Effect of hereditary thrombophilia on the clinical severity of COVID-19 pneumonia

Effect of Hereditary Thrombophilia on the Clinical Severity of COVID-19 Pneumonia Introduction: Coronavirus disease still continues as a serious problem around the world. The course of the disease may lead to various results including asymptomatic cases, acute respiratory distress syndrome and death. Mechanisms including endothelial dysfunction, coagulation, imbalance between coagulation and fibrinolysis, vasculopathy, cytokine release syndrome, and immunothrombosis can be seen during COVID-19 disease. As a result, thromboses are seen in both arterial and venous systems; and they have been shown to be associated with mortality. Severe coagulopathy is dominant in the COVID-19 pneumonia. In this study, we aimed to evaluate the effect of hereditary thrombophilia, which predisposes to thrombosis, on the severity of COVID-19 pneumonia. Material and Methods: Our study has been conducted on outpatients who had been monitored in Ankara City Hospital COVID-19 following polyclinic between March 2022 and July 2022. The study was started with the approval of Ankara Yıldırım Beyazıt University Ethics Committee. Patients who had COVID-19 pneumonia were decided to include in the study. A hundred cases who had been monitored by COVID-19 following polyclinic, and whose RT-PCR test was positive and thoracic BT was compatible with COVID-19 pneumonia were included in our study. The cases were divided into three groups according to their clinical burdens as outpatients, patients monitored in the ward unit, and patients monitored in the intensive care unit. The information of the patients included in the study regarding the period they had COVID-19 pneumonia was obtained retrospectively from the hospital registration system. The patients' demographic characteristics, comorbidities, acquired thrombophilia factors, and oxygen support treatments – if any provided – were recorded. Routine laboratory findings, pneumonia severity indices and the findings of thorax computed tomography of the patients during the period of pneumonia were recorded. A tube of blood was taken from the patients participating in the study to evaluate the presence of hereditary thrombophilia, and was stored at +4°C. On the day of analysis, studies on Thrombosis panel FII 20210 G>A (PTM), FV 1691 G>A (Leiden), MTHFR 677 C>T, MTHFR 1298 A>C and PAI-I 4G/5G were conducted. Results: The sample of cases were consisted of 37 male and 63 female individuals. The age range of the cases was 27-84 and the mean was 57.04 ± 12.68. Additional medical conditions were present in 65% of the cases included in the study. The most common condition was hypertension (37%), and it was respectively followed by diabetes mellitus (31%), heart disease (24%) and asthma (11%). Among the cases, it was determined that heterozygosity for Factor V-Leiden as 16%,heterozygosity for Prothrombin as 7%, PAI-1 4G/4G mutation as 19%, PAI-1 4G/5G mutation as 48%, heterozygosity for MTHFR 677 as 45%, homozygosity for MTHFR 677 as 6%, heterozygosity MTHFR 1298 as 42%, homozygosity for MTHFR 1298 as 14%. Homozygosity for Factor V-Leiden and homozygosity for Prothrombin were not observed. There was no statistically significant difference between the hereditary thrombophilia characteristics of the cases in regard to their clinical weights (p > 0.05). Yet, the presence of hereditary thrombophilia was observed in all cases except one. As a result of the conducted correlation analysis, a high positive correlation between CURB-65 and PSI, a moderate positive correlation between CURB-65 and Thorax CT prevalence, and a moderate positive significant correlation between PSI and Thorax CT were determined. However, no significant correlation was found between hereditary thrombophilia and the extent of CURB-65, PSI, and Thorax CT. Conclusion: Almost all of the cases with COVID-19 pneumonia included in our study tended to thrombophilia. This situation has been thought to pose a risk to COVID-19 pneumonia. However, the presence of hereditary thrombophilia did not differ between the case groups. It was thought that this situation can be related to the limited number of cases included in the study. In addition, no significant correlation between hereditary thrombophilia and pneumonia severity indicators, including CURB-65, PSI and Thorax CT prevalence was found. Keywords: Hereditary Thrombophilia, COVID-19, peumonia, pneumonia severity