• M Raadsen, T Langerak, J Du Toit, KruipM J H AMJHADepartment of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands., D Aynekulu Mersha, M P M De Maat, B Vermin, J P C Van den Akker, K S Schmitz, K Bakhtiari, MeijersJ C MJCMDepartment of Molecular Hematology, Sanquin Research, Amsterdam, the Netherlands., van GorpE C MECMDepartment of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands., K R Short, B Haagmans, R D de Vries, D A M P J Gommers, H Endeman, M Goeijenbier, and Dutch COVID & Thrombosis Coalition.
• Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands.
• J Crit Care. 2024 Feb 1; 79: 154463154463.

PurposePulmonary 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.MethodsPBMC 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.ResultsMC-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.ConclusionWe 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.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

12 keywords...

hide…