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Cytokine storm induced coagulopathy in septic shock and critical Covid-19: head-to-head comparison

BACKGROUND: Septic shock generates an important inflammatory reaction, endothelial activation and a procoagulant state leading to microvascular thrombosis and subsequent organ impairment [1]. Similarly, a severe inflammatory reaction and a coagulopathy with pulmonary micro-thrombosis eventually lead...

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Autores principales: Dechamps, M D M, De Poortere, J, Laterre, P F, Octave, M, Ginion, A, Robaux, V, Bodart, J, Gruson, D, Van Dievoet, M, Douxfils, J, Derive, M, Campion, A, Martin, M, Horman, S, Beauloye, C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767619/
http://dx.doi.org/10.1093/eurheartj/ehab724.3377
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author Dechamps, M D M
De Poortere, J
Laterre, P F
Octave, M
Ginion, A
Robaux, V
Bodart, J
Gruson, D
Van Dievoet, M
Douxfils, J
Derive, M
Campion, A
Martin, M
Horman, S
Beauloye, C
author_facet Dechamps, M D M
De Poortere, J
Laterre, P F
Octave, M
Ginion, A
Robaux, V
Bodart, J
Gruson, D
Van Dievoet, M
Douxfils, J
Derive, M
Campion, A
Martin, M
Horman, S
Beauloye, C
author_sort Dechamps, M D M
collection PubMed
description BACKGROUND: Septic shock generates an important inflammatory reaction, endothelial activation and a procoagulant state leading to microvascular thrombosis and subsequent organ impairment [1]. Similarly, a severe inflammatory reaction and a coagulopathy with pulmonary micro-thrombosis eventually leading to acute lung injury, is a typical feature of critical form of Coronavirus disease 2019 (Covid-19) [2]. Our aim was to compare coagulation, platelet activation and platelets-neutrophils interplay between control, septic shock and critical Covid-19 patients. METHODS/MATERIALS: A total of 118 patients were included in our prospective, monocentric, observational study between February 2019 and June 2020. Septic shock (n=48) and Covid-19 (n=22) patients were consecutively included at admission in our ICU department. Control patients (n=48) with matched gender and co-morbidities were recruited at central lab consultation. RESULTS: Septic shock patients had worse severity scores due to multiple organ failure (assessed by APACHE II and SOFA score) whereas Covid-19 patients had more severe respiratory failure and a longer ICU length-of-stay (Table 1). At the time of inclusion, CRP and lymphocyte count were comparable between septic shock and Covid-19 patients. White cell count ad neutrophil count was higher for septic shock patients. Analysis of coagulation showed a prolonged INR, TT and aPTT in septic shock although only INR was prolonged in Covid-19. Thrombin antithrombin complex (TATc) formation was similar in both pathologies, whereas consumption of antithrombin III (ATIII) and D-dimers formation was more pronounced in septic shock. Platelet count was lower in septic shock and platelet activation, assessed via plasmatic levels of soluble P-selectin (sCD62P) and Trem-like transcript 1 (sTLT-1), was more important in septic shock. Neutrophil activation and NETosis, evaluated by levels of circulating myeloperoxidase (MPO) and citrullinated histone 3 (H3-Cit), was similarly increased in both groups (Figure 1). CONCLUSIONS: This study confirmed an activation of coagulation cascade, platelet activation and NETosis in both septic shock and critical Covid-19, compared with control patients. Importantly, the extent of these changes was similar or less pronounced in critical COVID-19 compared with septic shock. FUNDING ACKNOWLEDGEMENT: Type of funding sources: Foundation. Main funding source(s): Fondation Saint Luc
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spelling pubmed-87676192022-01-20 Cytokine storm induced coagulopathy in septic shock and critical Covid-19: head-to-head comparison Dechamps, M D M De Poortere, J Laterre, P F Octave, M Ginion, A Robaux, V Bodart, J Gruson, D Van Dievoet, M Douxfils, J Derive, M Campion, A Martin, M Horman, S Beauloye, C Eur Heart J Abstract Supplement BACKGROUND: Septic shock generates an important inflammatory reaction, endothelial activation and a procoagulant state leading to microvascular thrombosis and subsequent organ impairment [1]. Similarly, a severe inflammatory reaction and a coagulopathy with pulmonary micro-thrombosis eventually leading to acute lung injury, is a typical feature of critical form of Coronavirus disease 2019 (Covid-19) [2]. Our aim was to compare coagulation, platelet activation and platelets-neutrophils interplay between control, septic shock and critical Covid-19 patients. METHODS/MATERIALS: A total of 118 patients were included in our prospective, monocentric, observational study between February 2019 and June 2020. Septic shock (n=48) and Covid-19 (n=22) patients were consecutively included at admission in our ICU department. Control patients (n=48) with matched gender and co-morbidities were recruited at central lab consultation. RESULTS: Septic shock patients had worse severity scores due to multiple organ failure (assessed by APACHE II and SOFA score) whereas Covid-19 patients had more severe respiratory failure and a longer ICU length-of-stay (Table 1). At the time of inclusion, CRP and lymphocyte count were comparable between septic shock and Covid-19 patients. White cell count ad neutrophil count was higher for septic shock patients. Analysis of coagulation showed a prolonged INR, TT and aPTT in septic shock although only INR was prolonged in Covid-19. Thrombin antithrombin complex (TATc) formation was similar in both pathologies, whereas consumption of antithrombin III (ATIII) and D-dimers formation was more pronounced in septic shock. Platelet count was lower in septic shock and platelet activation, assessed via plasmatic levels of soluble P-selectin (sCD62P) and Trem-like transcript 1 (sTLT-1), was more important in septic shock. Neutrophil activation and NETosis, evaluated by levels of circulating myeloperoxidase (MPO) and citrullinated histone 3 (H3-Cit), was similarly increased in both groups (Figure 1). CONCLUSIONS: This study confirmed an activation of coagulation cascade, platelet activation and NETosis in both septic shock and critical Covid-19, compared with control patients. Importantly, the extent of these changes was similar or less pronounced in critical COVID-19 compared with septic shock. FUNDING ACKNOWLEDGEMENT: Type of funding sources: Foundation. Main funding source(s): Fondation Saint Luc Oxford University Press 2021-10-14 /pmc/articles/PMC8767619/ http://dx.doi.org/10.1093/eurheartj/ehab724.3377 Text en Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com. https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_modelThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
spellingShingle Abstract Supplement
Dechamps, M D M
De Poortere, J
Laterre, P F
Octave, M
Ginion, A
Robaux, V
Bodart, J
Gruson, D
Van Dievoet, M
Douxfils, J
Derive, M
Campion, A
Martin, M
Horman, S
Beauloye, C
Cytokine storm induced coagulopathy in septic shock and critical Covid-19: head-to-head comparison
title Cytokine storm induced coagulopathy in septic shock and critical Covid-19: head-to-head comparison
title_full Cytokine storm induced coagulopathy in septic shock and critical Covid-19: head-to-head comparison
title_fullStr Cytokine storm induced coagulopathy in septic shock and critical Covid-19: head-to-head comparison
title_full_unstemmed Cytokine storm induced coagulopathy in septic shock and critical Covid-19: head-to-head comparison
title_short Cytokine storm induced coagulopathy in septic shock and critical Covid-19: head-to-head comparison
title_sort cytokine storm induced coagulopathy in septic shock and critical covid-19: head-to-head comparison
topic Abstract Supplement
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767619/
http://dx.doi.org/10.1093/eurheartj/ehab724.3377
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