Interplay between coagulopathy and inflammation in patients with COVID-19

Abstract

Background: Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a systemic disease. Most patients have mild-to-moderate symptoms; however, severe respiratory symptoms develop in some. Although increased inflammatory markers and abnormal coagulation profile are related to the severity and mortality of COVID-19, no definitive relation has been established. Materials and Methods: The laboratory data of 199 patients with COVID-19 admitted to our dedicated COVID-19 care facility, categorized into mild (36), moderate (76), and severe (87) cases, were analyzed for a statistical association between the inflammatory markers and coagulation profile. IBM SPSS V23 software, Chicago, was used for data analysis. Results: A gradual increase in serum IL-6, ferritin, and D-dimer levels were observed from mild, moderate, and severe categories with statistically significant differences among all three groups. A positive correlation was observed between serum IL-6 and D-dimer (r2 = 0.36, P < 0.01) only in the severe group. Among the three parameters, D-dimer had the best discriminating ability between severe and nonsevere disease with a serum cutoff level of 451 ng/mL. Conclusion: Thrombin has pro-inflammatory action. Similarly, IL-6 induces the release of acute-phase reactants like fibrinogen. Because of this interplay, patients with severe COVID-19 are at a dual risk of inflammatory and thromboembolic complications and must be monitored stringently.

Keywords

• coagulation-inflammation interplay
• covid-19
• d
• -dimer
• ferritin
• il-6