Abstract Number: PB0142
Meeting: ISTH 2021 Congress
Background: Hypercoagulability in COVID-19 has been attributed to immunothrombosis, a process that involves the formation of neutrophils extracellular traps (NETs). The moment of the COVID-19 evolution in which immunothrombosis mechanisms are triggered is not established.
Aims: To describe the association of the kinetics of NETs release during COVID-19 hospitalization with death and thrombosis.
Methods: We quantified markers of NETs (citrullinated H3) and inflammatory cytokines (TNF-α, IL-6) on 4 time points during COVID-19 hospitalization (admission, day 4, day 8 and last day) between May and July 2020. The association between changes in these markers levels and clinical outcomes was determined.
Results: Table 1 summarizes the patients characteristics. 101 patients were included, 59% were critically ill, 11% had a thrombotic event and 21% died. Figure 1 illustrates the changes in citH3, IL-6 and TNF- α levels during hospitalization. IL-6 levels were high on admission in survivors (median 25.32, IQR 24.19-28.15) and non-survivors (median 24.19, IQR 12.51-27.19), but gradually decreased after day 4 in survivors. TNF-α levels remained 2 times higher in non-survivors than in survivors during the entire hospitalization period. CitH3 levels were similar between non-survivors and survivors until day 4. On day 8, citH3 increased by 3-fold (median 3.80, IQR 1.98-10.15) in non-survivors and 2-fold (median 2.60, IQR 1.22-5.01) in survivors. While IL-6 and TNF-α levels were similar between patients with and without thrombosis, citH3 levels increased shortly before the occurrence of a thrombotic event.
|Age in years, median (SD)||58 (13.72)|
|Men, n (%)||63 (62.4)|
|Days in-hospital, median (SD)||15 (25.68)|
|Days in ICU, median (SD)||20 (17.47)|
|Obesity (BMI>30kg/m2), n (%)||27 (26.7%)|
|Diabetes, n (%)||44 (43.6)|
|Hypertension, n (%)||54 (53.5)|
|Pacients with a thrombotic event during hospitalization, n (%)||11 (10.9)|
|Death during hospitalization, n (%)||21 (20.9)|
Conclusions: Markers of inflammation and immunothrombosis were associated with poor outcomes in COVID-19; however, these disorders were detected in different moments during COVID-19 course. While an increased inflammatory response was observed since the beginning of hospitalization, markers of immunothrombosis arose latter during the course of the disease. Acknowledgment of the time-course of immunothrombosis development in COVID-19 is important for planning therapeutic strategies against this pathological process.
To cite this abstract in AMA style:Oliveira J, Vieira-Damiani G, Locachevic G, Mariolano J, Soares K, Santos A, Jacintho B, Vaz C, Mesquita G, Paula E, Orsi F. Time Course of the Development of Immunothrombosis during COVID-19 Hospitalization [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/time-course-of-the-development-of-immunothrombosis-during-covid-19-hospitalization/. Accessed November 29, 2023.
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