METHODS: A retrospective analysis of the extracorporeal coagulation status of 339 hemodialysis patients at our center before and after COVID-19 infection was performed, including subgroup analyses. Post-infection blood composition was analyzed by protein spectrometry and ELISA.
RESULTS: Compared to the pre-COVID-19 infection period, COVID-19-induced extracorporeal coagulation predominantly occurred in patients with severe/critical symptoms. Further proteomic analysis demonstrated that in patients with severe/critical symptoms, the coagulation cascade reaction, platelet activation, inflammation, and oxidative stress-related pathways were significantly amplified compared to those in patients with no/mild symptoms. Notably, the vWF/FBLN5 pathway, which is associated with inflammation, vascular injury, and coagulation, was significantly upregulated.
CONCLUSIONS: Patients with severe/critical COVID-19 symptoms are at a higher risk of extracorporeal coagulation during hemodialysis, which is associated with the upregulation of the vWF/FBLN5 signaling pathway. These findings highlight the importance of early anticoagulant therapy initiation in COVID-19 patients with severe/critical symptoms, particularly those undergoing hemodialysis. Additionally, vWF/FBLN5 upregulation may be a novel mechanism for virus-associated thrombosis/coagulation.
方法:回顾性分析本中心339例血液透析患者感染COVID-19前后的体外凝血状态,包括亚组分析。通过蛋白质光谱法和ELISA分析感染后的血液成分。
结果:与COVID-19感染前期相比,COVID-19诱导的体外凝血主要发生在有严重/危急症状的患者中。进一步的蛋白质组学分析表明,在患有严重/危重症状的患者中,凝血级联反应,血小板活化,炎症,与无/轻度症状的患者相比,氧化应激相关途径显着放大。值得注意的是,vWF/FBLN5通路,这与炎症有关,血管损伤,和凝血,显着上调。
结论:有严重/严重COVID-19症状的患者在血液透析期间发生体外凝血的风险较高,这与vWF/FBLN5信号通路的上调有关。这些发现强调了在有严重/危重症状的COVID-19患者中早期开始抗凝治疗的重要性,尤其是那些接受血液透析的人.此外,vWF/FBLN5上调可能是病毒相关血栓形成/凝血的新机制。