Endotheliopathy, Soluble Thrombomodulin and Its Role in Predicting Prognosis in Severe Coronavirus Disease-2019 Pneumonia

Introduction: The main reason for acute respiratory distress syndrome (ARDS) and mortality during coronavirus disease-2019 (COVID-19) infection is thrombotic events due to the tendency to coagulopathy. Systemic inflammation, endothelial dysfunction caused by severe hypoxia and thrombocyte abnormalities lead to coagulopathy. Here, we aimed to search for the relationship of soluble thrombomodulin (TM) and von Willebrand factor (vWF) antigen levels as endothelial dysfunction biomarkers with an early stage severe COVID-19 infection. Methods: Fifty-four patients admitted to our hospital with severe COVID-19 infection and 25 healthy asymptomatic patients were included in the study. Both the patient (at hospital admission date) and healthy control group gave venous blood samples for soluble TM and vWF antigen level measurements. The level of the searched parameters were compared between groups and hospital admission duration and mortality rate of the patient group. Results were evaluated using the SPSS program. Results: vWF antigen levels did not show any difference between groups, but soluble TM was significantly higher in the patient group. Thus, soluble TM level did not show a statistically significant relationship with duration of hospitalization or mortality. Conclusion: Early elevation of soluble thrombolic level can be considered as an early defense mechanism of endothelium against thrombosis in a severe COVID-19 infection.