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Serum fibrinogen levels and lung fibrosis in COVID-19 patients
Isnin A Marhana1, Adhitri Anggoro1, Bambang P Semedi2
1Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
Insights
Pulmonary fibrosis is common in fatal COVID-19 cases. While serum fibrinogen levels were elevated, they did not significantly correlate with the severity of lung fibrosis in these patients.
Area of Science:
- Pulmonary Medicine
- Pathology
- Hematology
Background:
- Coronavirus disease-2019 (COVID-19) is a global pandemic associated with severe complications.
- Elevated serum fibrinogen levels are observed in severe COVID-19 and may contribute to pulmonary fibrosis.
- The relationship between fibrinogen and lung fibrosis in COVID-19 requires further investigation.
Purpose of the Study:
- To analyze the correlation between serum fibrinogen levels and lung fibrosis in COVID-19 patients.
- To assess the incidence and degree of pulmonary fibrosis using core biopsy.
- To investigate the role of fibrinogen in COVID-19-related lung pathology.
Main Methods:
- Prospective observational study of deceased severe COVID-19 patients in intensive care.
- Serum fibrinogen levels measured using automated coagulometry (Clauss method).
- Lung core biopsies performed on radiologically identified fibrotic areas; fibrosis assessed by Ashcroft scale.
Main Results:
- Pulmonary fibrosis was detected in 35 of 37 (94.6%) lung biopsy samples.
- The most frequent degree of fibrosis was Ashcroft scale score 5 (37.8%).
- Mean serum fibrinogen was elevated at 616.14 mg/dL; no significant correlation found with fibrosis severity (p = 0.716).
Conclusions:
- Pulmonary fibrosis is a frequent finding in lung biopsies of fatal COVID-19 cases.
- Elevated serum fibrinogen levels were observed, tending to be higher in patients with fibrosis.
- Serum fibrinogen levels were not significantly associated with the severity of lung fibrosis based on the Ashcroft scale.
Introduction:
Coronavirus disease-2019 (COVID-19) has been declared a global pandemic. Along with multi-organ failure, increased fibrinogen occurs in severe disease and is converted to fibrin, which can trigger pulmonary fibrosis. This study aimed to analyse the correlation between serum fibrinogen levels and the occurrence of lung fibrosis in COVID-19 patients using the core biopsy technique.
Methodology:
This was a prospective observational study in patients who died during severe COVID-19 treatment in the intensive care unit of a tertiary hospital. Serum fibrinogen levels were measured using a Sysmex Coagulometer based on the Clauss method, which is an automated coagulometric technique. The core biopsy procedure was performed in fibrotic areas identified by radiological imaging. The degree of lung fibrosis according to the Ashcroft scale. Results of fibrinogen levels, fibrosis incidence, and the degree of fibrosis were compared.
Results:
There was an increase in fibrinogen with a mean level of 616.14 mg/dL, and 35 of 37 samples were positive for fibrosis. The Ashcroft scale score of 5 was the most common fibrosis degree (37.8%). Fibrosis was found among COVID-19 lung biopsies, and fibrinogen also tends to increase in lung fibrosis based on the Ashcroft score, despite no significant correlation between the serum fibrinogen levels and lung fibrosis degree (p = 0.716).
Conclusions:
Pulmonary fibrosis was frequently observed in lung biopsy specimens from patients with fatal COVID-19. Serum fibrinogen levels tended to be higher in patients with fibrosis, they were not significantly associated with fibrosis severity as assessed by the Ashcroft scale.