Measures of inflammation, complement activation and coagulation in patients with COVID-19

ABSTRACT

S56 Table 1Table to show measures of complement activation, inflammation and coagulation in patients with COVID-19 stratified by disease severityMildModerateSevereOverall P-ValueMild vs Mod*Mild vs Sev*Mod vs Sev*Number (%)30289----CRP (mg/L)75.5 [28.5,117.25]93.5 [72,143.5]60 [34,157.5]NSNSNSNSFerritin (ug/L)426 [290.5,847.5]728 [381.25,1071.5]857 [443,1607.5]NSNSNSNSPCT (ug/L)0.08 [0.06,0.19]0.16 [0.09,0.49]0.19 [0.12,0.8]0.019NS0.046NSLDH (U/L)708.5 [523.5,903]830 [569,1122]1037 [927.5,1086]0.008NS0.006NSPlatelets (10*9/L)220 [174.75,328.75]255 [203.5, 335]292 [209.5, 329.5]NSNSNSNSINR1.1 [1.08,1.23]1.1 [1.1, 1.2]1.1 [1.1, 1.15]NSNSNSNSAPTR0.9 [0.9,1.0]0.9 [0.9, 1.0]1.0 [0.95, 1.10]NSNSNS0.038D-dimer (ugFEU/ml)0.56 [0.38,0.95]0.74 [0.55, 1.52]0.85 [0.54, 19.2]NSNSNSNSFibrinogen (g/L)4.45 [4.05,5.22]4.7 [4.3, 6.38]4.3 [3.9, 6.0]NSNSNSNSThrombin-AT III Complex ug/L)4.75 [2.65,12.13]8.8 [5.3, 12]14.3 [6.9, 40.7]0.045NSNSNSProthrombin Fragment 1&2 (pMol/L)275 [164.5,380.5]311 [163, 492]301 [258, 709]NSNSNSNSCH50 (U Eq/ml)123.4 [101.75,174.7]113.4[88.68, 153.43]114.7 [74.6,158.9]NSNSNSNSComplement C5a (ng/ml)29 [21.5, 36]36.5[25.5, 48.75]68 [39.5,122.5]<0.0010.0380.001NSComplement C5 (mg/L)270 [235.25,290.5]263[235.25, 279]276 [220,299.5]NSNSNSNSComplement C3 (g/L)1.5 [1.25,1.77]1.48[1.33, 1.71]1.56 [1.16,1.73]NSNSNSNSSC5b-9 complex (ng/ml)1070.46 [836.41,1632.17]1725.48[1092.62, 2403.3]2392.66 [1245.68,5145.88]0.006NS0.019NSComplement Fragment Bb (µg/ml)0.2[0.15,0.27]0.25[0.17, 0.3]0.29 [0.2,0.43]NSNSNSNSComplement C3a ng/ml)296.88[244.33,345.22]325.88[248.33, 484.03]460.23 [282.49,652.1]NSNSNSNS*P-values given a Bonferroni adjustment to allow for multiple testing between subgroupsDiscussionOur findings demonstrated increased levels of complement activity in patients with COVID-19, particularly in those patients requiring non-invasive and mechanical ventilation and those patients that deteriorate requiring increasing ventilatory support. The complement cascade is a key player in protective immunity against pathogens, with its activation orchestrating key immunoprotective and anti-inflammatory effects Increased activation of the complement cascade may contribute to the dysregulated and destructive inflammatory response that leads to multi-organ failure and our findings suggest a potentially important treatment target for COVID-19.