Indicators of hemostasis and fibrinolysis systems in patients with pulmonary tuberculosis and chronic viral hepatitis who underwent COVID-19

• Rizvan Yu. Abdullaev
• Oksana G. Komissarova
• Violetta A. Shorokhova
• Tatyana V. Kurmaeva

Abstract

The problem of the effect of severe COVID-19 infection on the human body still remains in the field of view of many researchers. It is known that with COVID-19, changes in the hemostasis and fibrinolysis system are noted. The study of these changes in patients with concomitant pathology of tuberculosis and chronic viral hepatitis B and C after moderate and severe COVID-19 is of great interest, since these infections themselves can also cause various disorders in the hemostasis and fibrinolysis system.

The aim of the study was to assess the state of hemostasis and fibrinolysis systems in patients with pulmonary tuberculosis combined with chronic viral hepatitis after COVID-19.

Material and methods. 68 patients with pulmonary tuberculosis were examined, which were divided into 4 groups. The TB+HCV+COVID-19 group included 17 patients with pulmonary tuberculosis and chronic viral hepatitis who had suffered from COVID-19 infection. 17 patients with a similar diagnosis, but who had not suffered from COVID-19, were included in the TB+HCV group. Another 17 patients were diagnosed with pulmonary tuberculosis after suffering from COVID-19 (TB+COVID-19 group). At the same time, they did not have chronic viral hepatitis. The fourth group included 17 patients diagnosed with pulmonary tuberculosis, who had no history of HCV and had a COVID-19 infection (TB group). The assessment of the state of hemostasis and fibrinolysis systems in relation to indicators of systemic inflammation was carried out. The studies were conducted at the time of admission of patients for treatment.

The arithmetic mean (M), the standard deviation (σ), and the error of the mean (m) were calculated. The significance of the differences was determined using Pearson’s χ² criterion, Student’s t-test. Correlations have been determined between the estimated parameters (Spearman’s coefficient). The differences were considered statistically significant at a value of p<0.05.

Results and discussion. Analysis of the study results showed that hypercoagulation shift was significantly more often observed in the group of patients with TB+HCV+COVID-19. TB+COVID-19 patients are in second place in terms of the frequency of detection of hypercoagulation shift. At the same time, in both groups, these changes were confirmed by a shortening of the APTT, an increase in the concentration of fibrinogen and D-dimer, as well as an increase in the number of platelets in blood plasma. It was found that there are close correlations between markers of hemostasis and fibrinolysis systems and indicators of systemic inflammation. The number of platelets correlated with the level of CRP (r=0,565; p<0,01), fibrinogen (r=0,402; p<0,01) and to a lesser extent with ESR (r=0,268; p<0,05). The platelet count was negatively correlated with the hemoglobin level (r=-0.586; p<0.01). The fibrinogen level correlated with the level of CRP (r=0.420; p<0.01) and ESR (r=0.433; p<0.01). The prothrombin time index correlated with CRP (r=0.507; p<0.01) and with ESR (r=0,311; p<0.02).

Conclusion. The most pronounced changes in the indicators of hemostasis and fibrinolysis systems, as well as systemic inflammation, were detected in the group of patients with pulmonary tuberculosis combined with chronic viral hepatitis who underwent COVID-19. At the same time, these changes were associated with the severity of systemic inflammation.

Keywords: tuberculosis; COVID-19; hepatitis; systemic inflammatory response; hemostasis and fibrinolysis system

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