Clin Immunol

. 2021 Sep 11;108852.
doi: 10.1016/j.clim.2021.108852. Online ahead of print.
Inflammation/coagulopathy/fibrinolysis: Dynamic indicators of COVID-19 progression in patients with moderate COVID-19 in Wenzhou, China

Shengwei Jin 1 , Hui An 2 , Tong Zhou 3 , Ting Li 4 , Chengshui Chen 5 , Binyu Ying 6 , Zhangye Xu 7 , Xiaokun Li 8 , Ming Li 9



Background: Majority of coronavirus disease 2019 (COVID-19) non-survivors meet the criteria for disseminated intravascular coagulation (DIC). Although timely monitoring of clotting hemorrhagic development during the natural course of COVID-19 is critical for understanding pathogenesis, diagnosis, and treatment of the disease, however, limited data are available on the dynamic processes of inflammation/coagulopathy/fibrinolysis (ICF).
Methods: We monitored the dynamic progression of ICF in patients with moderate COVID-19. Out of 694 COVID-19 inpatients from 10 hospitals in Wenzhou, China, we selected 293 adult patients without comorbidities. These patients were divided into different daily cohorts according to the COVID-19 onset-time. Retrospective data were extracted from electronic medical records.
Results: The virus-induced damages to pre-hospitalization patients triggered two ICF fluctuations during the 14-day course of the disease. C-reactive protein (CRP), fibrinogen, and D-dimer levels increased and peaked at day 5 (D5) and D9 during the 1st and 2nd fluctuations, respectively. The ICF activities were higher during the 2nd fluctuation. Although twelve-day medication returned high CRP concentration to normal and blocked fibrinogen increase, the D-dimer levels remained high on 17 ± 2 and 23 ± 2 days of COVID-19 course.
Conclusion: COVID-19 is linked with chronic DIC, which could be responsible for the progression of the disease. Understanding and monitoring ICF progression during COVID-19 can help clinicians in identifying the stage of the disease quickly and accurately, and administer suitable treatment.

Keywords: C-reactive protein; Coagulopathy; Coronavirus disease 2019; D-dimer; Fibrinolysis.