COVID-19-Induced Thrombosis in Patients without Gastrointestinal Symptoms and Elevated Fecal Calprotectin: Hypothesis Regarding Mechanism of Intestinal Damage Associated with COVID-19.

Mauro Giuffrè,Gianluca Sambataro,Marco Cavallaro,Anna Crescenzi,Lory Saveria Crocè,Fabio Monica,Alessandro Agostino Occhipinti,Roberto Luzzati,Verena Zerbato,Andrea Palermo,Stefano Di Bella

doi:10.3390/tropicalmed5030147

Abstract

Background: Patients with coronavirus infectious disease 2019 (COVID-19) and gastrointestinal symptoms showed increased values of fecal calprotectin (FC). Additionally, bowel abnormalities were a common finding during abdominal imaging of individuals with COVID-19 despite being asymptomatic. The current pilot study aims at evaluating FC concentrations in patients without gastrointestinal symptoms. Methods: we enrolled 25 consecutive inpatients with COVID-19 pneumonia, who were admitted without gastrointestinal symptoms and a previous history of inflammatory bowel disease. Results: At admission, 21 patients showed increased FC with median values of 116 (87.5; 243.5) mg/kg despite absent gastrointestinal symptoms. We found a strong positive correlation between FC and D-Dimer (r = 0.745, p < 0.0001). Two patients developed bowel perforation. Conclusion: our findings may change the current understanding of COVID-19 intestinal-related disease pathogenesis, shedding new light on the potential role of thrombosis and the consequent hypoxic intestinal damage.

Highlights

At the time of writing this letter, the principal cause of mortality in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is respiratory failure with exudative diffuse alveolar damage and massive capillary congestion often accompanied by microthrombi or, in lower percentages, by generalized thrombotic microangiopathy, as reported by post-mortem examinations [1]
Gastrointestinal symptoms are present in up to 28% of patients with COVID-19 [7,8,9], and fecal SARS-CoV-2-RNA was detected in approximately 50% of positive individuals [8,9,10]
Effenberger et al [5] proposed the role of fecal calprotectin (FC) as a marker of intestinal inflammation in COVID-19 patients who developed gastrointestinal (GI) symptoms

Summary

Introduction

At the time of writing this letter, the principal cause of mortality in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is respiratory failure with exudative diffuse alveolar damage and massive capillary congestion often accompanied by microthrombi or, in lower percentages, by generalized thrombotic microangiopathy, as reported by post-mortem examinations [1]. Gastrointestinal symptoms are present in up to 28% of patients with COVID-19 [7,8,9], and fecal SARS-CoV-2-RNA was detected in approximately 50% of positive individuals [8,9,10]. The authors detected significantly higher FC values in patients with acute diarrhea if compared to patients without diarrhea or with ceased diarrhea (>48 h) In this pilot study, we aimed to externally validate the results of Effenberger et al [5] by determining the actual absence of significant FC concentrations in patients who did not present gastrointestinal symptoms and without previous history of inflammatory bowel disease (IBD). Patients with coronavirus infectious disease 2019 (COVID-19) and gastrointestinal symptoms showed increased values of fecal calprotectin (FC). Conclusion: our findings may change the current understanding of COVID-19 intestinal-related disease pathogenesis, shedding new light on the potential role of thrombosis and the consequent hypoxic intestinal damage

Objectives

Methods

Results