Presence of procoagulant peripheral blood mononuclear cells in severe COVID-19 patients relate to ventilation perfusion mismatch and precede pulmonary embolism

被引：2

作者：

Raadsen, M. ^{[1
]}

Langerak, T. ^{[1
]}

Du Toit, J. ^{[1
,2
]}

Kruip, M. J. H. A. ^{[3
]}

Mersha, D. Aynekulu ^{[1
,5
]}

De Maat, M. P. M. ^{[3
]}

Vermin, B. ^{[4
]}

Van den Akker, J. P. C. ^{[5
]}

Schmitz, K. S. ^{[1
]}

Bakhtiari, K. ^{[6
]}

Meijers, J. C. M. ^{[6
]}

van Gorp, E. C. M. ^{[1
]}

Short, K. R. ^{[7
]}

Haagmans, B. ^{[1
]}

de Vries, R. D. ^{[1
]}

Gommers, D. A. M. P. J. ^{[5
]}

Endeman, H. ^{[5
]}

Goeijenbier, M. ^{[4
,5
]}

机构：

[1] Erasmus MC, Dept Virosci, Rotterdam, Netherlands

[2] Wits Donal Gordon Med Ctr, Dept Hematol, Johannesburg, South Africa

[3] Erasmus MC, Dept Hematol, Rotterdam, Netherlands

[4] Spaarne Gasthuis, Dept Intens Care, Hoofddorp, Netherlands

[5] Erasmus MC, Dept Intens Care, Rotterdam, Netherlands

[6] Sanquin Res, Dept Mol Hematol, Amsterdam, Netherlands

[7] Univ Queensland, Sch Chem & Mol Biosci, St Lucia, Australia

来源：

JOURNAL OF CRITICAL CARE | 2024年 / 79卷

关键词：

COVID-19; SARS-CoV-2; Immunothrombosis; Pulmonary embolism; Tissue factor;

D O I：

10.1016/j.jcrc.2023.154463

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose: Pulmonary emboli (PE) contribute substantially to coronavirus disease 2019 (COVID-19) related mortality and morbidity. Immune cell-mediated hyperinflammation drives the procoagulant state in COVID-19 patients, resulting in immunothrombosis. To study the role of peripheral blood mononuclear cells (PBMC) in the procoagulant state of COVID-19 patients, we performed a functional bioassay and related outcomes to the occurrence of PE. Secondary aims were to relate this functional assay to plasma D-dimer levels, ventilation perfusion mismatch and TF expression on monocyte subsets.Methods: PBMC from an ICU biobank were obtained from 20 patients with a computed tomography angiograph (CTA) proven PE and compared to 15 COVID-19 controls without a proven PE. Functional procoagulant properties of PBMC were measured using a modified fibrin generation time (MC-FGT) assay. Tissue factor (TF) expression on monocyte subsets were measured by flow cytometry. Additional clinical data were obtained from patient records including end-tidal to arterial carbon dioxide gradient.Results: MC-FGT levels were highest in the samples taken closest to the PE detection, similar to the end-tidal to arterial carbon dioxide gradient (ETCO2 - PaCO2), a measurement to quantify ventilation-perfusion mismatch. In patients without proven PE, peak MC-FGT relates to an increase in end-tidal to arterial carbon dioxide gradient. We identified non-classical, CD16 positive monocytes as the subset with increased TF expression.Conclusion: We show that the procoagulant state of PBMC could aid in early detection of PE in COVID-19 ICU patients. Combined with end-tidal to ETCO2 - PaCO2 gradient, these tests could improve early detection of PE on the ICU.

引用

页数：8

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