Relationship between proinflammatory cytokines and associated coagulopathies among COVID-19 patients at Mulago national hospital, Kampala

Abstract

Cytokine storm and coagulopathy are two main complications of COVID-19 and are more profound in severe cases. Hyperinflammation and hypercoagulability are two common features, accompanied by a higher rate of morbidity and mortality. This study evaluated the role of inflammatory cytokines in COVID-19 associated Coagulopathy among COVID-19 infected patients at Mulago National Specialised Hospital in Kampala, Uganda. This was an analytical cross-sectional study design. One hundred hospitalised patients diagnosed with a positive SARS-CoV-2 polymerase chain reaction (PCR), were selected for this study. Invitro quantitative determination of inflammatory cytokines and assessment of the coagulation cascade was done. The difference in means of blood plasma concentration levels for IL-6, TNF-α, and IFN-γ, between COVID-19 patients and healthy individuals were statistically significant. The mean difference of prothrombin time between COVID-19 patients and healthy individuals, were statistically significant. However, this was an exception for the female participants below 50 years of age (p= 0.162). Furthermore, the mean differences of PT-INR between COVID-19 patients and healthy individuals were statistically significant, except for male participants ≥ 50 years age (p=0.092). There was no statistical significance in the mean differences between aPTT results between COVID-19 patients and healthy individuals. Additionally, the mean differences of D-dimer concentrations among COVID-19 patients and healthy individuals were statistically significant. COVID-19 patients with elevated levels of IL-6 were at high risk of presenting with coagulopathies (binary Logistic model: OR =10.76, CI 95% 1.3, 93.0, p-value 0.031). It is concluded from this study that, COVID-19 patients admitted at Mulago hospital, with elevated levels of IL-6 were at a high risk of presenting with coagulopathies as opposed to TNF-α and IFN-γ. The study recommends that IL-6 a proinflammatory cytokine, be used as a biomarker to monitor inflammatory responses in COVID-19 patients which puts them at increased risk of coagulopathies.