Over time relationship between platelet reactivity, myocardial injury and mortality in patients with SARS-CoV-2-associated respiratory failure

Gianluca Campo, Marco Contoli, Alberto Fogagnolo, Francesco Vieceli Dalla Sega, Ottavio Zucchetti, Luca Ronzoni, Marco Verri, Francesca Fortini, Rita Pavasini, Luca Morandi, Simone Biscaglia, Luca Di Ienno, Emanuele D'Aniello, Marco Manfrini, Roberto Zoppellari, Paola Rizzo, Roberto Ferrari, Carlo Alberto Volta, Alberto Papi, Savino Spadaro, Gianluca Campo, Marco Contoli, Alberto Fogagnolo, Francesco Vieceli Dalla Sega, Ottavio Zucchetti, Luca Ronzoni, Marco Verri, Francesca Fortini, Rita Pavasini, Luca Morandi, Simone Biscaglia, Luca Di Ienno, Emanuele D'Aniello, Marco Manfrini, Roberto Zoppellari, Paola Rizzo, Roberto Ferrari, Carlo Alberto Volta, Alberto Papi, Savino Spadaro

Abstract

The aim of this study (NCT04343053) is to investigate the relationship between platelet activation, myocardial injury, and mortality in patients affected by Coronavirus disease 2019 (COVID-19). Fifty-four patients with respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were enrolled as cases. Eleven patients with the same clinical presentation, but negative for SARS-CoV-2 infection, were included as controls. Blood samples were collected at three different time points (inclusion [T1], after 7 ± 2 days [T2] and 14 ± 2 days [T3]). Platelet aggregation by light transmittance aggregometry and the circulating levels of soluble CD40 ligand (sCD40L) and P-selectin were measured. Platelet biomarkers did not differ between cases and controls, except for sCD40L which was higher in COVID-19 patients (p = .003). In COVID-19 patients, P-selectin and sCD40L levels decreased from T1 to T3 and were higher in cases requiring admission to intensive care unit (p = .004 and p = .008, respectively). Patients with myocardial injury (37%), as well as those who died (30%), had higher values of all biomarkers of platelet activation (p < .05 for all). Myocardial injury was an independent predictor of mortality. In COVID-19 patients admitted to hospital for respiratory failure, heightened platelet activation is associated with severity of illness, myocardial injury, and mortality.ClinicalTrials.gov number: NCT04343053.

Keywords: COVID-19; P-selectin; myocardial injury; platelet aggregation; soluble CD40 ligand.

Figures

Figure 1.
Figure 1.
Comparison of platelet biomarkers in ICU vs. non-ICU patients
Figure 2.
Figure 2.
Comparison of platelet biomarkers in patients with or without myocardial injury
Figure 3.
Figure 3.
Comparison of platelet biomarkers in survivors vs. non-survivors

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