دور كل من العامل المنشط للصفائح الدموية (PAF) وجزيئتي الالتصاق (ICAM-1, VCAM-1) والمركب النهائي لنظام المتمم المناعي (MAC) على التخثر المناعي عند المرضى المصابين بفايروس كورونا في محافظة كربلاء المقدسة

The Role of PAF, ICAM-1, VCAM-1 and Membrane Attack Complex on Immunothrombosis in Patients with COVID-19 in Kerbala Province

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
COVID-19 is characterized by the presence of an immunothrombosis, which is manifested by an increase in the levels of some inflammatory and biochemical parameters as well as alterations in the blood parameters.
The study aimed to investigate and evaluate the role of ICAM-1, VCAM-1, PAF and membrane attack complex (MAC) along with other hematological, biochemical, and coagulation parameters in the immunothrombosis that develops in COVID-19 patients.
In order to achieve this goal, 82 participants were enrolled in this study who had COVID-19 confirmed by real-time-PCR on a nasopharyngeal swab specimen. Patients were treated in Imam Al-Hussein Medical City in Kerbala province during the period from October 2021 to May 2022.
The patients were divided into three groups (mild n = 27, severe n = 27 and critical n = 28). The mean age was 59.9 years, and the age range was between 25 and 85 years. Among them, 44 (53.7%) were male and 38 (46.3%) were female.
A significant mortality rate (17%) occurred among older patients in the severe and critical groups, while no mortality occurred among mild patients, who were mostly younger in age. These results indicated that older patients were at a higher risk for mortality.
The levels of ICAM-1, VCAM-1 and MAC were significantly increased with disease progression (p < 0.001; p = 0.002; p = 0.047, respectively). While, the level of platelet activating factor (PAF) was increased in the mild patients and stabilized within a limited range in the severe and critical patients (p = 0.447).
D-dimer was the only coagulation parameter that was significantly increased with disease severity in this study (p < 0.001), and most mortality cases associated with high D-dimer levels, whereas no significant changes occurred in prothrombin time (PT), partial thromboplastin time (PTT) or platelet count (p= 0.053, p = 0.259, p = 0.422, respectively).
The C-reactive protein (CRP) level was significantly elevated with disease severity (p < 0.001). That was an indicator of the activation of the inflammatory process during COVID-19.
The lymphocyte percentage was significantly decreased (p < 0.001), while neutrophil percentage was significantly increased (p < 0.001) with disease severity.
In conclusion, the data indicated that all studied immunological parameters (ICAM-1, VCAM-1, MAC, and PAF) significantly correlated with the occurrence of inflammatory immunothrombosis in COVID-19 and the immunothrombosis was significantly associated with disease severity and increased mortality.