Evaluating interactions between hyperglycemia and clotting factors in patients suffering with SARS-CoV-2 infection
, 2, 3, 3, 4, 5, 5, 6, 7, 7
Abstract
Background. With coronavirus disease-19 (COVID-19), patients with diabetes mellitus are dealing with two pandemics and are at a higher risk of mortality. The present study was undertaken to evaluate interactions between hyperglycemia and clotting factors in COVID-19 patients.
Methods. In this retrospective observational study, 53 real-time RT-PCR SARS-CoV-2 positive cases in 40 to 70 years of age, representing both sexes, were enrolled in the study from SMS Medical College, Jaipur (Rajasthan, India). Based on their history of diabetes mellitus and exclusion criterion, patients were divided into diabetics (N = 11) and non-diabetics (N = 17) groups. The data on clinical profile and coagulation profile was recorded along with the markers of inflammation and infection. The two groups were compared using the Mann-Whitney test and the Fisher’s exact test. Correlation coefficients between clotting factors were compared between two groups using Student t test. Results. There was no significant difference in age (p = 0.25) or gender (p = 0.12) between the two groups.
The coagulation indicators FDP (p = 0.79), D-dimer (p = 0.30), APPT (p = 0.96), PT (p = 0.79), INR (p = 1.00) PLT (p = 0.17) and the markers of inflammation and infection did not differ significantly between the two groups. There was no significant difference in correlation coefficients among coagulation indicators between the two groups (p > 0.05).
Conclusion. The study concludes that pathogenesis in clotting system is not significantly different in stud-ied groups. Further research is needed to explain the higher mortality in diabetic patients suffering from COVID-19.
Keywords: clotting factorsCOVID-19diabetes mellitushyperglycemiaSARS-CoV-2.
References
- WHO Coronavirus Disease (COVID-19) Dashboard. COVID 19 Special Issue. 2020; 10(1).
- IDF Diabetes Atlas Ninth edition 2019, International Diabetes Federation. Available online: https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html. [Last accessed: 05.11.2020].
- Bloomgarden ZT. Diabetes and COVID-19. J Diabetes. 2020; 12(4): 347–348.
- Nishikawa T, Araki E. Impact of mitochondrial ROS production in the pathogenesis of diabetes mellitus and its complications. Antioxid Redox Signal. 2007; 9(3): 343–353.
- Ma X, Chen Z, Wang Le, et al. The pathogenesis of diabetes mellitus by oxidative stress and inflammation: its inhibition by berberine. Front Pharmacol. 2018; 9: 782.
- Singh AK, Gupta R, Ghosh A, et al. Diabetes in COVID-19: prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr. 2020; 14(4): 303–310.
- Indrayan A, Malhotra RK. Medical biostatistics. 4th ed. In: Relationships. Quantitative Outcome. CRC Press, Taylor & Francis Group 2018: 456.
- JASP Team, JASP (version 0.12.2) [Computer Software], University of Amsterdam, Netherlands. 2020; Copyright 2013–2019.
- MATLAB Team, Statistics and Machine Learning Toolbox 10.2, MATLAB. version 9.0.0.341360 (R 2016a). Natick, Massachusetts : The Mathworks Inc.
- Boron WF, Boulpaep EL. Medical physiology. 4th ed. Elsevier Health Sciences 2016: 439–442.
- , et al Fauci AS, Kasper DL, Hauser SL, et al. Harrison's principles of internal medicine. : McGraw-Hill, New York 2012: 973.
- Mann KG, Butenas S, Brummel K. The dynamics of thrombin formation. Arterioscler Thromb Vasc Biol. 2003; 23(1): 17–25.
- Jose R, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. The Lancet Respiratory Medicine. 2020; 8(6): e46–e47.
- Aziz M, Fatima R, Assaly R. Elevated interleukin-6 and severe COVID-19: A meta-analysis. J Med Virol. 2020; 92(11): 2283–2285.
- Terpos E, Ntanasis-Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020; 95(7): 834–847.
- Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. 2020; 127: 104362.
- Dolhnikoff M, Duarte-Neto AN, de Almeida Monteiro RA, et al. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost. 2020; 18(6): 1517–1519.
- Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020; 18(7): 1559–1561.
- Ceriello A. Coagulation activation in diabetes mellitus: the role of hyperglycaemia and therapeutic prospects. Diabetologia. 1993; 36(11): 1119–1125.
- Alzahrani SH, Ajjan RA. Review article: Coagulation and fibrinolysis in diabetes. Diabetes and Vascular Disease Research. 2010; 7(4): 260–273.
- Abdulla AM, Elmissbah TE, Hamid EM, et al. Assessment of coagulation process in diabetic patients using prothrombin time and activated thromboplastin time tests. Int. J. of Multidisciplinary and Current Research. 2017; 5: 343–347.
- Bukhari M. COVID-19 in patients with gestational diabetes: review of literature. Clinical Diabetology. 2020; 9(6): 367–371.