Altered platelet and coagulation function in moderate-to-severe COVID-19

AbstractTo reveal if coagulopathies relate to the course of COVID-19, we examined 255 patients with moderate and severe COVID-19, receiving anticoagulants and immunosuppressive drugs. Coagulopathy manifested predominantly as hypercoagulability that correlated directly with systemic inflammation, disease severity, comorbidities, and mortality risk. The prolonged clotting tests in about ¼ of cases were associated with high levels of C-reactive protein and antiphospholipid antibodies, which impeded coagulation in vitro. Contraction of blood clots was hindered in about ½ of patients, especially in severe and fatal cases, and correlated directly with prothrombotic parameters. A decrease in platelet contractility was due to moderate thrombocytopenia in combination with platelet dysfunction. Clots with impaired contraction were porous, had a low content of compressed polyhedral erythrocytes (polyhedrocytes) and an even distribution of fibrin, suggesting that the uncompacted intravital clots are more obstructive but patients could also be prone to bleeding. The absence of consumption coagulopathy suggests the predominance of local and/or regional microthrombosis rather than disseminated intravascular coagulation. The results obtained (i) confirm the importance of hemostatic disorders in COVID-19 and their relation to systemic inflammation; (ii) justify monitoring of hemostasis, including the kinetics of blood clot contraction; (iii) substantiate the active prophylaxis of thrombotic complications in COVID-19.

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Transformation ofLeishmania mexicanametacyclic promastigotes to amastigote-like forms mediated by binding of human C-reactive protein

Parasitology ◽

10.1017/s0031182001007612 ◽

2001 ◽

Vol 122 (5) ◽

pp. 521-529 ◽

Cited By ~ 14

Author(s):

A. BEE ◽

F. J. CULLEY ◽

I. S. ALKHALIFE ◽

K. B. BODMAN-SMITH ◽

J. G. RAYNES ◽

...

Keyword(s):

Human Serum ◽

Fluorescent Antibody ◽

Antibody Test ◽

Normal Serum ◽

C Reactive Protein ◽

Reactive Protein ◽

Metacyclic Promastigotes ◽

Normal Human ◽

Kinetics Of

Infective metacyclic promastigote forms ofLeishmania mexicanaare introduced by the bite of sandfly vectors into their human hosts where they transform into the amastigote form. The kinetics of this process was examinedin vitroin response to different combinations of temperature (26 °C or 32 °C), pH (7.2 or 5.5), and exposure to human serum. Little transformation occurred at 26 °C/pH 7.2, intermediate levels at 26 °C/pH 5.5 and 32 °C/ pH 7.2, and the greatest response at 32 °C/pH 5.5. Transformation was stimulated by exposure to normal human serum, but was markedly reduced when serum previously incubated at 56 °C for 1 h was used (complement heat-inactivated). This stimulatory effect was reproduced by exposure to a single purified component of human serum, C-reactive protein (CRP). Binding of CRP to the whole surface ofL. mexicanametacyclic promastigotes, including the flagella, was demonstrated by an indirect fluorescent antibody test. The effect of purified CRP was dose dependent and occurred using normal serum concentrations. The stimulatory effect of whole serum was oblated by CRP depletion and restored by addition of purified CRP. The effects of cAMP analogues indicated that transformation could be mediated via an adenylate cyclase cascade.

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Forecasting thrombotic complications in patients with community acquired pneumonia according to multidimensional analysis of severity, systematic inflammation, endothelial function and hemostasis

Infusion & Chemotherapy ◽

10.32902/2663-0338-2021-3-12-17 ◽

2021 ◽

pp. 12-17

Author(s):

T.O. Pertseva ◽

K.O. Bielosludtseva ◽

M.A. Krykhtina

Keyword(s):

