Immature platelets in patients with Covid-19: association with disease severity
Tóm tắt
Coronavirus disease 2019 (Covid-19) is associated with a high incidence of venous and arterial thromboembolic events. Currently, there are no clinical or laboratory markers that predict thrombotic risk. Circulating immature platelets are hyper-reactive platelets, which are associated with arterial thrombotic events. The aim of this study was to assess whether the proportion of circulating immature platelets is associated with disease severity in Covid-19 patients. Patients admitted with Covid-19 disease were prospectively assessed. Immature platelet count (IPC) and immature platelet fraction (IPF) were measured at admission and at additional time points during the hospital course using the Sysmex XN-3000 auto-analyzer. A total of 136 consecutive patients with Covid-19 were recruited [mean age 60 ± 19 years, 49% woman, 56 (41%) had mild-moderate disease and 80 (59%) had severe disease at presentation]. The median IPF% was higher in patients with severe compared to mild-moderate disease [5.8 (3.9–8.7) vs. 4.2 (2.73–6.45), respectively, p = 0.01]. The maximal IPC value was also higher in patients with severe disease [15 (10.03–21.56), vs 10.9 (IQR 6.79–15.62), respectively, p = 0.001]. Increased IPC was associated with increased length of hospital stay. Patients with severe Covid-19 have higher levels of IPF than patients with mild-moderate disease. IPF may serve as a prognostic marker for disease severity in Covid-19 patients.
Tài liệu tham khảo
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y et al (2020) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395(10223):507–513
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet 395(10223):497–506
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan China. JAMA 323(11):1061–1069
Boonyawat K, Chantrathammachart P, Numthavaj P, Nanthatanti N, Phusanti S, Phuphuakrat A, Niparuck P, Angchaisuksiri P (2020) Incidence of thromboembolism in patients with Covid-19: a systematic review and meta-analysis. Thromb J 18(1):34
Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, Zhang C, Li H, Xia X, Kong S et al (2020) Deep vein thrombosis in hospitalized patients with Covid-19 in Wuhan, China: prevalence, risk factors, and outcome. Circulation 142(2):114–128
Dubois-Silva Á, Barbagelata-López C, Mena Á, Piñeiro-Parga P, Llinares-García D, Freire-Castro S (2020) Pulmonary embolism and screening for concomitant proximal deep vein thrombosis in noncritically ill hospitalized patients with coronavirus disease 2019. Intern Emerg Med 15(5):865–870
Mestre-Gómez B, Lorente-Ramos RM, Rogado J, Franco-Moreno A, Obispo B, Salazar-Chiriboga D, Saez-Vaquero T, Torres-Macho J, Abad-Motos A, Cortina-Camarero C, Infanta Leonor Thrombosis Research Group (2021) Incidence of pulmonary embolism in non-critically ill Covid-19 patients. Predicting factors for a challenging diagnosis. J Thromb Thrombolysis 51(1):40–46
Shang W, Dong J, Ren Y, Tian M, Li W, Hu J, Li Y (2020) The value of clinical parameters in predicting the severity of Covid-19. J Med Virol 92(10):2188–2192
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, Xing F, Liu J, Yip CC, Poon RW et al (2020) A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 395(10223):514–523
Lippi G, Plebani M, Henry BM (2020) Thrombocytopenia is associated with severe coronavirus disease 2019 (Covid-19) infections: a meta-analysis. Clin Chim Acta 506:145–148
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X et al (2020) Clinical course and risk factors for mortality of adult inpatients with Covid-19 in Wuhan, China: a retrospective cohort study. Lancet 395(10229):1054–1062
Tang N, Li D, Wang X, Sun Z (2020) Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 18(4):844–847
Lev EI (2016) Immature platelets: clinical relevance and research perspectives. Circulation 134(14):987–988
