Abstract
This study aimed to detect, analyze, and correlate the clinical characteristics, blood coagulation functions, blood calcium levels, and inflammatory factors in patients with mild and severe COVID-19 infections. The enrolled COVID-19 infected patients were from Wuhan Jin Yin-tan Hospital (17 cases, Wuhan, China), Suzhou Infectious Disease Hospital (87 cases, Suzhou, China), and Xuzhou Infectious Disease Hospital (14 cases, Xuzhou, China). After admission, basic information was collected; X-ray and chest CT images were obtained; and data from routine blood tests, liver and kidney function, myocardial enzymes, electrolytes, blood coagulation function, (erythrocyte sedimentation rate) ESR, C-reactive protein (CRP), IL-6, procalcitonin (PCT), calcitonin, and other laboratory tests were obtained. The patients were grouped according to the clinical classification method based on the pneumonia diagnosis and treatment plan for new coronavirus infection (trial version 7) in China. The measurements from mild (56 cases) and severe cases (51 cases) were compared and analyzed. Most COVID-19 patients presented with fever. Chest X-ray and CT images showed multiple patchy and ground glass opacities in the lungs of COVID 19 infected patients, especially in patients with severe cases. Compared with patients with mild infection, patients with severe infection were older (p = 0.023) and had a significant increase in AST and BUN. The levels of CK, LDH, CK-MB, proBNP, and Myo in patients with severe COVID-19 infection were also increased significantly compared to those in patients with mild cases. Patients with severe COVID-19 infections presented coagulation dysfunction and increased D-dimer and fibrin degradation product (FDP) levels. Severe COVID-19 patients had low serum calcium ion (Ca2+) concentrations and high calcitonin and PCT levels and exhibited serious systemic inflammation. Ca2+ in COVID-19 patients was significantly negatively correlated with PCT, calcitonin, D-dimer, PFDP, ESR, CRP and IL-6. D-dimer in COVID-19 patients was a significantly positively correlated with CRP and IL-6. In conclusion, patients with severe COVID-19 infection presented significant metabolic dysfunction and abnormal blood coagulation, a sharp increase in inflammatory factors and calcitonin and procalcitonin levels, and a significant decrease in Ca2+. Decreased Ca2+ and coagulation dysfunction in COVID-19 patients were significantly correlated with each other and with inflammatory factors.
Highlights
It has been nearly a year since the discovery of the novel coronavirus—COVID-19, which has become a global-scale disaster event
We focused on the coagulation function of these cases and compared and analyzed the correlations among decreased Ca2+, coagulation disorder and other test results, including systemic inflammation and metabolic disorders, in mild and severe COVID-19 infected patients
All patients were diagnosed with positive SARS-CoV-2 gene expression by RT-polymerase chain reaction (PCR)
Summary
It has been nearly a year since the discovery of the novel coronavirus—COVID-19, which has become a global-scale disaster event. Dysfunction of the coagulation/fibrinolysis system is an important pathophysiological feature of COVID-19 patients, and it is related to the inflammatory cascade induced by viral infection [5,6,7]. The diffuse intravascular coagulation (DIC) induced by severe infections often becomes a decisive factor in the death of patients with severe infection [8,9,10,11]. Many studies have revealed dysfunction of the coagulation/fibrinolysis system in COVID-19 infected patients. A review titled “Coagulation and anticoagulation in COVID-19” was recently published [12], the specific relationship between the coagulation function and inflammation in patients with mild and severe COVID-19 infection, as well as the correlation between coagulation function and serum Ca2+ [which was abnormally decreased in patients with severe COVID-19 infection [13]], has not yet been determined
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