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High Plasma tPAPAI-1C Levels May Be Related to a Poor Prognosis in Patients with Severe or Critical COVID-19: A

Kunihiro Shirai1, Michiko Ishikawa1, Tomoyuki Kobayashi1

  • 1Department of Emergency, Disaster and Critical Care Medicine, Hyogo Medical University, Nishinomiya 663-8501, Japan.

Journal of Clinical Medicine
|March 11, 2023
PubMed

Insights

Severe COVID-19 patients often experience blood clots and death. This study found that higher levels of tissue plasminogen activator/plasminogen activator inhibitor-1 complex (tPAPAI-1C) predict poor outcomes in critical novel coronavirus disease 2019 (COVID-19) patients.

Area of Science:

  • Hematology
  • Critical Care Medicine
  • Pathophysiology

Background:

  • Severe novel coronavirus disease 2019 (COVID-19) is associated with high rates of thrombotic complications and mortality.
  • The underlying pathophysiology involves coagulopathy, fibrinolytic system impairment, and vascular endothelial damage.

Purpose of the Study:

  • To investigate coagulation and fibrinolytic markers as predictors of outcomes in severe COVID-19 patients.
  • To identify specific hematological parameters associated with mortality in intensive care unit (ICU) admitted COVID-19 patients.

Main Methods:

  • Retrospective observational study of 164 COVID-19 patients.
  • Comparison of hematological parameters (platelets, PIC, tPAPAI-1C, D-dimer, FDP) on days 1, 3, 5, and 7 between survivors and nonsurvivors.
  • Multivariate logistic regression analysis to identify independent predictors of mortality.

Main Results:

  • Nonsurvivors had higher APACHE II, SOFA scores, and age compared to survivors.
  • Nonsurvivors exhibited significantly lower platelet counts and higher levels of PIC, tPAPAI-1C, D-dimer, and FDP throughout the study period.
  • Maximum tPAPAI-1C levels were identified as an independent predictor of mortality (AUC = 0.713).

Conclusions:

  • COVID-19 patients with poor outcomes show exacerbated coagulopathy, fibrinolysis inhibition, and endothelial damage.
  • Plasma tPAPAI-1C levels can serve as a valuable prognostic marker for severe or critical COVID-19.
  • Monitoring tPAPAI-1C may aid in predicting patient outcomes and guiding treatment strategies.

Keywords:
COVID-19coagulopathyendothelial damagefibrinolysistPAPAI-1C

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