Frequency of thrombotic microangiopathy in COVID-19 patients and its correlation with disease severity at Ndola teaching hospital and levy Mwanawasa university teaching hospital in Zambia
1 Department of Biomedical Sciences, Institute of Distance Education, University of Zambia, Zambia.
2 Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Zambia.
3 Department of Medical Education Development School of Medicine, University of Zambia, Zambia.
Research Article
Open Access Research Journal of Science and Technology, 2023, 09(01), 063–074.
Article DOI: 10.53022/oarjst.2023.9.1.0061
Publication history:
Received on 28 August 2023; revised on 04 October 2023; accepted on 07 October 2023
Abstract:
Severe COVID-19 can result in multiorgan dysfunction, with the lungs being the most commonly affected and prominent organ. Recent studies suggest that an exaggerated immune response characterized by a cytokine storm may play a crucial role in the extensive organ damage observed in this disease. Additionally, COVID-19 patients often exhibit hypercoagulability, with a high incidence of thrombosis and a higher-than-expected failure rate of anticoagulation therapy. While macrovascular thrombosis is frequently observed, the presence of extensive microvascular thromboses, as reported in several case series and studies, raises the possibility of Thrombotic Microangiopathy (TMA) contributing to the thrombotic and multiorgan complications associated with COVID-19. Identifying TMA promptly and addressing the underlying pathophysiology may potentially improve outcomes for critically ill patients.
The objective of the study was to determine the incidence of thrombotic microangiopathy (TMA) in COVID-19 patients and its association with COVID-19 disease severity at two tertiary hospitals in Zambia. The study was conducted at Ndola Teaching Hospital (NTH) and Levy Mwanawasa University Teaching Hospitals (LMUTH) using a hospital-based cross-sectional study design. The study recruited 173 COVID-19 positive patients and 167 COVID-19 negative patients using the simple random sampling technique. TMA was diagnosed in any COVID-19 patient presenting with anemia (hemoglobin concentration < 13.0 g/dl for men and < 12.0 g/dL for women), thrombocytopenia (platelet count < 150 x 109/L), reduced haptoglobin (<40 mg/dl), and the presence of more than 1% schistocytes on a May-Grunwald-Giemsa stained blood smear. Statistical analysis was performed using SPSS version 21, and the results were summarized in tables and graphs.
According to the study, 22% of COVID-19 patients had Thrombotic Microangiopathy (TMA), and these patients had significantly elevated levels of cytokines such as Interleukin 1 (IL-1) (77.97±31.71 ng/l), Interleukin 6 (IL-6) (64.92±32.43 ng/l), Interleukin 8 (IL-8) (126.99±64.06 ng/l), and Tumor Necrosis Factor (TNF) (70.91±21.81 ng/l) compared to TMA-negative COVID-19 patients, in which the inflammatory cytokine profiles were Interleukin 1 (IL-1) (32.97±22.53 ng/l), Interleukin 6 (IL-6) (27.01±25.5 ng/l), Interleukin 8 (IL-8) (65.36±32.52 ng/l), and Tumor Necrosis Factor (TNF) (37.09±27.74 ng/l). Additionally, the study reported that all COVID-19 patients in critical condition had TMA.
The authors recommended that a rational stepwise approach be implemented in diagnosing TMA in all COVID-19 patients suspected of thrombosis so as to institute appropriate treatment for TMA other than anticoagulation therapy.
Keywords:
COVID-19; Thrombotic Microangiopathy; VwF; ADAMTS13; Endotheliopathy; Hypercoagulability
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