Multiple Enzyme Release, Inflammation Storm and Hypercoagulability Are Prominent Indicators For Disease Progression In COVID-19: A Multi-Centered, Correlation Study with CT Imaging Score

Background: Last winter, a new coronavirus-induced pneumonia, COVID-19, broke out in Wuhan, China, and spread rapidly throughout the country due to its high infectivity. Although several researches on its clinical characteristics have been published, indicators and its dynamic changes during the disease progression are still not clear and need to be further explored.Methods: We retrospectively studied 165 patients with COVID-19 who were admitted to five hospitals in and outside Wuhan from January 2 to February 5, 2020. Demographic data, laboratory tests, chest computed tomography (CT) scans, etc. were extracted. A series of factors indicating disease progression were screened out from two patient groups according to the CT imaging score. The correlation between the CT imaging score and the levels of each indicators, and the dynamic changes of these selected indicators during disease progression, were analyzed.Findings: The data showed that, in addition to the differences reported already, chest CT presented that most patients (95.4%) had bilateral patchy shadows or low-middle leaf frosted glass shadows in the lung. The lung pathological changes were evaluated according to CT imaging score, and we found that the CT imaging score were closely correlated with the disease severity. The higher the CT imaging score is, the more severe the patient is. Based on CT imaging score, a series of enzymes, inflammation markers, and coagulation-related indicators including IL-6, C-reactive protein(CRP), erythrocyte sedimentation rate (ESR), serum amyloid A (SAA), Serum ferritin, aspartate aminotransferase (AST), lactic dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (HBDH), D-dimer and fibrinogen (FIB) were screened out. The levels of these indicators were increased in the group with higher CT imaging score. Correlation analysis showed that the levels of IL-6, CRP, LDH, AST, D-dimer and FIB had linear correlations with CT imaging score, and they were dynamically changed during the disease progression and treatment.Interpretation: Our findings provide the evidence that the CT imaging score can be used to reflect disease severity, and the multiple enzyme release, inflammation storm, and hypercoagulability are prominent indicators to monitor the changes of disease progression and prognosis of COVID-19, which are critical to explain the multiple organ injuries or death in clinic and also guide therapeutic strategy.Funding Statement: This study was funded by the grants from the project of Thousand Youth Talents for DH; and from the China National Natural Science Foundation (Nos. 31770983 and 81974249 to DH, No. 81601747 to SL, No.81201026 to HW, No.81974530 to LZ ).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This case series was approved by the Institutional Ethics Board of Wuhan Union Hospital of Tongji Medical School, Huazhong University of Science and Technology. Written informed consent was waived by the Ethics Commission of the designated hospital for the emerging infectious diseases.