COVID-19 and Pulmonary Embolism
Purpose. To establish the features of laboratory indicators of inflammation and endothelial dysfunction in persons with new SARS-CoV-2 coronavirus infection and pulmonary artery thromboembolism verified by computed tomographic angiography. Materials and methods. The study enrolled 116 patients with the confirmed coronavirus infection SARS-CoV-2 who were treated in the health care institution "4th City Clinical Hospital named after N.E. Savchenko" of Minsk in whom computed tomographic angiography (CTA) was performed to verify the diagnosis of pulmonary embolism (PE). The median age of the subjects was 62.0 (52.0-70.0) years, the proportion of males was 45.7% (53), females - 54.3% (63). The study group consisted of patients with SARS-COV-2 and confirmed diagnosis of PE (n=37), comparison group included patients with SARS-COV-2 whose diagnosis of PE was excluded on CTA (n=79). The formed groups were comparable by gender, age, presence of diabetes mellitus, bad habits, degree of arterial hypertension, and severity of course of COVID-19. The serum levels of tumor necrosis factor alpha (TNF-a), interleukin-6 (IL-6), interleukin-1 beta (IL-1β), big endothelin-1 (Big ET-1), homocysteine were determined on the day when CTA was performed by enzyme immunoassay (EIA). A level of D-dimer on the day when CTA was performed was additionally analyzed. Results. In individuals with coronavirus infection and PE group mean values of IL-6, D-dimer, big ET-1, and homocysteine were significantly higher compared with the group without PE: 41.65 (21.84-136.36) versus 25.79 (15.93-36.17) pg/mL (U=135, p<0.05); 2058.5 (826.0-4026.0) versus 982.5 (656.5-1936.0) ng/mL (U=141.5, p<0.05); 0.34 (0.26- 0.51) versus 0.29 (0.07-0.38) pg/ml (U=137, p<0.05); 19.55 (13.81-23.84) versus 16.01 (11.07-19.13) pg/ml (U=139, p<0.05) respectively. There were no significant differences between group mean values of TNF-a, interleukin-1β in the study and comparison groups. In the group of patients with PE and COVID-19 values of IL-6 and big ET-1 (ρ=0.66; p<0.05); TNF-a (ρ=0.62; p<0.05) were moderately positively correlated, values of IL-6 and D-dimer (ρ=0.78; p<0.05); interleukin-1β (ρ=0.80; p<0.05) were highly positively correlated. Conclusion. The obtained data demonstrates that in patients with COVID-19 and PE the course of the disease is accompanied by a more pronounced increase in serum levels of markers of inflammation (IL-6) and endothelial dysfunction (large endothelin-1, homocysteine). The correlation between the levels of IL-6 and big ET-1, D-dimer indicates the association of the activity of systemic inflammation with the level of endothelial dysfunction markers.