Investigation of the Molecular Mechanism of Coagulopathy in Severe and Critical Patients With COVID-19.

Coagulopathy is a frequently reported finding in the pathology of coronavirus disease 2019 (COVID-19); however, the molecular mechanism, the involved coagulation factors, and the role of regulatory proteins in homeostasis are not fully investigated. We explored the dynamic changes of nine coagulation tests in patients and controls to propose a molecular mechanism for COVID-19-associated coagulopathy. Coagulation tests including prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen (FIB), lupus anticoagulant (LAC), proteins C and S, antithrombin III (ATIII), D-dimer, and fibrin degradation products (FDPs) were performed on plasma collected from 105 individuals (35 critical patients, 35 severe patients, and 35 healthy controls). There was a statically significant difference when the results of the critical (CRT) and/or severe (SVR) group for the following tests were compared to the control (CRL) group: PT _CRT (15.014) and PT _SVR (13.846) (PT _CRL  = 13.383, p  < 0.001), PTT _CRT (42.923) and PTT _SVR (37.8) (PTT _CRL  = 36.494, p  < 0.001), LAC _CRT (49.414) and LAC _SVR (47.046) (LAC _CRL  = 40.763, p  < 0.001), FIB _CRT (537.66) and FIB _SVR (480.29) (FIB _CRL  = 283.57, p  < 0.001), ProC _CRT (85.57%) and ProC _SVR (99.34%) (ProC _CRL  = 94.31%, p  = 0.04), ProS _CRT (62.91%) and ProS _SVR (65.06%) (ProS _CRL  = 75.03%, p  < 0.001), D-dimer ( p  < 0.0001, χ ²  = 34.812), and FDP ( p  < 0.002, χ ²  = 15.205). No significant association was found in the ATIII results in groups (ATIII _CRT  = 95.71% and ATIII _SVR  = 99.63%; ATIII _CRL  = 98.74%, p  = 0.321). D-dimer, FIB, PT, PTT, LAC, protein S, FDP, and protein C (ordered according to p -values) have significance in the prognosis of patients. Disruptions in homeostasis in protein C (and S), VIII/VIIIa and V/Va axes, probably play a role in COVID-19-associated coagulopathy.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2021 Elieh Ali Komi, Rahimi, Asghari, Jafari, Rasouli, Mohebalizadeh, Abbasi, Nejadrahim, Rezazadeh and Shafiei-Irannejad.)