HEMOCOAGULATION DISORDERS AND ACUTE PHASE MARKERS IN THE CONTEXT OF THE PATHOGENESIS OF CORONAVIRUS DISEASE 2019
DOI:
https://doi.org/10.11603/1681-2727.2025.3.15592Keywords:
Coronavirus disease 2019, acute phase inflammation markers, hemostasis system, thromboelastography, thrombohemorrhagic syndrome, coagulopathyAbstract
SUMMARY. Objective. To analyze the state of hemostasis system parameters, acute phase inflammatory markers, and their interrelations in patients with varying severity of COVID-19.
Materials and Methods. A total of 179 (100 %) patients with COVID-19 who were treated at the “Regional Children’s Infectious Clinical Hospital” of the Kharkiv Regional Council from 2020 to 2024 were examined. Upon hospital admission, all patients underwent chest CT or radiography, complete blood count, and coagulation tests (fibrinogen, D-dimer, prothrombin time, prothrombin according to Quick, activated partial thromboplastin time (APTT), and international normalized ratio (INR)) using standard laboratory methods. Levels of C-reactive protein (CRP), ferritin, and interleukin-6 (IL-6) were measured by ELISA. Thromboelastography (TEG) was also performed using the TEG® 5000 system. A control group of 42 practically healthy individuals who were blood donors was used. The results were processed using standard statistical methods, including Student’s t-test, Pearson’s chi-square test, and Spearman’s rank correlation coefficient (Rho, ρ).
Results. The clinical picture was dominated by general intoxication symptoms (93.3 %), catarrhal-respiratory syndrome (70.95%), psycho-neurological disorders (64.3 %), and signs of respiratory failure (50.8 %). Pneumonia was diagnosed in 178 (99.4 %) patients, more often bilateral (p<0.001). Changes in clinical blood analysis included leukocytosis and increased erythrocyte sedimentation rate. Serum levels of CRP, ferritin, IL-6, D-dimer, and fibrinogen were significantly higher in COVID-19 patients than in the control group (p<0.001), while prothrombin time, INR, APTT, and prothrombin by Quick did not differ significantly (p>0.05). Most parameters were related to the severity of the disease. Thromboelastography in COVID-19 patients showed a decrease in the maximum rate of thrombus formation and overall thrombin generation, a decreased maximum lysis rate and increased time to reach it, as well as reduced clot elasticity (p<0.02). Correlation analysis revealed numerous associations between TEG parameters, acute phase markers, and coagulation indicators, indicating mutual influence of different pathogenetic links in SARS-CoV-2 infection.
Conclusions. COVID-19 patients demonstrated elevated serum levels of CRP, ferritin, IL-6, D-dimer, and fibrinogen compared to the control group, with values correlating with disease severity: higher in severe cases than in moderate ones.
Thromboelastography revealed increased thrombotic and decreased lytic activity, indicating a state of hypercoagulation.
Numerous correlations were found between TEG parameters, acute phase markers, and coagulation indicators, confirming the interdependence of various pathogenetic pathways in COVID-19.
Monitoring fibrinogen and D-dimer levels in COVID-19 patients may be used to assess the risk of thrombohemorrhagic complications.
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