Cytokine-Storm-Induced Coagulopathy In Critical COVID-19 and Septic Shock Patients: Head-to-Head Comparison

Abstract

Background: A cytokine-storm-induced coagulopathy has been described in both critical COVID-19 and septic shock. Improving the understanding of the critical COVID-19 pathophysiology could help in finding new therapeutic targets already explored in the treatment of septic shock. Methods: This prospective observational was conducted between February 1, 2019, and June 1, 2020. Consecutive adult patients admitted to ICU for critical COVID-19 with acute respiratory distress syndrome (ARDS) (n=22), septic shock (n=48) and matched control patients (n=48) were enrolled. A between-group comparison of lung histopathology, clinical characteristics and outcomes and key plasmatic soluble biomarkers of inflammation and coagulopathy was performed. Findings: The histopathological findings showed microthrombi with NETosis in both COVID-19- and septic shock-related ARDS. In the prospective cohort, the critical COVID-19 patients exhibited a prolonged ICU length-of-stay, less organ failure, no sepsis-induced coagulopathy, a higher level of soluble tissue factor (106±57 versus 60±28pg/mL for septic shock, pInterpretation: Critical COVID-19 exhibits a prolonged disease course but less organ failure compared to septic shock. At ICU admission, COVID-19 is characterized by a lymphocytic immune response and distinct coagulopathy with less platelet or coagulation factor consumption, and fibrinolysis alterations. Clinical Trial Registration Details: NCT04107402.Funding Information: Fondation Saint-Luc (Brussels, Belgium) and QUALIblood s.a.Declaration of Interests: The Division of Cardiology at Cliniques universitaires Saint-Luc, Belgium, has received unrestricted research grants from AstraZeneca (Belgium). J.D. is the CEO and founder of QUALIblood s.a., a Belgian Contract Research Organization. The remaining authors declare no competing interests.Ethics Approval Statement: The ethics committee approved the study protocol, and all patients signed their informed consent (B403201938590, NCT04107402). Protocol amendment was done to include COVID-19 patients in the ongoing study.