Systemic Inflammation ◽

Protein C ◽

Community Acquired Pneumonia ◽

Multidimensional Analysis ◽

C Reactive Protein ◽

Reactive Protein ◽

Low Protein ◽

Thrombotic Complications ◽

Cluster 2 ◽

Timely Treatment

BACKGROUND. Despite the significant progress in the diagnostic and treatment of community-acquired pneumonia (CAP), the issues of timely defining thrombotic complications of CAP and their timely treatment have not yet been fully resolved. OBJECTIVE. To determine the prognostic signs of the risk of thrombotic complications in patients with CAP. MATERIALS AND METHODS. Thus, 45 patients with CAP of the 3rd and 4th clinical groups were examined. The result of the cluster analysis was the distribution of patients into certain clusters (classes). There were 3 clusters of patients depending on the predisposition to thrombosis. RESULTS AND DISCUSSION. Patients belonging to cluster 2 and cluster 3 had a high risk of thrombosis. A feature of these patients was a severe course of CAP (by SMRT-CO scale), accompanied by significant leukocytosis or leukopenia in combination with severe systemic inflammation (C-reactive protein) and low protein C. CONCLUSIONS. This category of patients should consider the possibility of prescribing anticoagulant therapy. While in patients with mild CAP, less pronounced systemic inflammation and high levels of protein C, the risk of thrombosis will be low. Therefore, this category of patients will not require the appointment of anticoagulants.

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Evaluation of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and C-Reactive Protein in Tension-Type Headache Patients

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1730124 ◽

2021 ◽

Author(s):

Hasan Hüseyin Özdemir ◽

Ahmet Dönder

Keyword(s):

Systemic Inflammation ◽

Tension Type Headache ◽

Neutrophil To Lymphocyte Ratio ◽

Control Group ◽

C Reactive Protein ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Significant Difference ◽

Type Headache

Abstract Objectives A tension headache is the most common type of headache, and its causes are multifactorial. A relationship has been shown between migraine headaches and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP). In this study, we investigated the NLR, PLR, and serum CRP levels in frequent episodic tension-type headache (FETTH) and chronic tension-type headache (CTTH) patients. Materials and Methods This retrospective study included 64 patients with FETTH, 80 patients with CTTH, and 60 healthy controls who were followed up in the neurology clinic. Hematological parameters were compared between the patient and control groups. Results In CTTH patients, platelets, NLR, PLR, and CRP values were statistically higher than in FETTH patients and patients in the control group. In FETTH patients, the PLR value was higher than in patients in the control group, but there was no statistically significant difference in NLR and CRP values between FETTH patients and patients in the control group. Also, there was no correlation between these values and age and gender. Conclusion Increase platelet count might have an effect on tension-type headache pathophysiology. Systemic inflammation parameters were shown to be significantly higher in CTTH patients. More comprehensive studies are needed to evaluate the effect of systemic inflammation on the chronicity of tension headaches.

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The influence of sugar–protein complexes on the thermostability of C-reactive protein (CRP)

Scientific Reports ◽

10.1038/s41598-021-92522-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Andreea Lorena Mateescu ◽

Nicolae-Bogdan Mincu ◽

Silvana Vasilca ◽

Roxana Apetrei ◽

Diana Stan ◽

...

Keyword(s):

Diagnostic Tests ◽

Protein Complexes ◽

C Reactive Protein ◽

Time Resolved Fluorescence ◽

Time Resolved ◽

Reactive Protein ◽

In Vitro Diagnostic ◽

The Stability ◽

Positive Controls

AbstractThe purpose of the present study was to evaluate de influence of protein–sugar complexation on the stability and functionality of C-reactive protein, after exposure to constant high temperatures, in order to develop highly stable positive controls for in-vitro diagnostic tests. C-reactive protein is a plasmatic protein used as a biomarker for the diagnosis of a series of health problems such as ulcerative colitis, cardiovascular diseases, metabolic syndrome, due to its essential role in the evolution of chronic inflammation. The sugar–protein interaction was investigated using steady state and time resolved fluorescence. The results revealed that there are more than two classes of tryptophan, with different degree of accessibility for the quencher molecule. Our study also revealed that sugar–protein complexes have superior thermostability, especially after gamma irradiation at 2 kGy, the protein being stable and functional even after 22 days exposure to 40 °C.