Hille L, Lenz M, Vlachos A, Grüning B, Hein L, Neumann FJ, Nührenberg TG, Trenk D (2020) Ultrastructural, transcriptional, and functional differences between human reticulated and non-reticulated platelets. J Thromb Haemost 18(8):2034–2046
Bernlochner I, Goedel A, Plischke C, Schüpke S, Haller B, Schulz C, Mayer K, Morath T, Braun S, Schunkert H et al (2015) Impact of immature platelets on platelet response to ticagrelor and prasugrel in patients with acute coronary syndrome. Eur Heart J 36(45):3202–3210
Freynhofer MK, Gruber SC, Grove EL, Weiss TW, Wojta J, Huber K (2015) Antiplatelet drugs in patients with enhanced platelet turnover: biomarkers versus platelet function testing. Thromb Haemost 114(3):459–468
Pons I, Monteagudo M, Lucchetti G, Muñoz L, Perea G, Colomina I, Guiu J, Obiols J (2010) Correlation between immature platelet fraction and reticulated platelets Usefulness in the etiology diagnosis of thrombocytopenia. Eur J Haematol 85(2):158–163
Cohen A, Harari E, Cipok M, Laish-Farkash A, Bryk G, Yahud E, Sela Y, Lador NK, Mann T, Mayo A et al (2021) Immature platelets in patients hospitalized with Covid-19. J Thromb Thrombolysis 51(3):608–616
Lenz, Maximilian, et al. Covid-19 Treatment guidelines panel. Coronavirus Disease 2019 (Covid-19) Treatment Guidelines. National Institutes of Health
Spiezia L, Boscolo A, Poletto F, Cerruti L, Tiberio I, Campello E, Navalesi P, Simioni P (2020) Covid-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thromb Haemost 120(6):998–1000
Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shah B, Ibrahim H, Friedman GH, Thompson C, Alviar CL et al (2020) ST-segment elevation in patients with Covid-19—a case series. N Engl J Med 382(25):2478–2480
Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, De Leacy RA, Shigematsu T, Ladner TR, Yaeger KA et al (2020) Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 382(20):e60
Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, Metra M, Curello S, Maffeo D, Pero G et al (2020) ST-elevation myocardial infarction in patients with Covid-19: clinical and angiographic outcomes. Circulation 141(25):2113–2116
Cesari F, Marcucci R, Gori AM, Caporale R, Fanelli A, Casola G, Balzi D, Barchielli A, Valente S, Giglioli C et al (2013) Reticulated platelets predict cardiovascular death in acute coronary syndrome patients. Insights from the AMI-Florence 2 Study. Thromb Haemost 109(5):846–853
Martin JF, Kristensen SD, Mathur A, Grove EL, Choudry FA (2012) The causal role of megakaryocyte–platelet hyperactivity in acute coronary syndromes. Nat Rev Cardiol 9(11):658–670
Grove EL, Hvas AM, Mortensen SB, Larsen SB, Kristensen SD (2011) Effect of platelet turnover on whole blood platelet aggregation in patients with coronary artery disease. J Thromb Haemost 9(1):185–191
López-Jiménez RA, Martín-Herrero F, González-Porras JR, Sánchez-Barba M, Martín-Luengo C, Pabón-Osuna P (2013) Immature platelet fraction: a new prognostic marker in acute coronary syndrome. Rev Esp Cardiol 66(2):147–148
Gonzalez-Porras JR, Martin-Herrero F, Gonzalez-Lopez TJ, Olazabal J, Diez-Campelo M, Pabon P, Alberca I, San Miguel JF (2010) The role of immature platelet fraction in acute coronary syndrome. Thromb Haemost 103(1):247–249
Grove EL, Hvas AM, Kristensen SD (2009) Immature platelets in patients with acute coronary syndromes. Thromb Haemost 101(1):151–156
Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A et al (2020) Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med 383(2):120–128
Bunce PE, High SM, Nadjafi M, Stanley K, Liles WC, Christian MD (2011) Pandemic H1N1 influenza infection and vascular thrombosis. Clin Infect Dis 52(2):e14–e17
Rondina MT, Brewster B, Grissom CK, Zimmerman GA, Kastendieck DH, Harris ES, Weyrich AS (2012) In vivo platelet activation in critically ill patients with primary 2009 influenza A(H1N1). Chest 141(6):1490–1495
Zhang S, Liu Y, Wang X, Yang L, Li H, Wang Y, Liu M, Zhao X, Xie Y, Yang Y et al (2020) SARS-CoV-2 binds platelet ACE2 to enhance thrombosis in Covid-19. J Hematol Oncol 13(1):120