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ISSN 2448-8909 (Print)

2022, Number 2

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Med Crit 2022; 36 (2)

Thrombotic events and inflammatory markers in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)

López RPS, Rodríguez SAY, Palacios CA, Aisa ÁA, Aguirre SJS, Chaires GR

Language: Spanish
References: 25
Page: 75-81
PDF size: 323.92 Kb.


ABSTRACT

Introduction: SARS-CoV-2 pneumonia is associated with an important secretion of cytokines and agglomeration of immune cells, which activate endothelial cells conditioning coagulopathy, affecting the lung at an early stage, with a clinical phenotype of Acute Respiratory Distress Syndrome (ARDS), which later progresses to a systemic inflammatory response deregulated by inflammatory markers that cause greater endothelial injury generating thrombosis. Many patients present high levels of D-dimer (DD), as well as C-reactive protein (CRP), interleukin-6 (IL-6) and ferritin, subordinating the formation of clots, with the interruption of circulation (arterial or venous) at any level of the circulatory system. Objectives: To determine if there is a relationship between elevated levels of inflammatory markers and thrombotic events in patients with SARS-CoV-2 pneumonia with invasive mechanical ventilation (IMV). Material and methods: We conducted an observational, retrospective and longitudinal cohort study in patients admitted to the Respiratory Therapy Unit of the ABC Medical Center, from April to July 2020, with a diagnosis of SARS-CoV-2 pneumonia with IMV. We use the STATA program for statistical analysis. We performed a linear analysis of repetitive measures by logistic regression to evaluate the chronological behavior of the inflammatory variables. Subsequently, we adjusted the inflammatory markers with demographic variables, to obtain diagnostic certainty and prediction of risk of thrombotic events. Results: We analyzed a total of 100 patients, the male sex prevailing in 78%. 18% had thrombosis. Initially the statistically significant inflammatory markers were DD (p = 0.010) with levels of 1375.5 ng/mL (967-2651) and ferritin (p = 0.030) with levels 1391.5 ng/mL (622-1779). With the adjustment of inflammatory variables by age, gender, Body Mass Index (BMI) and severity scales, the statistically significant variables were DD (p = 0.001) and ferritin (p = 0.004), obtaining a diagnostic certainty of 80.57% to predict risk of thrombotic events. Conclusion: Tight control of laboratory parameters and a high index of suspicion are vital to formulating a personalized treatment approach for patients, and can also help classify patients at high risk for thrombotic events. Our model emphasizes that caution must be exercised with elevated levels of DD and ferritin.


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