Inflammation-Induced Coagulopathy Substantially Differs Between COVID-19 and Septic Shock: A Prospective Observational Study

Frontiers in Medicine

Medicine

Manon Martin¹  Laurent Gatto¹  Damien Gruson²  Marie-Astrid Van Dievoet²  Pierre-François Laterre³  Virginie Montiel³  Ludovic Gerard⁴  Laure Morimont⁵  Jonathan Douxfils⁵  Hélène Haguet⁵  Laure Dumoutier⁶  Caroline Bouzin⁷  Aurélie Daumerie⁷  Lucie Jolly⁸  Marc Derive⁸  Laurence Pirotton⁹  Julie Bodart⁹  Sandrine Horman⁹  Marie Octave⁹  Valentine Robaux⁹  Luc Bertrand⁹  Julien De Poortere⁹  Alessandro Campion⁹  Audrey Ginion⁹  Mélanie Dechamps^1,10  Diego Castanares-Zapatero^1,11  Christophe Beauloye^1,12 

[1] Computational Biology and Bioinformatics Unit, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium;Department of Clinical Biology, Cliniques Universitaires Saint-Luc, Brussels, Belgium;Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium;Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium;Pôle de Pneumologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium;Department of Pharmacy, Namur Research Institute for Life Sciences, Namur, Belgium;Qualiblood, s.a., Namur, Belgium;Experimental Medicine Unit, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium;IREC Imaging Platform, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium;Inotrem s.a., Vandoeuvre-les-Nancy, France;Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium;Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium;Department of Cardiovascular Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium;Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium;Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium;Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium;Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium;

关键词: COVID-19;    septic shock;    inflammation;    coagulopathy;    platelet;    NETosis;    endothelium;   

DOI  :  10.3389/fmed.2021.780750

 received in 2021-09-21, accepted in 2021-12-24,  发布年份 2022

来源: Frontiers

【 摘 要 】

Critical COVID-19, like septic shock, is related to a dysregulated systemic inflammatory reaction and is associated with a high incidence of thrombosis and microthrombosis. Improving the understanding of the underlying pathophysiology of critical COVID-19 could help in finding new therapeutic targets already explored in the treatment of septic shock. The current study prospectively compared 48 patients with septic shock and 22 patients with critical COVID-19 regarding their clinical characteristics and outcomes, as well as key plasmatic soluble biomarkers of inflammation, coagulation, endothelial activation, platelet activation, and NETosis. Forty-eight patients with matched age, gender, and co-morbidities were used as controls. Critical COVID-19 patients exhibited less organ failure but a prolonged ICU length-of-stay due to a prolonged respiratory failure. Inflammatory reaction of critical COVID-19 was distinguished by very high levels of interleukin (IL)-1β and T lymphocyte activation (including IL-7 and CD40L), whereas septic shock displays higher levels of IL-6, IL-8, and a more significant elevation of myeloid response biomarkers, including Triggering Receptor Expressed on Myeloid cells-1 (TREM-1) and IL-1ra. Subsequent inflammation-induced coagulopathy of COVID-19 also differed from sepsis-induced coagulopathy (SIC) and was characterized by a marked increase in soluble tissue factor (TF) but less platelets, antithrombin, and fibrinogen consumption, and less fibrinolysis alteration. In conclusion, COVID-19 inflammation-induced coagulopathy substantially differs from SIC. Modulating TF release and activity should be evaluated in critical COVID-19 patients.

【 授权许可】

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Copyright © 2022 Dechamps, De Poortere, Martin, Gatto, Daumerie, Bouzin, Octave, Ginion, Robaux, Pirotton, Bodart, Gerard, Montiel, Campion, Gruson, Van Dievoet, Douxfils, Haguet, Morimont, Derive, Jolly, Bertrand, Dumoutier, Castanares-Zapatero, Laterre, Horman and Beauloye.