PDF(Pubmed)
Abstract：
BACKGROUND: COVID-19 has been shown to increase the risk of extracorporeal coagulation during hemodialysis in patients, but the underlying mechanism remains unclear. This study aimed to investigate the effect and mechanism of COVID-19 on the risk of extracorporeal coagulation in patients with chronic kidney disease undergoing hemodialysis.
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.
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.
摘要：
背景：COVID-19已被证明会增加患者血液透析期间体外凝血的风险，但潜在的机制仍不清楚。本研究旨在探讨COVID-19对慢性肾脏病血液透析患者体外凝血风险的影响及机制。
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。
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。
