of data collection. A D-dimer concentration of > 0.5 mg/L on admission was significantly associated with 30 day mortality, and a D-dimer concentration of > 5 mg/L was found in a much higher proportion of non-survivors than survivors. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) scoring systems were dichotomised as < 4 or ≥ 4 and < 5 or ≥ 5, respectively, and the mortality rate was significantly different between the two stratifications in both scoring systems. Enoxaparin was administered to 68 (37.78 %) patients for thromboembolic prophylaxis, and stratification by the D-dimer concentration and DIC score confirmed lower mortality in patients who received enoxaparin when the D-dimer concentration was > 2 than < 2 mg/L or DIC score was ≥ 5 than < 5. A low platelet count and low serum calcium concentration were also related to mortality. Conclusions A D-dimer concentration of > 0.5 mg/L on admission is a risk factor for severe disease. A SIC score of > 4 and DIC score of > 5 may be used to predict mortality. Thromboembolic prophylaxis can reduce mortality only in patients with a D-dimer concentration of > 2 mg/L or DIC score of ≥ 5.

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“…Proteins like A2M, SERPINA4, SERPINA3, SERPING1, and FGG that are involved in regulated exocytosis of platelets were upregulated in the severe cohort suggesting an increased consumption of platelets. This could be a possible reason for the lower platelet count (clinically called thrombocytopenia) commonly reported in many severe cases of COVID-19 50 , which is also associated with coagulation abnormalities, disease severity, and mortality [51][52][53] . There is enough evidence to suggest that aside from their role in hemostasis, platelets have potent immune and in ammatory effector functions.…”

Section: Discussionmentioning

confidence: 99%

A multipronged deep omics-based investigation of COVID-19 plasma samples identifies key molecular networks of disease severity progression

Suvarna

Srivastava

2020

Preprint

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Prognosis and management of COVID-19 severity is a challenge even after months of the pandemic. We employed high resolution mass spectrometry-based deep proteomics and metabolomics based investigation to study a cohort of 186 patients plasma samples to understand the COVID-19 disease severity mechanism. A cohort of patients displayed COVID-19 like symptoms but were negative for the virus while the COVID-19 positive patients were classified as non-severe or severe groups based on the clinical manifestation of the disease. Of the 1200 proteins detected, 27 were differentially regulated in COVID positive group while 38 were found to be differentially expressed between non-severe and severe groups. GO enrichment analysis highlighted the involvement of regulation of peptidase activity, regulated exocytosis, extracellular structure organization, blood coagulation, fibrin clot formation, complement activation, leukocyte activation involved in immune response, and response to glucocorticoid biological processes to be dysregulated in severe SARS-CoV-2 infection. Further, metabolomics identified 15 significant metabolites indicating dysregulation in tryptophan, glycine, serine, threonine, arginine, proline, and porphyrin metabolism pathways. We validated the potential severity biomarkers such as angiotensinogen, apolipoprotein B, SERPINA3, SERPING1, and Fibrinogen gamma chain using targeted proteomics. Moreover, using our proteomics dataset and docking studies we found FDA-approved drugs Selinexor and Ponatinib having potential to be repurposed for the therapeutics intervention of COVID-19.

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SARS-CoV-2 induced thrombocytopenia as an important biomarker significantly correlated with abnormal coagulation function, increased intravascular blood clot risk and mortality in COVID-19 patients

Cited by 93 publications

References 20 publications

Characteristics of coagulation alteration in patients with COVID-19

Characteristics of coagulation alteration in patients with COVID-19

COVID-19-associated coagulopathy: thromboembolism prophylaxis and poor prognosis in ICU

A multipronged deep omics-based investigation of COVID-19 plasma samples identifies key molecular networks of disease severity progression

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