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Moness H, Mousa SO, Mousa SO, Adel NM, Ibrahim RA, Hassan EE, Abdelhameed NI, Meshref DA, Abdullah NM. Thrombophilia genetic mutations and their relation to disease severity among patients with COVID-19. PLoS One 2024; 19:e0296668. [PMID: 38507367 PMCID: PMC10954113 DOI: 10.1371/journal.pone.0296668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 12/13/2023] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES Patients with COVID-19 infection appear to develop virus-induced hypercoagulability resulting in numerous thrombotic events. The aim of the present study was to determine the relationship between the thrombophilia genes mutations (prothrombin G20210A, factor V Leiden, and methyltetrahydrofolate reductase (MTHFR)) and the severity of COVID-19 patients. DESIGN Prospective cross-sectional study. METHOD One hundred and forty patients (80 adults and 60 children) were included in the current study. They were divided into the severe COVID-19 group and the mild COVID-19 group, with each group comprising 40 adults and 30 children. The patients were assessed for FV R506Q, FV R2H1299R, MTHFR A1298C, MTHFR C677T, and prothrombin gene G20210A polymorphisms. CBC, D-dimer, renal and liver function tests, hs-CRP, ferritin, and LDH were also assessed. Thrombotic events were clinically and radiologically documented. RESULTS Severe COVID-19 cases were significantly more frequent to have a heterozygous mutation for all the studied genes compared to mild COVID-19 cases (p<0.05 for all). Being mutant to gene FV R506Q carried the highest risk of developing a severe disease course (p<0.0001). Patients with abnormally high D-dimer levels were significantly more frequent to be heterozygous for FV R506Q, FV R2H1299R, and prothrombin gene G20210A (p = 0.006, 0.007, and 0.02, respectively). CONCLUSION We concluded that there is an evident relationship between severe COVID-19 and inherited thrombophilia. In the current study, FV R506Q gene mutation carried the highest risk of developing a severe COVID-19 disease course.
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Affiliation(s)
- Hend Moness
- Clinical Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Suzan Omar Mousa
- Pediatric Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Sarah Omar Mousa
- Anesthesiology and Intensive Care Department, Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Reham Ali Ibrahim
- Microbiology and Immunology Department, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Ebtesam Esmail Hassan
- Public Health and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | | | | | - Noha M. Abdullah
- Clinical Pathology Department, Faculty of Medicine, Minia University, Minia, Egypt
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Sayyadi M, Hassani S, Shams M, Dorgalaleh A. Status of major hemostatic components in the setting of COVID-19: the effect on endothelium, platelets, coagulation factors, fibrinolytic system, and complement. Ann Hematol 2023; 102:1307-1322. [PMID: 37074380 PMCID: PMC10115391 DOI: 10.1007/s00277-023-05234-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/14/2023] [Indexed: 04/20/2023]
Abstract
The coagulation, fibrinolytic, anticoagulation, and complement systems are in delicate balance with the vessel wall endothelium ensuring appropriate hemostasis. Coagulopathy in coronavirus disease 2019 (COVID-19) is not a simple disorder of one hemostatic component but a complicated process affecting most of the hemostasis system. COVID-19 disturbs the balance between the procoagulant systems and the regulatory mechanisms. Here, we investigate the effect of COVID-19 on key hemostatic components, including platelets, endothelial cells, coagulation factors, fibrinolytic system, anticoagulant protein system, and complement system, to improve our understanding of the pathophysiological processes underlying COVID-19 coagulopathy based on evidence.
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Affiliation(s)
- Mohammad Sayyadi
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Arak University of Medical Sciences, Arak, Iran
| | - Saeed Hassani
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Arak University of Medical Sciences, Arak, Iran.
| | - Mahmood Shams
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Wu X, Jing H, Wang C, Wang Y, Zuo N, Jiang T, Novakovic VA, Shi J. Intestinal Damage in COVID-19: SARS-CoV-2 Infection and Intestinal Thrombosis. Front Microbiol 2022; 13:860931. [PMID: 35391725 PMCID: PMC8981312 DOI: 10.3389/fmicb.2022.860931] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/24/2022] [Indexed: 12/15/2022] Open
Abstract
The intestinal tract, with high expression of angiotensin-converting enzyme 2 (ACE2), is a major site of extrapulmonary infection in COVID-19. During pulmonary infection, the virus enters the bloodstream forming viremia, which infects and damages extrapulmonary organs. Uncontrolled viral infection induces cytokine storm and promotes a hypercoagulable state, leading to systemic microthrombi. Both viral infection and microthrombi can damage the gut–blood barrier, resulting in malabsorption, malnutrition, and intestinal flora entering the blood, ultimately increasing disease severity and mortality. Early prophylactic antithrombotic therapy can prevent these damages, thereby reducing mortality. In this review, we discuss the effects of SARS-CoV-2 infection and intestinal thrombosis on intestinal injury and disease severity, as well as corresponding treatment strategies.
