ARTERIAL THROMBOSIS IN PATIENTS WITH TYPE 2 DIABETES AND COVID-19
Keywords:type 2 diabetes mellitus, COVID-19, arterial thrombosis
The aim of the study: to assess the importance of the inflammatory status of the body in patients with diabetic 2 type and severe COVID-19 as an unfavorable factor for the occurrence of arterial thrombosis of the lower extremities, the course of acute ischemia and the prognosis for ischemic limb.
Materials and Methods. The study included 35 patients with type 2 diabetes mellitus and acute arterial thrombosis of the lower extremities without a history of intermittent claudication with an ischemia of 6-12 h, who underwent urgent surgical successful thrombectomy. All studied patients were tested for the SARS-CoV-2 virus, 18 had a negative result (control group), the diagnosis of COVID-19 in 17 patients of the main group was confirmed by a transcriptional polymerase chain reaction. The average age of patients in the control group was 72.3 yrs, the main group — 69.8 yrs.
Results. During examination, distal forms of arterial thrombosis were registered in 70.6 % of patients in the main group and 72.2 % in the controls. The concentration of myoglobin in the serum at 6 h after the surgery was the highest, reaching the highest values in patients of the main group. There was a significantly lower concentration of myoglobin in the control group during the first days after the restoration of blood flow. ICAM-1 levels were significantly higher in the COVID-19 group than in the control group during the first day after blood flow recovery. The association between endothelial dysfunction and subsequent thrombotic events is already well known in cardiovascular disease and diabetes. Six of our cases had comorbidities such as arterial hypertension, dyslipidemia, diabetes mellitus, and signs of chronic arterial disease. Thus, previous endothelial activation status caused by these comorbidities exacerbated endothelial dysfunction caused by SARS-CoV-2 infection and its inflammatory response, and may have been the cause of the most common fatalities described in these patients. Recurrences of thrombosis in the early postoperative period occurred in 5 (29.4 %) patients of the main group, which led to amputation. In the control group, recurrent thrombosis led to amputation in 2 (11.1 %) cases. In 7 patients of the main group (41.2 %) and 2 patients of the control group (11.1 %) in the early postoperative period developed adverse cardiopulmonary events, which in 4 patients of the main group (23.5 %) caused death.
Conclusions. Оur results suggest the involvement of endothelial dysfunction and thrombosis in COVID-19. Consistent with this hypothesis, patients with type 2 diabetes mellitus and severe COVID-19 have been noted to have significant increase in serum level of inflammatory markers (TNF-α, IL-1β, IL-6, IL-8, IL-10). One of the significant factors of endothelial dysfunction as a result of our study was ICAM-1 thereby indicating the occurrence of macrophage activation syndrome. These thrombotic events can be fatal in patients with type 2 diabetes, and early diagnosis can help health professionals adjust the anticoagulation regimen and affect endothelial stabilization in high-risk patients, alleviate thrombogenic events, systemic inflammatory response syndrome, and multiorgan failure. K ey wor d s : type 2 diabetes mellitus, COVID-19, arterial thrombosis.
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