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Pathogenetic mechanisms of hypofibrinogenemia in COVID-19

Патогенетические механизмы развития гипофибриногенемии при COVID-19

Pathogenetic mechanisms of hypofibrinogenemia in COVID-19

Abstract

Введение. Коагулопатия у пациентов с новой коронавирусной инфекцией COVID-19 имеет важное значение в течении и прогнозе заболевания. Типичными проявлениями коагулопатии в острой фазе болезни является склонность к гиперкоагуляции, гиперфибриногенемии и повышенному тромбообразованию. Гипофибриногенемия при COVID‑19 широко не представлена в литературе, и частота, а также причины её развития неизвестны. Одной из возможных причин возникновения гипофибриногенемии является применение генно-инженерных биологических препаратов (ГИБП), однако механизмы развития данного состояния не ясны. Цель исследования: определить роль терапии антагонистами рецепторов интерлейкина-6 при развитии гипофибриногенемии у пациентов с COVID-19-пневмонией, клиническую значимость гипофибриногенемии и механизм её возникновения. Материалы и методы. В ретроспективное исследование путём случайной выборки включено 239 пациентов в возрасте от 18 до 96 лет с подтверждённой методом полимеразной цепной реакции SARS-CoV-2 инфекцией, КТ-признаками (при поступлении в стационар) вирусной пневмонии 2–4 степени и длительностью госпитализации более 2 сут. Всем пациентам проводили лабораторный мониторинг, включавший определение значений гемоглобина, тромбоцитов, С-реактивного белка (СРБ), печёночных ферментов и фибриногена по Клаусу. Всем пациентам проводилась стартовая терапия гидроксихлорохином и азитромицином. Тоцилизумаб на момент исследования был единственным ГИБП, применяемым в стационаре. Терапия тоцилизумабом была проведена 164 (68,6%) пациентам. В исследовании учитывали максимальные и минимальные значения гемоглобина, тромбоцитов, фибриногена и СРБ в течение всей госпитализации. Результаты. Гипофибриногенемия различной степени выраженности наблюдалась у 39 пациентов, получивших тоцилизумаб, что значимо выше частоты гипофибриногенемии у 2 пациентов, не получавших терапию тоцилизумабом (ОР = 8,9; 95% ДИ = 2,2–25,9). Заключение. Применение тоцилизумаба у пациентов с COVID‑19 достоверно повышает риск развития гипофибриногенемии. Background. Coagulopathy in patients with new coronavirus infection COVID-19 is important for the course and prognosis of the disease. Hypercoagulation, hyperfibrinogenemia and thrombosis are typical manifestations of coagulopathy in the acute phase of the disease. Hypofibrinogenemia in COVID‑19 is not widely reported in the literature, and the frequency and reasons of its development are unknown. The use of genetically engineered biological drugs (GEBD) may be one of the possible causes of hypofibrinogenemia but the mechanisms of its development are not clear. Objectives: to determine the role of therapy with interleukin-6 receptor antagonists in the development of hypofibrinogenemia in patients with COVID-19-pneumonia, the clinical significance of hypofibrinogenemia and the mechanism of its occurrence. Patients/Methods. A randomized retrospective study included 239 patients aged 18 to 96 years with confirmed by polymerase chain reaction SARS-CoV-2 infection, computed tomography signs (upon admission to the hospital) of viral pneumonia (grade 2–4) and a duration of hospitalization of more than 2 days. All patients underwent laboratory monitoring, including the determination of hemoglobin, platelets, C-reactive protein (CRP), liver enzymes and fibrinogen according to Claus. All patients received initial therapy with hydroxychloroquine and azithromycin. At the time of the study, tocilizumab was the only GEBD drug used in the hospital. Therapy with tocilizumab was performed in 164 (68.6%) patients. The study took into account the maximum and minimum values of hemoglobin, platelet, fibrinogen and CRP levels during the hospitalization. Results. Hypofibrinogenemia of varying severity was observed in 39 patients treated with tocilizumab, that was significantly higher than hypofibrinogenemia frequency in 2 patients who did not receive tocilizumab (RR = 8.9; 95% CI = 2.2–25.9). Conclusions. Tocilizumab usage in patients with COVID-19 significantly increases the risk of hypofibrinogenemia.

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
1
Average
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