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Affiliation(s)
- Xiaoming Wu
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin, China
| | - Chengyue Wang
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin, China
| | - Yufeng Wang
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin, China
| | - Nan Zuo
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin, China
| | - Tao Jiang
- Department of General Surgery, The First Hospital, Harbin Medical University, Harbin, China
| | - Valerie A Novakovic
- Department of Research, VA Boston Healthcare System, Harvard Medical School, Boston, MA, United States
| | - Jialan Shi
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin, China.,Department of Research, VA Boston Healthcare System, Harvard Medical School, Boston, MA, United States.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
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Tang Y, Sun J, Pan H, Yao F, Yuan Y, Zeng M, Ye G, Yang G, Zheng B, Fan J, Pan Y, Zhao Z, Guo S, Liu Y, Liao F, Duan Y, Jiao X, Li Y. Aberrant cytokine expression in COVID-19 patients: Associations between cytokines and disease severity. Cytokine 2021; 143:155523. [PMID: 33840589 PMCID: PMC8011640 DOI: 10.1016/j.cyto.2021.155523] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/12/2021] [Accepted: 03/28/2021] [Indexed: 02/05/2023]
Abstract
Cytokines play pleiotropic, antagonistic, and collaborative in viral disease. The high morbidity and mortality of coronavirus disease 2019 (COVID-19) make it a significant threat to global public health. Elucidating its pathogenesis is essential to finding effective therapy. A retrospective study was conducted on 71 patients hospitalized with COVID-19. Data on cytokines, T lymphocytes, and other clinical and laboratory characteristics were collected from patients with variable disease severity. The effects of cytokines on the overall survival (OS) and event-free survival (EFS) of patients were analyzed. The critically severe and severe patients had higher infection indexes and significant multiple organ function abnormalities than the mild patients (P < 0.05). IL-6 and IL-10 were significantly higher in the critically severe patients than in the severe and mild patients (P < 0.05). IL-6 and IL-10 were closely associated with white blood cells, neutrophils, T lymphocyte subsets, D-D dimer, blood urea nitrogen, complement C1q, procalcitonin C-reactive protein. Moreover, the IL-6 and IL-10 levels were closely correlated to dyspnea and dizziness (P < 0.05). The patients with higher IL-10 levels had shorter OS than the group with lower levels (P < 0.05). The older patients with higher levels of single IL-6 or IL-10 tended to have shorter EFS (P < 0.05), while the patients who had more elevated IL-6 and IL-10 had shorter OS (P < 0.05). The Cox proportional hazard model revealed that IL-6 was the independent factor affecting EFS. IL-6 and IL-10 play crucial roles in COVID-19 prognosis.
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Affiliation(s)
- Yueting Tang
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Jiayu Sun
- Department of Cell Biology, Shantou University Medical College, Shantou, Guangdong, China.
| | - Huaqin Pan
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67813517, China.
| | - Fen Yao
- Department of Cell Biology, Shantou University Medical College, Shantou, Guangdong, China.
| | - Yumeng Yuan
- Department of Cell Biology, Shantou University Medical College, Shantou, Guangdong, China.
| | - Mi Zeng
- Department of Cell Biology, Shantou University Medical College, Shantou, Guangdong, China.
| | - Guangming Ye
- Center for Clinical Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Gui Yang
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Bokun Zheng
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Junli Fan
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Yunbao Pan
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Ziwu Zhao
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Shuang Guo
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Yinjuan Liu
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Fanlu Liao
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Yongwei Duan
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
| | - Xiaoyang Jiao
- Department of Cell Biology, Shantou University Medical College, Shantou, Guangdong, China.
| | - Yirong Li
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 86-027-67812888, China.
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El Hasbani G, Taher AT. Should we screen Eastern Mediterranean COVID-19 patients for inherited thrombophilia? Med Hypotheses 2021; 152:110621. [PMID: 34116360 PMCID: PMC8176888 DOI: 10.1016/j.mehy.2021.110621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022]
Abstract
The inflammatory component of Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) creates a pro-thrombotic state that necessitates a thrombophylactic strategy for hospitalized patients. Such strategies are difficult to be standardized because certain individuals can have pro-thrombotic conditions, such as inherited thrombophilia, which pre-dispose them to an additional coagulative risk. Whether outside the hospital or when admitted, patients with inherited thrombophilia need special anticoagulant and antiplatelet attention. Identifying such patients, especially in susceptible populations like the eastern Mediterranean (EM) region, will aid primary providers in risk stratification for choosing the optimal anticoagulation or antiplatelet plan.
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Affiliation(s)
- Georges El Hasbani
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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