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Low density lipoprotein and very low density lipoprotein are selectively bound by aggregated C-reactive protein.

Journal of Experimental Medicine ◽

10.1084/jem.156.1.230 ◽

1982 ◽

Vol 156 (1) ◽

pp. 230-242 ◽

Cited By ~ 120

Author(s):

F C de Beer ◽

A K Soutar ◽

M L Baltz ◽

I M Trayner ◽

A Feinstein ◽

...

Keyword(s):

Acute Phase ◽

Solid Phase ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Very Low Density Lipoprotein ◽

Low Density ◽

C Reactive Protein ◽

Calcium Dependent ◽

Reactive Protein

C-reactive protein (CRP), the classical acute-phase protein, can bind phospholipids by virtue of its specific, calcium-dependent reactivity with phosphorylcholine residues. However, analysis of acute-phase serum by gel filtration and by density gradient ultracentrifugation showed that the CRP was in a free, uncomplexed form, despite the coexistent presence of the various classes of serum lipoproteins, all of which contain phospholipids. In contrast, when isolated CRP was aggregated by immobilization at a sufficient density on a solid phase and then exposed to normal human serum, it selectively bound low density lipoprotein (LDL) and traces of very low density lipoprotein. The reaction was calcium dependent and reversible by free phosphorylcholine but not by heparin. LDL isolated from normal plasma was also bound by aggregated CRP. CRP reacts in vitro with a wide variety of different ligands both of extrinsic and of autogenous origin, e.g., microbial products and damaged cell membranes, respectively. If CRP aggregated in vivo by complexing with these ligands than acquires the capacity to selectively bind LDL, the phenomenon may have significant implications for the function of CRP and for the metabolism, clearance, and deposition of LDL.

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Post-operative kinetics of C-reactive protein to distinguish between bacterial infection and systemic inflammation in infants after cardiopulmonary bypass surgery: the early and the late period

Cardiology in the Young ◽

10.1017/s1047951121003231 ◽

2021 ◽

pp. 1-8

Author(s):

Hanna Renk ◽

David Grosse ◽

Sarah Schober ◽

Christian Schlensak ◽

Michael Hofbeck ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Bacterial Infection ◽

Congenital Heart ◽

Bypass Surgery ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

C Reactive Protein ◽

Reactive Protein ◽

Post Operative Period ◽

Kinetics Of

Abstract Objectives: Differentiation between post-operative inflammation and bacterial infection remains an important issue in infants following congenital heart surgery. We primarily assessed kinetics and predictive value of C-reactive protein for bacterial infection in the early (days 0–4) and late (days 5–28) period after cardiopulmonary bypass surgery. Secondary objectives were frequency, type, and timing of post-operative infection related to the risk adjustment for congenital heart surgery score. Methods: This 3-year single-centre retrospective cohort study in a paediatric cardiac ICU analysed 191 infants accounting for 235 episodes of CPBP surgery. Primary outcome was kinetics of CRP in the first 28 days after CPBP surgery in infected and non-infected patients. Results: We observed 22 infectious episodes in the early and 34 in the late post-operative period. CRP kinetics in the early post-operative period did not accurately differentiate between infected and non-infected patients. In the late post-operative period, infected infants displayed significantly higher CRP values with a median of 7.91 (1.64–22.02) and 6.92 mg/dl (1.92–19.65) on days 2 and 3 compared to 4.02 (1.99–15.9) and 3.72 mg/dl (1.08–9.72) in the non-infection group. Combining CRP on days 2 and 3 after suspicion of infection revealed a cut-off of 9.47 mg/L with an acceptable predictive accuracy of 76%. Conclusions: In neonates and infants, CRP kinetics is not useful to predict infection in the first 72 hours after CPBP surgery due to the inflammatory response. However, in the late post-operative period, CRP is a valuable adjunctive diagnostic test in conjunction with clinical presentation and microbiological diagnostics.

