Inflammation/coagulopathy/fibrinolysis: Dynamic indicators of COVID-19 progression in patients with moderate COVID-19 in Wenzhou, China

The majority of the coronavirus disease 2019 (COVID-19) non-survivors meet the criteria for disseminated intravascular coagulation (DIC). Although timely monitoring of clotting hemorrhagic development during the natural course of COVID-19 is critical for understanding pathogenesis, diagnosis, and tr...

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Veröffentlicht in:Clinical immunology (Orlando, Fla.) Fla.), 2021-11, Vol.232, p.108852-108852, Article 108852
Hauptverfasser: An, Hui, Zhang, Jitai, Zhou, Tong, Li, Ting, Li, Shan, Huang, Caili, Chen, Chengshui, Ying, Binyu, Xu, Zhangye, Jin, Shengwei, Li, Xiaokun, Li, Ming
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Sprache:eng
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Zusammenfassung:The majority of the coronavirus disease 2019 (COVID-19) non-survivors meet the criteria for disseminated intravascular coagulation (DIC). Although timely monitoring of clotting hemorrhagic development during the natural course of COVID-19 is critical for understanding pathogenesis, diagnosis, and treatment of the disease, however, limited data are available on the dynamic processes of inflammation/coagulopathy/fibrinolysis (ICF). We monitored the dynamic progression of ICF in patients with moderate COVID-19. Out of 694 COVID-19 inpatients from 10 hospitals in Wenzhou, China, we selected 293 adult patients without comorbidities. These patients were divided into different daily cohorts according to the COVID-19 onset-time. Furthermore, data of 223 COVID-19 patients with comorbidities and 22 critical cases were analyzed. Retrospective data were extracted from electronic medical records. The virus-induced damages to pre-hospitalization patients triggered two ICF fluctuations during the 14-day course of the disease. C-reactive protein (CRP), fibrinogen, and D-dimer levels increased and peaked at day 5 (D) 5 and D9 during the 1st and 2nd fluctuations, respectively. The ICF activities were higher during the 2nd fluctuation. Although 12-day medication returned high CRP concentrations to normal and blocked fibrinogen increase, the D-dimer levels remained high on days 17 ± 2 and 23 ± 2 days of the COVID-19 course. Notably, although the oxygenation index, prothrombin time and activated partial thromboplastin time were within the normal range in critical COVID-19 patients at administration, 86% of these patients had a D-dimer level > 500 μg/L. COVID-19 is linked with chronic DIC, which could be responsible for the progression of the disease. Understanding and monitoring ICF progression during COVID-19 can help clinicians in identifying the stage of the disease quickly and accurately and administering suitable treatment. •The coronavirus 2 (SARS-CoV-2) -induced damages in patients with COVID-19 triggers two inflammation/coagulopathy/fibrinolysis (ICF) fluctuations (peaks at day 5 and day 9, respectively) during the 14-day course of the disease.•Although twelve-day medication returned high CRP concentration to normal and blocked fibrinogen increase, the D-dimer levels remained high on 17 ± 2 and 23 ± 2 days of COVID-19 course.•Elucidation of ICF progression during the course of COVID-19 can help clinicians in identifying the stage of the disease quickly and accurately,
ISSN:1521-6616
1521-7035
DOI:10.1016/j.clim.2021.108852