Over time relationship between platelet reactivity, myocardial injury and mortality in patients with SARS-CoV-2-associated respiratory failure

Abstract

The aim of this study (NCT04343053) is to investigate the relationship between platelet activation, myocardial injury, and mortality in patients affected by Coronavirus disease 2019 (COVID-19). Fifty-four patients with respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were enrolled as cases. Eleven patients with the same clinical presentation, but negative for SARS-CoV-2 infection, were included as controls. Blood samples were collected at three different time points (inclusion [T1], after 7 ± 2 days [T2] and 14 ± 2 days [T3]). Platelet aggregation by light transmittance aggregometry and the circulating levels of soluble CD40 ligand (sCD40L) and P-selectin were measured. Platelet biomarkers did not differ between cases and controls, except for sCD40L which was higher in COVID-19 patients (p = .003). In COVID-19 patients, P-selectin and sCD40L levels decreased from T1 to T3 and were higher in cases requiring admission to intensive care unit (p = .004 and p = .008, respectively). Patients with myocardial injury (37%), as well as those who died (30%), had higher values of all biomarkers of platelet activation (p < .05 for all). Myocardial injury was an independent predictor of mortality. In COVID-19 patients admitted to hospital for respiratory failure, heightened platelet activation is associated with severity of illness, myocardial injury, and mortality.

ClinicalTrials.gov number: NCT04343053.

Keywords:

• COVID-19
• myocardial injury
• platelet aggregation
• P-selectin
• soluble CD40 ligand

Author Contribution Statement

Conceived and designed the research: Gianluca Campo, Marco Contoli, Savino Spadaro. Acquired the data: Ottavio Zucchetti, Luca Ronzoni, Luca Morandi, Marco Verri, Simone Biscaglia, Rita Pavasini, Luca Di Ienno, Emanuele D’Aniello. Perfomed laboratory analyses: Francesco Vieceli Dalla Sega, Francesca Fortini, Paola Rizzo. Performed statistical analysis: Marco Manfrini. Handled funding and supervision: Roberto Ferrari, Roberto Zoppellari. Drafted the manuscript: Gianluca Campo, Marco Contoli, Savino Spadaro, Alberto Fogagnolo. Made critical revision of the manuscript for key intellectual content: Carlo Alberto Volta, Alberto Papi.

Declaration Of Interest

No authors reported conflict of interest.

DATA AVAILABILITY STATEMENT

The data underlying this article will be shared on reasonable request by contacting the corresponding author.

Additional information

Funding

The study was an investigator-driven clinical trial conducted by the University of Ferrara.