Dynamics of coagulopathy in patients with different COVID-19 severity

  1. Anna Kalinskaya
  2. Oleg Dukhin
  3. Ivan Molodtsov
  4. Alexandra Maltseva
  5. Denis Sokorev
  6. Antonina Elizarova
  7. Olga Sapozhnikova
  8. Ksenia Glebova
  9. Daria Stonogina
  10. Soslan Shakhidzhanov
  11. Evgeniy Nikonov
  12. Alexey Mazus
  13. Ilia Spiridonov
  14. Fazly Ataullakhanov
  15. Leonid Margolis
  16. Alexander Shpektor
  17. Elena Vasilieva

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Abstract

With the progress of COVID-19 studies, it became evident that SARS-CoV-2 infection is often associated with thrombotic complications. The goal of our present study was to evaluate which component of clot formation process including endothelial function, platelets aggregation and plasma coagulation, as well as endogenous fibrinolysis in patients with COVID-19 correlates with the severity of the disease. We prospectively included 58 patients with COVID-19 and 47 healthy volunteers as a control group that we recruited before the pandemic started. It turns out that plasma coagulation with subsequent platelet aggregation, but not endothelial function, correlates with the severity of the COVID-19. IL-6 blockade may play a beneficial role in COVID-19 induced coagulopathy.

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    SciScore for 10.1101/2020.07.02.20145284: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study protocol was developed in accordance with the principles of the Helsinki Declaration and was approved by the local ethics committee.
    Consent: Informed written consent was obtained from all study subjects.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    There were no significant differences in the clinical data; however, patients receiving tocilizumab were characterized by a higher level of inflammation markers (hs-CRP, aspartate aminotransferase (AST), lactate dehydrogenase (LDH)), a lower lymphocyte count, and a shorter PT (see supplemental table №1) Statistical analysis: Statistical analysis was performed with the Python 3 programming language using the numpy, scipy, and pandas packages.
    Python
    suggested: (IPython, RRID:SCR_001658)
    numpy
    suggested: (NumPy, RRID:SCR_008633)
    scipy
    suggested: (SciPy, RRID:SCR_008058)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Despite the fact that the FMD-test has limitations in assessing small-caliber vessels, in our study we did not observe generalized endothelial dysfunction. In our study the initial depression of platelet aggregation in patients compared with the control group was followed by a significant increase in platelet reactivity during disease progression. This increase was more pronounced in the severely ill patients, in agreement with literature data6. We demonstrated for the first time the deferred mode of this activation. Nevertheless, platelet aggregation values in patient subgroups ranged between lower and upper limits reported for normal individuals. In contrast, we found out that plasma coagulation activation was much more active in COVID-19 patients than in the control group. Furthermore, the level of activation correlated with the severity of the disease in particular during disease progression. It is important that this activation was evaluated despite the 100% usage of anticoagulants in our patients. Optimal anticoagulation therapy, especially in severe patients, needs further study. Also, we found that the process of endogenous fibrinolysis was significantly more active in COVID-19 patients compared to control group. However, we did not find any differences in process of endogenous fibrinolysis between the severely and moderately ill subgroups of patients, with the exception of elevated levels of D-dimer (in particular, among severely ill patients), like many other author...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.07.02.20145284v1 on medRxiv