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Postoperative Kinetics of C-Reactive Protein and Erythrocyte Sediment Rate in One-, Two-, and Multilevel Posterior Spinal Decompressions and Instrumentations

Global Spine Journal ◽

10.1177/2192568217699389 ◽

2017 ◽

Vol 7 (5) ◽

pp. 448-451 ◽

Cited By ~ 4

Author(s):

Sombat Kunakornsawat ◽

Rachata Tungsiripat ◽

Dechporn Putthiwara ◽

Chaiwat Piyakulkaew ◽

Tinnakorn Pluemvitayaporn ◽

...

Keyword(s):

C Reactive Protein ◽

Reactive Protein ◽

Kinetics Of

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Kinetics of Procalcitonin in Pediatric Patients on Extracorporeal Membrane Oxygenation

Biomarker Insights ◽

10.1177/1177271917751900 ◽

2018 ◽

Vol 13 ◽

pp. 117727191775190 ◽

Cited By ~ 5

Author(s):

Sara Bobillo ◽

Javier Rodríguez-Fanjul ◽

Anna Solé ◽

Julio Moreno ◽

Mònica Balaguer ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Prospective Observational Study ◽

Pediatric Patients ◽

Clinical Situation ◽

Multiple Organ ◽

C Reactive Protein ◽

Reactive Protein ◽

Membrane Oxygenation ◽

Neurologic Sequelae ◽

Kinetics Of

Objectives: To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in pediatric patients who required extracorporeal membrane oxygenation (ECMO) and to analyze its relationship with morbidity and mortality. Patients and methods: Prospective observational study including pediatric patients who required ECMO. Both PCT and CRP were sequentially drawn before ECMO (P0) and until 72 hours after ECMO. Results: A total of 40 patients were recruited. Two cohorts were established based on the value of the P0 PCT (>10 ng/mL). Comparing the kinetics of PCT and CRP in these cohorts, the described curves were the expected for each clinical situation. The cutoff for P0 PCT to predict multiple organ dysfunction syndrome was 2.55 ng/mL (sensibility 83%, specificity 100%). Both PCT and CRP did not predict risk of neurologic sequelae or mortality in any group. Conclusions: Procalcitonin does not seem to be modified by ECMO and could be a good biomarker of evolution.

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TITANIUM NANOPARTICLES CONJUGATED WITH STREPTOKINASE AS A MODIFIED THROMBOLYTIC AGENT

International Journal of Current Pharmaceutical Research ◽

10.22159/ijcpr.2020v12i1.36824 ◽

2020 ◽

pp. 18-25

Author(s):

HAYDER H. ABED ◽

ESTABRAQ AR. ALWASITI ◽

AMIR T. TAWFEEQ

Keyword(s):

Thrombolytic Agent ◽

Blood Clot ◽

Control Group ◽

Thrombolytic Activity ◽

Protein Assay ◽

Blood Clots ◽

Ft Ir ◽

Titanium Nanoparticles ◽

D Dimer

Objective: Blood clots are the main cause of death worldwide by stroke and myocardial infarction. Streptokinase a thrombolytic agent that is used in the treatment of circulatory disorders. Methods: Titanium Nanoparticles was supplied from Changsha Santech Co. Its characterized were studied using (FT-IR, XRD, AFM, FE-SEM). Streptokinase at concentration 0.1 mg/ml was conjugated with Titanium nanoparticles using PH equal to 5.2 with continuous stirring. Formation of Streptokinase loading Titanium nanoparticles confirmed using FT-IR, Ninhydrine’s test and Bradford protein assay. Physicochemical Properties were studied in vitro. Thrombolytic activity in vitro was determined using d–dimer indicator and weight of blood clot after treatment as indicators of thrombolytic activity. Results: Titanium nanoparticles show particle size at range 31 nm. The thrombolytic activity of streptokinase loading Titanium nanoparticles shows significant value in d-dimer and weight of blood clot compared with the control group and non-significant compared with an equivalent amount of streptokinase alone. Conclusion: Titanium nanoparticles conjugated with streptokinase show high thrombolytic activity against blood clots in vitro.

