Keywords
thrombosis
polymorphism
genetic
Fibrin Degradation Products
How to Cite
Abstract
Introduction: the most severe clinical presentations and the fatal outcomes resulting from SARS-CoV-2 infection have been associated with hyperactivation of the immune system with immunothrombosis, a process characterized by an exacerbated inflammatory response and hypercoagulability. Different comorbidities and genetic factors of each individual could be involved in a worse prognosis. The objective of this study was to analyze whether different biomarkers related to inflammation and coagulation, as well as certain clinical variables, addressed at the time of hospital admission, could be risk factors associated with an adverse clinical outcome. Likewise, to investigate the possible association between the carriage of the genetic variants factor V Leiden, G20210A variant in the factor II gene and the allelic variants 10034C/T in the fibrinogen gamma gene and 7872C/T in the factor XI gene and the clinical outcome of COVID-19 patients. Materials and methods: 204 adult patients with a confirmed diagnosis of COVID-19+, hospitalized during the first wave of the pandemic, were included. Demographic and clinical variables including comorbidities were recorded and various plasma biochemical parameters were measured. The patients were divided into two groups (survival: n=141 and death: n=63) to compare their clinical evolution. Results: it was found that the deceased patients were older and had a higher body mass index. They also had lower platelet and lymphocyte counts, higher total leukocyte and neutrophil counts, higher neutrophil/ lymphocyte ratio, and higher levels of D-dimer, ferritin, and LDH compared to survivors (p<0.05). Establishing cut-off points, it was found that a platelet count <200.103/ul [OR=2.81, IC 95% (1.51- 5.23)], a leukocyte count >10.103/ul [OR=2.54, IC 95% (1.32-5.23)], a percentage of lymphocytes <10% [OR=3.48, IC 95% (1.85-6.54]), a percentage of neutrophils >70% [OR=2.82, IC 95% (1.43-5.59)] a relationship neutrophils/lymphocytes >4 [OR=2.77, IC 95% (1.40-5.40)], D-dimer levels >1500 ng/ml FEU [OR=2.67 IC 95% (1.33-5.37)] and ferritin >1000 ng/ml [OR=2.33, IC 95%(1.21-4.49)] at the time of hospital admission would be associated with greater chances of suffering a fatal outcome. No significant differences were found in the genotypic distributions of the genetic variants studied between both groups. Discussion: according to previous investigations, it was found that age, obesity and the levels of hematological/ plasma markers measured at the time of hospital admission, would be predictors of poor prognosis in non-immunized patients. Despite the typical exacerbation of coagulation mechanisms in cases of severe COVID-19, the carriage of the prothrombotic genetic variants studied would not be associated with a worse prognosis.
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