Yang Guang, Shan Hui, Wu Dibin, Li Sanmu, Lai Zhiwei, Zheng Fengping, Xiong Zibo, Xiong Zuying, Diao Yuhan, Shan Ying, Chen Yun, Wang Aihong, Liang Wei, Yin Yuxin
Division of Renal Medicine, Peking University Shenzhen Hospital, Peking University, Shenzhen, 518036, China.
Shenzhen Clinical Research Centre for Urology and Nephrology, Shenzhen, 518036, China.
BMC Infect Dis. 2024 Apr 22;24(1):427. doi: 10.1186/s12879-024-09245-9.
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.
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.
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.
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.
COVID-19已被证明会增加患者血液透析期间体外凝血的风险，但其潜在机制仍不清楚。本研究旨在探讨COVID-19对接受血液透析的慢性肾脏病患者体外凝血风险的影响及机制。
对本中心339例血液透析患者在感染COVID-19前后的体外凝血状态进行回顾性分析，包括亚组分析。采用蛋白质谱法和酶联免疫吸附测定法分析感染后血液成分。
与COVID-19感染前相比，COVID-19诱导的体外凝血主要发生在重症/危重症患者中。进一步的蛋白质组学分析表明，与无/轻症患者相比，重症/危重症患者的凝血级联反应、血小板活化、炎症和氧化应激相关途径显著增强。值得注意的是，与炎症、血管损伤和凝血相关的血管性血友病因子/纤维连接蛋白5（vWF/FBLN5）途径显著上调。
COVID-19重症/危重症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。这些发现凸显了对COVID-19重症/危重症患者，尤其是接受血液透析的患者尽早启动抗凝治疗的重要性。此外，vWF/FBLN5上调可能是病毒相关血栓形成/凝血的一种新机制。