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P4679Changes in systemic inflammation and endothelial dysfunction after balloon pulmonary angioplasty

European Heart Journal ◽

10.1093/eurheartj/ehz745.1061 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 1

Author(s):

W Magon ◽

J Stepniewski ◽

K Jonas ◽

M Waligora ◽

P Podolec ◽

...

Keyword(s):

Endothelial Dysfunction ◽

Serum Concentration ◽

Systemic Inflammation ◽

Interleukin 6 ◽

C Reactive Protein ◽

Pulmonary Hemodynamics ◽

Endothelin 1 ◽

Reactive Protein ◽

Balloon Pulmonary Angioplasty

Abstract Introduction Pulmonary endarterectomy leads to a decrease in systemic inflammation and improvement in endothelial function in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Balloon pulmonary angioplasty (BPA) improves pulmonary hemodynamics in patients with inoperable CTEPH. Aim To assess changes in systemic inflammation and endothelial dysfunction after a single BPA session and after completion of the treatment. Methods We enrolled consecutive, inoperable CTEPH patients who underwent BPA. Interleukin 6, 10 (IL-6, IL-10), and C-reactive protein (hsCRP) constituted markers of systemic inflammation. Endothelin-1 (ET-1) served as a marker of endothelial dysfunction. Serum concentration of selected markers was assessed in every patient before, 24 hours after the first BPA session and 6 months after completion of the BPA treatment. Age- and sex-matched healthy subjects served as a control group. Results We recruited 20 patients with inoperable CTEPH (6 males [30%]), aged 67 [61–74] years in New York Heart Association class III (n=19 [95%]) and II (n=1 [5%]). BPA treatment was completed with a median of 5 [2–8] BPA sessions per patient. Before starting the treatment CTEPH patients, as compared to controls (n=10), had raised serum level of IL-6 (3.82 [2.75 - 6.03] vs. 2.64 [0.88 - 4.75] pg/ml; p=0.04), hsCRP (2.47 [0.93 - 4.27] vs. 1.23 [0.48–3.21] ng/ml; p=0.02) and ET-1 (2.68 [2.24 - 3.64] vs. 1.47 [1.4 - 1.82] pg/ml; p=0.004). There was no difference in IL-10 level. 24 hours after a BPA session we observed an increased level of IL-6, IL-10 and hsCRP. (Tab.) 6 months after completion of the BPA treatment there was a reduced level of IL-6, hsCRP and ET-1 (Tab.) Table 1. Changes (Δ) in serum concentration of analyzed markers 24 hours after a single BPA session and at 6-months assessment after completion of the BPA treatment (n=20) Initial Δ at 24 hours after single BPA p Δ at 6-months follow-up p ET-1 [pg/ml] 2.68 [2.24; 3.64] −0.2 [−0.5; 0.23] 0.21 −0.47 [−0.96; 0.05] 0.004 IL-6 [pg/ml] 3.82 [2.75; 6.03] 3.67 [1.41; 7.16] 0.008 −0.82 [−3.11; 0.54] 0.04 IL-10 [pg/ml] 0.53 [0.44; 0.58] 0.32 [0.21; 0.87] 0.006 −0.11 [−0.33; 0.14] 0.94 hsCRP [ng/ml] 2.47 [0.93; 4.27] 5.4 [3.96; 10.59] 0.008 −0.36 [−0.94; 0.16] 0.02 ET-1, endothelin 1; hsCRP, C-reactive protein; IL-6, interleukin 6; IL-10, interleukin 10. Conclusions Patients with inoperable CTEPH, as compared to healthy controls, exhibit an increased systemic inflammation and endothelial dysfunction, which both improve after completion of the BPA treatment. At short-term follow-up after single BPA session there is an increase in systemic inflammatory response.

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