Association of D-dimer, inflammatory markers, cytokines abnormality, and disease severity in COVID-19 severe/critical patients in Wuhan
10.3760/cma.j.issn.0253-2727.2020.11.008
- VernacularTitle:武汉地区重型及危重型2019新型冠状病毒肺炎（COVID-19）患者D-二聚体、炎症指标、细胞因子与疾病严重程度的关系
- Author:
Jie ZHANG
1
;
Xiaoling GAO
;
Dengju LI
;
Yi JIANG
;
Yan LIU
;
Ling PANG
;
Dong XU
;
Linhua YANG
Author Information
1. 山西医科大学，太原 030001；山西医科大学第一医院消化内科，太原 030001
- Keywords:
COVID-19;
Coagulation;
D-dimer;
Cytokines
- From:
Chinese Journal of Hematology
2020;41(11):927-931
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the association of D-dimer levels, inflammatory indicators, cytokine abnormality, and disease severity in COVID-19 severe/critical type patients.Methods:The medical records of 41 patients were collected from a single center in Wuhan from February 8, 2020 to March 25, 2020. The patients were divided into severe type group (28 patients) and critical type group (13 patients) . The levels of D-dimer, WBC, ANC, PCT, hsCRP, IL-2R, IL-6, IL-8, and TNF-α were compared among patients with different clinical types of COVID-19 infection. Moreover, the changes in the cytokines were analyzed in patients with different D-dimer levels. And, the levels of D-dimer, IL-2R, IL-6, IL-8, and TNF-α before and after anticoagulant therapy were assessed. Statistical analyses were performed using Student t test, Mann-Whitney U test, and Chi-square test. Results:Among the 41 patients, 23 were men (56.1%) and 18 were women (43.9%) ; the median patient age was 57 y. The age of the critical type patients [ (61.1±10.4) y] was higher than that of severe type patients [ (52.8±11.7) y]; the difference was significant ( t=-2.264, P=0.032) . The proportion of critical type patients with chronic diseases, especially hypertension, cardiovascular disease, and cerebrovascular disease, was higher as compared to that in those with severe type patients; the differences were significant (all P<0.05) . The prevalence of dyspnea, sweats, and fatigue symptoms in the critical type patients was higher than that in those with severe type disease; the differences were significant ( χ2=14.898, 6.972, 7.823; P<0.001, 0.008, 0.005) . The levels of D-dimer, WBC, ANC, PCT, hsCRP, and IL-8 in critical type patients were higher than those in severe type patients; the differences were significant (all P<0.05) . The levels of IL-2R, IL-8, and TNF-α in patients with abnormal D-dimer were higher as compared to those in patients with normal D-dimer levels; the differences were significant (all P<0.05) . Eight patients were treated with prophylactic anticoagulation; the levels of D-dimer, IL-2R, IL-6 and IL-8 after anticoagulant therapy were lower than those before treatment. Conclusions:COVID-19 critical type patients have more serious coagulation-immune dysfunction and dynamic monitoring of D-dimer and cytokines levels helps in identifying critical type patients as early as possible; anticoagulant therapy may improve the patient’s condition by correcting coagulation-immune dysfunction.
