Original Article

Thrombocytopenia Secondary to COVID-19: Outcomes Analysis in Terms of Thrombotic Microangiopathy, Acute Kidney Injury, and Mortality

Abstract

Background: COVID-19 usually complicates respiratory failure; microvascular, macrovascular, and renal complications are common. Both micro and macrovascular complications are associated with multi-organ dysfunction and in-hospital mortality. Thrombotic microangiopathy (TMA) causes microvascular thromboses associated with organ failure, including acute kidney injury (AKI).

Materials and Methods: This Retrospective Cohort study included 100 COVID-19 patients with thrombocytopenia, followed up in a university hospital’s intensive care unit (ICU). The primary endpoints were in-hospital mortality or discharge from the hospital and assessing the occurrence of TMA and AKI during the hospitalization. The effect of thrombotic microangiopathy and acute kidney injury on mortality was investigated using logistic regression models in Stata software version 12.1.

Results: The TMA and AKI were associated with in-hospital mortality in COVID-19 patients presenting with thrombocytopenia in multivariate regression analysis, adjusted for other variables. The effect of AKI on mortality was obtained (adjusted OR 4.09, 95% CI: 1.33–12.53, p = 0.01). Moreover, the odds of mortality due to TMA were ten-fold higher in the patients who had TMA than those who did not (adjusted OR 10.26, 95% CI: 1.26–83.76, p = 0.03).

Conclusion: We outlined TMA in COVID-19 patients, which could be responsible for kidney injury and mortality in critically COVID-19 patients.

1. Kaffashian MR, Shirani M, Koupaei M, et al. Clinical Manifestations, imaging procedures and laboratory parameters among hospitalized patients with COVID-19 in Ilam Province, Western Iran. Ethiop J Health Sci. 2022; 32(3):485-496
2. Altowyan E, Alnujeidi O, Alhujilan A, et al. COVID-19 presenting as thrombotic thrombocytopenic purpura (TTP). BMJ Case Rep. 2020;13(12):e238026.
3. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.
4. Sukrita B, Banerjee M. Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review. SN Compr Clin Me. 2020;2(11):2048-2058.
5. Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020;99(6):1205-8.
6. Alkhalifa H, Alsalman Z, Alfaraj A. Thrombocytopenia and clinical outcomes among patients with COVID‐19 disease: A cohort study. Health Sci Rep. 2023;6(2):e1111.
7. Tehrani HA, Darnahal M, Vaezi M, et al. COVID-19 associated thrombotic thrombocytopenic purpura (TTP); A case series and mini-review. Int Immunopharmacol. 2021;93:107397.
8. Malgaj Vrečko M, Aleš Rigler A, Večerić-Haler Ž. Coronavirus disease 2019-associated thrombotic microangiopathy: A literature review. Int J Mol Sci. 2022;23(19):11307.
9. Gąsecka A, Borovac JA, Guerreiro RA, et al. Thrombotic complications in patients with COVID-19: pathophysiological mechanisms, diagnosis, and treatment. Cardiovasc Drugs Ther. 2021;35(2):215-229.
10. Brocklebank V, Wood KM, Kavanagh D. Thrombotic microangiopathy and the kidney. Clin J Am Soc Nephrol. 2018;13(2):300-317.
11. Falter T, Rossmann H, Menge P, et al. No evidence for classic thrombotic microangiopathy in COVID-19. J Clin Med. 2021;10(4):671.
12. Tiwari NR, Phatak S, Sharma VR, et al. COVID-19 and thrombotic microangiopathies. Thromb Res. 2021; 202:191-198.
13. Semeraro N, Colucci M. The prothrombotic state associated with SARS-CoV-2 infection: pathophysiological aspects. Mediterr J Hematol Infect Dis. 2021;13(1):e2021045.
14. Palma LMP, Sridharan M, Sethi S. Complement in secondary thrombotic microangiopathy. Kidney Int Rep. 2021;6(1):11-23.
15. Adamski J. Thrombotic microangiopathy and indications for therapeutic plasma exchange. Hematology Am Soc Hematol Educ Program. 2014;2014(1):444-9.
16. George JN, Nester CM. Syndromes of thrombotic microangiopathy. N Engl J Med . 2014;371(7):654-66.
17. Little DJ, Mathias LM, Page EE, et al. Long-term kidney outcomes in patients with acquired thrombotic thrombocytopenic purpura. Kidney Int Rep. 2017;2(6):1088-1095.
18. Jhaveri KD, Meir LR, Chang BSF, et al. Thrombotic microangiopathy in a patient with COVID-19. Kidney Int. 2020;98(2):509-12.
19. Dierkes F, Andriopoulos N, Sucker C, et al. Indicators of acute and persistent renal damage in adult thrombotic microangiopathy. PLoS One. 2012;7(1):e30886.
20. Bell TD. COVID-19 in the critically ill patient. Infect Dis Clin North Am. 2022;36(2):365-377.
21. Zini G, d'Onofrio G, Erber WN, et al. 2021 update of the 2012 ICSH Recommendations for identification, diagnostic value, and quantitation of schistocytes: Impact and revisions. Int J Lab Hematol. 2021;43(6):1264-71.
22. Schapkaitz E, Halefom Mezgebe M. The clinical significance of schistocytes: a prospective evaluation of the International Council for Standardization in Hematology schistocyte guidelines. Turk J Haematol. 2017;34(1):59-63.
23. Sparrow HG, Swan JT, Moore LW, et al. Disparate outcomes observed within Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury stage 1. Kidney Int. 2019;95(4):905-13.
24. Jewell, NP. Estimation of Logistic Regression Model Parameters Ch. 13. Statistics for Epidemiology (1st ed.). Chapman and Hall/CRC, USA, 2004, pp 258-259.
25. Nagori EK, Ghantarchyan H, Qadir A, et al. COVID-19-Induced Thrombocytopenia: A Brief Literature Review and Case Report. Cureus. 2022;14(11) : e30993.
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IssueVol 18, No 1 (2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijhoscr.v18i1.14740
Keywords
SARS-CoV-2; COVID-19; Acute kidney injuries; Thromboses; Thrombocytopenia; Thrombotic microangiopathy

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How to Cite
1.
Gheiasi B, Taghinezhad F, Kumar Patel D, Salimi E, Babashahi M, Mozafari A. Thrombocytopenia Secondary to COVID-19: Outcomes Analysis in Terms of Thrombotic Microangiopathy, Acute Kidney Injury, and Mortality. Int J Hematol Oncol Stem Cell Res. 2024;18(1):7-13.