Hypercoagulability, endotheliopathy, and inflammation approximating 1 year after recovery: Assessing the long-term outcomes..., 2022, Eugene Fan et al

[Andy]

Full title: Hypercoagulability, endotheliopathy, and inflammation approximating 1 year after recovery: Assessing the long-term outcomes in COVID-19 patients

Abstract

Sustained hypercoagulability and endotheliopathy are present in convalescent COVID-19 patients for up to 4 months from recovery. The hemostatic, endothelial, and inflammatory profiles of 39 recovered COVID-19 patients were evaluated up to 16 months after recovery from COVID-19. These values were compared with a control group of healthy volunteers (n = 124). 39 patients (71.8% males, median age 43 years) were reviewed at a mean of 12.7 ± 3.6 months following recovery. One patient without cardiovascular risk factors had post COVID-19 acute ischaemic limb.

Elevated D-dimer and Factor VIII levels above normal ranges were noted in 17.9% (7/39) and 48.7% (19/39) of patients respectively, with a higher median D-dimer 0.34 FEU μg/mL (IQR 0.28, 0.46) (p < .001) and Factor VIII 150% (IQR 171, 203) (p = .004), versus controls. Thrombin generation (Thromboscreen) showed a higher median endogenous thrombin potential (ETP) of 1352 nM*min (IQR 1152, 1490) (p = .002) and a higher median peak height of 221.4 nM (IQR 170.2, 280.4) (p = 0.01) and delayed lag time 2.4 min (1.42–2.97) (p = 0.0002) versus controls. Raised vWF:Ag and ICAM-1 levels were observed in 17.9% (7/39) and 7.7% (3/39) of patients respectively, with a higher median VWF:Ag 117% (IQR 86, 154) (p = 0.02) and ICAM-1 54.1 ng/mL (IQR 43.8, 64.1) (p = .004) than controls. IL-6 was noted to be raised in 35.9% (14/39) of patients, with a higher median IL-6 of 1.5 pg/mL (IQR 0.6, 3.0) (p = 0.004) versus controls. Subgroup analysis stratifying patients by COVID-19 severity and COVID-19 vaccination preceding SARS-CoV-2 infection did not show statistically significant differences.

Hypercoagulability, endothelial dysfunction, and inflammation are still detectable in some patients approximately 1 year after recovery from COVID-19.

Open access, https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.26575

 

[Andy]

Twitter thread from author

 

[Hutan]

Interesting study at around the one year mark.

This is a bit scary:

while 1 male patient aged 37 years old with prior asymptomatic COVID-19 in May 2020 (SARS-CoV-2 PCR negative, raised Immunoglobulin G for SARS-CoV-2 [Roche Elecsys Anti-SARS-CoV-2]) and no significant cardiovascular risk factors suffered from post-COVID-19 right acute ischaemic limb embolism in August 2021 requiring embolectomy, with CT angiography showing a mural aortic thrombus, and thrombi involving the right popliteal artery and right external iliac artery. The patient had no radiological evidence of vasculitis, aortitis, dissection, or aneurysm in the arterial system, and his thrombophilia screen was negative.

There are % errors in Table 1.


Figure 1: Box and whisker plots of statistically significant hemostatic, endothelial and inflammatory parameters



Also:

C-reactive protein was raised in 43.6% (17/39) of recovered patients with a raised median level of 20.4 mg/L; however, CRP was unable to be performed on the stored plasma of historical controls.

Some questions from our point of view are,
do these results correlate with Long Covid symptoms?
how unique are these results to post-Covid-19, i.e. do people with ME/CFS following other illnesses show these results too?