Increased hs-CRP and Sepsis Influence the Occurrence of Thrombocytopenia in Severe and Critically Ill COVID-19 Patients Receiving Anticoagulants

The Indonesian Biomedical Journal Pub Date : 2023-02-23 DOI:10.18585/inabj.v15i1.2045

Ami Ashariati Prayoga, S. U. Y. Bintoro, P. Z. Romadhon, M. N. Diansyah, P. N. Amrita, Merlyna Savitri, Choirina Windradi, Krisnina Nurul Widiyastuti

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Abstract

BACKGROUND: Despites its benefits, as one of COVID-19 principal treatments, anticoagulant raises a significant concern regarding the anticoagulant-related thrombocytopenia. However, up to date, there is lack of study examining anticoagulantinduced thrombocytopenia during COVID-19, hence this study was conducted to determine the factors inducing anticoagulant-induced thrombocytopenia in COVID-19 patients.METHODS: An observational cross-sectional study of 106 anticoagulant-treated COVID-19 subjects was conducted. Blood serum was drawn from subjects, then platelets, prothrombin time (PT), activated partial thromboplastin (aPPT), international ratio (INR), D-dimer, ferritin, fibrinogen, and high-sensitivity C-reactive protein (hs-CRP), were measured. For thrombocytopenia risk assessment, the 4T score was calculated. To assess the risk of thrombocytopenia. Statistical analysis using Chi-square and Mann-Whitney U test were performed and followed by multivariate analysis to examine the correlation among the thrombocytopenia risk factors.RESULTS: Significant differences were identified in the length of stay (LOS) (p=0.04), disease severity (p=0.021), sepsis (p=0.006), hs-CRP (p=0.003), and mortality rate (p=0.028) between thrombocytopenia and nonthrombocytopenia groups. A multivariate analysis through linear and logistic regression disclosed an increase in hs-CRP (OR=-0.29; p=0.045) and sepsis (OR=4.32; p=0.03)that precipitate the thrombocytopenia events.CONCLUSION: In severe and critically ill COVID-19 patients, the occurrence of thrombocytopenia was followed by an increase in inflammatory parameters such as D-dimer, fibrinogen, ferritin, hs-CRP and prolonged coagulation. The increase in hs-CRP and sepsis may raise the risk of thrombocytopenia, especially in severe and crtically ill cases of COVID-19.KEYWORDS: COVID-19, anticoagulant, thrombocytopenia, inflammation, infectious disease

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hs-CRP升高和脓毒症对接受抗凝治疗的重症、危重症患者血小板减少症发生的影响

背景:作为COVID-19的主要治疗方法之一，抗凝剂尽管有其益处，但却引起了抗凝相关性血小板减少症的重大关注。然而，目前缺乏对COVID-19患者抗凝血性血小板减少的研究，因此本研究旨在确定COVID-19患者抗凝血性血小板减少的诱发因素。方法:对106例接受抗凝治疗的COVID-19患者进行观察性横断面研究。采集受试者血清，测定血小板、凝血酶原时间(PT)、活化部分凝血活素(aPPT)、国际比值(INR)、d -二聚体、铁蛋白、纤维蛋白原和高敏c反应蛋白(hs-CRP)。对于血小板减少风险评估，计算4T评分。评估血小板减少的风险。采用卡方检验和Mann-Whitney U检验进行统计学分析，然后进行多因素分析，检验血小板减少危险因素之间的相关性。结果:血小板减少组和非血小板减少组在住院时间(LOS) (p=0.04)、疾病严重程度(p=0.021)、脓毒症(p=0.006)、hs-CRP (p=0.003)和死亡率(p=0.028)方面存在显著差异。通过线性和逻辑回归的多因素分析显示hs-CRP升高(OR=-0.29;p=0.045)和脓毒症(OR=4.32;P =0.03)，沉淀血小板减少事件。结论:COVID-19重症、危重症患者发生血小板减少后，d -二聚体、纤维蛋白原、铁蛋白、hs-CRP等炎症指标升高，凝血时间延长。hs-CRP和败血症的升高可能会增加血小板减少的风险，特别是在COVID-19重症和危重症患者中。关键词:COVID-19、抗凝剂、血小板减少症、炎症、传染病

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The Indonesian Biomedical Journal

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