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Multiple Enzyme Release, Inflammation Storm and Hypercoagulability Are Prominent Indicators For Disease Progression In COVID-19: A Multi-Centered, Correlation Study with CT Imaging Score

21 Pages Posted: 2 Mar 2020

See all articles by Haijun Wang

Haijun Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurosurgery

Shanshan Luo

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Hematology

Yin Shen

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurosurgery

Mingyue Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Zili Zhang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Yalan Dong

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Haifeng Zhou

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Lan Lin

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Weina Guo

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Zhenyu Kang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Lihua Xing

Zhengzhou University - Respiratory Intensive Care Unit

Junlu Li

Zhengzhou University - Respiratory Intensive Care Unit

Hao Ye

People's Hospital of Jingshan - Department of Infectious Disease

Wei Gui

People's Hospital of Jingshan - Department of Infectious Disease

Yi Hu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Hematology

Mingli Yuan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pulmonary and Critical Care Medicine

Shuqing Han

Wuhan Red Cross Hospital - Department of Neurosurgery

Rui Zhu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Youfan Ye

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Ophthalmology

Lin Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Clinical Laboratory

Xiaobing Jiang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurosurgery

Hongyang Zhao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurosurgery

Xin Zheng

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Infectious Diseases

Heng Fan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Lei Zhao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Infectious Diseases

Yu Hu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Institute of Hematology; Huazhong University of Science and Technology (Formerly Tongi Medical University) - Collaborative Innovation Center of Hematology

Desheng Hu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

More...

Abstract

Background: Last winter, a new coronavirus-induced pneumonia, COVID-19, broke out in Wuhan, China, and spread rapidly throughout the country due to its high infectivity. Although several researches on its clinical characteristics have been published, indicators and its dynamic changes during the disease progression are still not clear and need to be further explored.

Methods: We retrospectively studied 165 patients with COVID-19 who were admitted to five hospitals in and outside Wuhan from January 2 to February 5, 2020. Demographic data, laboratory tests, chest computed tomography (CT) scans, etc. were extracted. A series of factors indicating disease progression were screened out from two patient groups according to the CT imaging score. The correlation between the CT imaging score and the levels of each indicators, and the dynamic changes of these selected indicators during disease progression, were analyzed.

Findings: The data showed that, in addition to the differences reported already, chest CT presented that most patients (95.4%) had bilateral patchy shadows or low-middle leaf frosted glass shadows in the lung. The lung pathological changes were evaluated according to CT imaging score, and we found that the CT imaging score were closely correlated with the disease severity. The higher the CT imaging score is, the more severe the patient is. Based on CT imaging score, a series of enzymes, inflammation markers, and coagulation-related indicators including IL-6, C-reactive protein(CRP), erythrocyte sedimentation rate (ESR), serum amyloid A (SAA), Serum ferritin, aspartate aminotransferase (AST), lactic dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (HBDH), D-dimer and fibrinogen (FIB) were screened out. The levels of these indicators were increased in the group with higher CT imaging score. Correlation analysis showed that the levels of IL-6, CRP, LDH, AST, D-dimer and FIB had linear correlations with CT imaging score, and they were dynamically changed during the disease progression and treatment.

Interpretation: Our findings provide the evidence that the CT imaging score can be used to reflect disease severity, and the multiple enzyme release, inflammation storm, and hypercoagulability are prominent indicators to monitor the changes of disease progression and prognosis of COVID-19, which are critical to explain the multiple organ injuries or death in clinic and also guide therapeutic strategy.

Funding Statement: This study was funded by the grants from the project of Thousand Youth Talents for DH; and from the China National Natural Science Foundation (Nos. 31770983 and 81974249 to DH, No. 81601747 to SL, No.81201026 to HW, No.81974530 to LZ ).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: This case series was approved by the Institutional Ethics Board of Wuhan Union Hospital of Tongji Medical School, Huazhong University of Science and Technology. Written informed consent was waived by the Ethics Commission of the designated hospital for the emerging infectious diseases.

Keywords: COVID-19, inflammation storm, enzyme release, hypercoagulability, CT imaging score

Suggested Citation

Wang, Haijun and Luo, Shanshan and Shen, Yin and Li, Mingyue and Zhang, Zili and Dong, Yalan and Zhou, Haifeng and Lin, Lan and Guo, Weina and Kang, Zhenyu and Xing, Lihua and Li, Junlu and Ye, Hao and Gui, Wei and Hu, Yi and Yuan, Mingli and Han, Shuqing and Zhu, Rui and Ye, Youfan and Wang, Lin and Jiang, Xiaobing and Zhao, Hongyang and Zheng, Xin and Fan, Heng and Zhao, Lei and Hu, Yu and Hu, Desheng, Multiple Enzyme Release, Inflammation Storm and Hypercoagulability Are Prominent Indicators For Disease Progression In COVID-19: A Multi-Centered, Correlation Study with CT Imaging Score (February 24, 2020). Available at SSRN: https://ssrn.com/abstract=3544837 or http://dx.doi.org/10.2139/ssrn.3544837

Haijun Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurosurgery

China

Shanshan Luo

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Hematology

1277 Jiefang Avenue
Wuhan, 430022
China

Yin Shen

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurosurgery

China

Mingyue Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Wuhan
China

Zili Zhang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Wuhan
China

Yalan Dong

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Wuhan
China

Haifeng Zhou

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Wuhan
China

Lan Lin

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Wuhan
China

Weina Guo

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Wuhan
China

Zhenyu Kang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Wuhan
China

Lihua Xing

Zhengzhou University - Respiratory Intensive Care Unit

China

Junlu Li

Zhengzhou University - Respiratory Intensive Care Unit

China

Hao Ye

People's Hospital of Jingshan - Department of Infectious Disease

China

Wei Gui

People's Hospital of Jingshan - Department of Infectious Disease

China

Yi Hu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Hematology

1277 Jiefang Avenue
Wuhan, 430022
China

Mingli Yuan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pulmonary and Critical Care Medicine

China

Shuqing Han

Wuhan Red Cross Hospital - Department of Neurosurgery

China

Rui Zhu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Wuhan
China

Youfan Ye

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Ophthalmology

China

Lin Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Clinical Laboratory

China

Xiaobing Jiang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurosurgery

China

Hongyang Zhao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Neurosurgery

China

Xin Zheng

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Infectious Diseases ( email )

Wuhan
China

Heng Fan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine

Wuhan
China

Lei Zhao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Infectious Diseases ( email )

Wuhan
China

Yu Hu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Institute of Hematology ( email )

Wuhan
China

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Collaborative Innovation Center of Hematology ( email )

Wuhan
China

Desheng Hu (Contact Author)

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Integrated Traditional Chinese and Western Medicine ( email )

Wuhan
China

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