Open AccessLow-Grade Endotoxemia and Thrombosis in COVID-19
Author(s) -
Alessandra Oliva,
Vittoria Cammisotto,
Roberto Cangemi,
Domenico Ferro,
Maria Claudia Miele,
Massimiliano De Angelis,
Francesca Cancelli,
Pasquale Pignatelli,
Mario Venditti,
Francesco Pugliese,
Claudio Maria Mastroianni,
Francesco Violi
Publication year - 2021
Publication title -
clinical and translational gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.673
H-Index - 35
ISSN - 2155-384X
DOI - 10.14309/ctg.0000000000000348
Subject(s) - interquartile range , medicine , covid-19 , gastroenterology , d dimer , thrombosis , pneumonia , logistic regression , case control study , cardiology , disease , infectious disease (medical specialty)
Patients with community-acquired pneumonia display enhanced levels of lipopolysaccharides (LPS) compared with controls, suggesting that low-grade endotoxemia may be implicated in vascular disturbances. It is unknown whether this occurs in patients with coronavirus 2019 (COVID-19) and its impact on thrombotic complications. METHODS: We measured serum levels of zonulin, a marker of gut permeability, LPS, and D-dimer in 81 patients with COVID-19 and 81 healthy subjects; the occurrence of thrombotic events in COVID-19 during the intrahospital stay was registered. RESULTS: Serum LPS and zonulin were higher in patients with COVID-19 than in control subjects and, in COVID-19, significantly correlated ( R = 0.513; P < 0.001). Among the 81 patients with COVID-19, 11 (14%) experienced thrombotic events in the arterial (n = 5) and venous circulation (n = 6) during a median follow-up of 18 days (interquartile range 11–27 days). A logistic regression analysis showed that LPS ( P = 0.024) and D-dimer ( P = 0.041) independently predicted thrombotic events. DISCUSSION: The study reports that low-grade endotoxemia is detectable in patients with COVID-19 and is associated with thrombotic events. The coexistence of low-grade endotoxemia with enhanced levels of zonulin may suggest enhanced gut permeability as an underlying mechanism.