Coagulopathy as a Prodrome of Cytokine Storm in COVID-19-Infected Patients

Frontiers in Medicine

article

Hui Guo¹  LeJian Wang²  Jing Li³  Fengchao Wang¹  Ying Sheng⁴  Wei Li⁵  Fei Li⁶  Zongyu Xie⁷  Jing Li¹  Yuhe Zhu⁸  Jian Geng⁸  Gang Liu⁹ 

[1] Department of Laboratory Medicine, The First Affiliated Hospital of Bengbu Medical College;Department of Laboratory Medicine, Zhejiang University of Traditional Chinese Medicine Affiliated XinHua Hospital;Department of Surgery, University of Michigan School of Medicine, United States;School of Nursing, Indiana University, United States;Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College;Department of Laboratory Medicine, Taizhou Central Hospital (Taizhou University Hospital);Department of Radiology, The First Affiliated Hospital of Bengbu Medical College;Department of Laboratory Medicine, Bengbu Medical College;Department of Thoracic Surgery, The Second Affiliated Hospital of Bengbu Medical College

关键词: COVID-19;    coagulopathy;    cytokine storm;    prodrome;    d-dimer;    IL-6;   

DOI  :  10.3389/fmed.2020.572989

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: The rapid coronavirus disease 2019 (COVID-19) pandemic has hit hard on the world and causes panic since the virus causes serious infectious respiratory illness and easily leads to severe conditions such as immune system overactivation or cytokine storm. Due to the limited knowledge on the course of infection of this coronavirus and the lack of an effective treatment for this fatal disease, mortality remains high. The emergence of a cytokine storm in patients with a severe condition has been reported as the top reason of the death of patients with COVID-19 infection. However, the causative mechanism of cytokine storm remains elusive. Thus, we aim to observe the association of coagulopathy (D-dimer) with cytokine (i.e., IL-6) and CT imaging in COVID-19-infected patients. Methods: In this retrospective observational study, we systematically analyzed the comprehensive clinical laboratory data of COVID-19-positive patients in different illness groups of mild, moderate, and severe conditions according to the Chinese Clinical Guidance for COVID-19 Pneumonia Diagnosis and Treatment (7th edition). T tests and chi-square tests were used for two-group comparisons. One-way ANOVA was used for three-group comparisons. Pearson and Spearman correlation coefficients of the D-dimer level with IL-6 and CT imaging were computed at baseline. With regular liquid biopsy approach, D-dimer, IL-6, and neutrophil-to-lymphocyte ratio were recorded repeatedly with a time curve to investigate disease progression, along with CT imaging, and other indicators. Results: All the 64 patients were clinically evaluated and classified into three groups of mild (32 cases), moderate (23 cases), and severe (nine cases) conditions. The D-dimer level positively correlated with IL-6 ( R = 0.5) at baseline when the COVID-19-infected patients were admitted. In addition, we observed that D-dimer rises earlier than the cytokine storm represented by IL-6 surge, which suggests that coagulopathy might act as a trigger to potentiate a cytokine storm. Conclusion: Integrated analysis revealed a positive correlation of coagulopathy with cytokine storm in COVID-19-infected patients; the D-dimer rises early, which indicates that coagulopathy acts as a prodrome of cytokine storm. Coagulopathy can be used to monitor early cytokine storm in COVID-19-infected patients.

【 授权许可】

CC BY