High D-dimer and CRP Levels in an Asymptomatic COVID-19 Patient: A Case Report and Brief Literature Review
Abstract
SARS-CoV-2 is a highly transmittable virus and now declared as pandemic. Many of individuals infected by this novel coronavirus remain asymptomatic. The asymptomatic patients are challenging to manage because they could easily act as source of transmission and could also be at risk of worse outcome. Thrombosis is one of the factors associated with severe COVID-19 infection. In this report, we present a case of 60-year-old asymptomatic woman who was confirmed positive for COVID-19. Although asymptomatic, she had increased D-dimer and CRP level, which is associated with the risk of thrombosis. The patient was treated with standard regimen of oseltamivir, azithromycin, and vitamin B complex. Patient was given rivaroxaban 15 mg once a day for seven days in conjunction with elevated D-dimer level. On the last day of treatment, D-dimer level was decreased. The presence of high D-dimer in asymptomatic patients suggest that even with no symptoms, COVID-19 patients are at risk of worse outcome, for example, pulmonary embolism or venous thromboembolism due to prothrombic state induced by the infection. Thus, D-dimer and CRP monitoring are important in order to minimize the risk of thrombotic formation. Prophylactic anticoagulant might be given to patients with high risk of thrombotic events.
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Meo, S. A. et al. Novel coronavirus 2019-nCoV: Prevalence, biological and clinical characteristics comparison with SARS-CoV and MERS-CoV. Eur. Rev. Med. Pharmacol. Sci. 24, 2012–2019 (2020).
Zhang, J. et al. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics. Lancet Respir. Med. 8, e11–e12(2020).
He, J., Guo, Y., Mao, R. & Zhang, J. Proportion of asymptomatic coronavirus disease 2019: A systematic review and meta-analysis. J. Med. Virol. (2020) doi:10.1002/jmv.26326.
Nickbakhsh, S. et al. Epidemiology of Seasonal Coronaviruses: Establishing the Context for the Emergence of Coronavirus Disease 2019. J. Infect. Dis. 222, 17–25 (2020).
Polat, V. & Bostancı, G. İ. Sudden death due to acute pulmonary embolism in a young woman with COVID-19. J. Thromb. Thrombolysis 50, 239–241 (2020).
Nishiura, H. et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Int. J. Infect. Dis. 94, 154–155 (2020).
Djakpo, D. K. et al. Blood routine test in mild and common 2019 coronavirus (COVID-19) patients. Biosci. Rep. 40, 1–5 (2020).
Rivett, L. et al. Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission. Elife 9, 1–20 (2020).
Ferrari, D., Motta, A., Strollo, M., Banfi, G. & Locatelli, M. Routine blood tests as a potential diagnostic tool for COVID-19. Clin. Chem. Lab. Med. 58, 1095–1099 (2020).
Fernández-Atucha, A. et al. Sex differences in the aging pattern of renin-angiotensin system serum peptidases. Biol. Sex Differ. 8, 1–8 (2017).
Bansal, A. et al. A Systematic Review and Meta-analysis of D-Dimer Levels in Patients Hospitalized with Coronavirus Disease 2019 (COVID-19). medRxiv 2020.06.24.20139600 (2020).
Ge, H. et al. The epidemiology and clinical information about COVID-19. Eur. J. Clin. Microbiol. Infect. Dis. 39, 1011–1019 (2020).
Lapić, I., Rogić, D., Plebani, M. & Plebani, M. Erythrocyte sedimentation rate is associated with severe coronavirus disease 2019 (COVID-19): A pooled analysis. Clin. Chem. Lab. Med. 58, 1146–1148 (2020).
Zhou, F. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395, 1054–1062 (2020).
Chong, P. Y. et al. Analysis of Deaths during the Severe Acute Respiratory Syndrome (SARS) Epidemic in Singapore: Challenges in Determining a SARS Diagnosis. Arch. Pathol. Lab. Med. 128, 195–204 (2004).
Xu, P., Zhou, Q. & Xu, J. Mechanism of thrombocytopenia in COVID-19 patients. Annals of Hematology vol. 99 1205–1208 (2020).
Lang, Z. W. et al. A clinicopathological study of three cases of severe acute respiratory syndrome (SARS). Pathology 35, 526–531 (2003).
Maiese, A. et al. Autopsy findings in COVID-19-related deaths: a literature review. Forensic Sci. Med. Pathol. (2020) doi:10.1007/s12024-020-00310-8.
Edler, C. et al. Erratum: Correction to: Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany (International journal of legal medicine (2020) 134 4 (1275-1284)). Int. J. Legal Med. 134, 1977 (2020).
Wichmann, D. et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. Ann. Intern. Med. 173, 268–277 (2020).
Bagot, C. N. & Arya, R. Virchow and his triad: A question of attribution. Br. J. Haematol. 143, 180–190 (2008).
Visseren, F. L. J. et al. Procoagulant activity of endothelial cells after infection with respiratory viruses. Thromb. Haemost. 84, 319–324 (2000).
Akel, T., Qaqa, F., Abuarqoub, A. & Shamoon, F. Pulmonary embolism: A complication of COVID 19 infection. Thrombosis Research vol. 193 79–82 (2020).
Wang, K. et al. SARS-CoV-2 invades host cells via a novel route: CD147-spike protein. bioRxiv 2020.03.14.988345 (2020) doi:10.1101/2020.03.14.988345.
Gupta, N., Zhao, Y. Y. & Evans, C. E. The stimulation of thrombosis by hypoxia. Thromb. Res. 181, 77–83 (2019).
Iba, T., Levy, J. H., Levi, M. & Thachil, J. Coagulopathy in COVID-19. J. Thromb. Haemost. 18, 2103–2109 (2020).
Klok, F. A. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb. Res. 191, 145–147 (2020).
Cawcutt, K. & Kalil, A. C. Pneumonia with bacterial and viral coinfection. Curr. Opin. Crit. Care 23, 385–390 (2017).
Hanada, S., Pirzadeh, M., Carver, K. Y. & Deng, J. C. Respiratory viral infection-induced microbiome alterations and secondary bacterial pneumonia. Front. Immunol. 9, 1–15 (2018).
Zhang, J. jin et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy Eur. J. Allergy Clin. Immunol. 75, 1730–1741 (2020).
Ali, R. M. M. & Ghonimy, M. B. I. Radiological findings spectrum of asymptomatic coronavirus (COVID-19) patients. Egypt. J. Radiol. Nucl. Med. 51, 0–5 (2020).
Kronbichler, A. et al. Asymptomatic patients as a source of COVID-19 infections: A systematic review and meta-analysis. Int. J. Infect. Dis. 98, 180–186 (2020).
Siddiqi, H. K. & Mehra, M. R. COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal. Journal of Heart and Lung Transplantation vol. 39 405–407 (2020).
Rosenberg, D. J. et al. External validation of the IMPROVE bleeding Risk Assessment Model in medical patients. Thromb. Haemost. 116, 530–536 (2016).
Indonesia, I. D. Rekomendasi IDI Pemberian Antikoagulan Profilaksis pada Pasien COVID-19 yang Dirawat di Rumah Sakit. (Ikatan Dokter Indonesia (IDI), 2020).
Ellinghaus, P. et al. Expression of pro-inflammatory genes in human endothelial cells: Comparison of rivaroxaban and dabigatran. Thromb. Res. 142, 44–51 (2016).
Coughlin, S. R. Thrombin signalling and protease-activated receptors. Nature 407, 258–264 (2000
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Ruang Jurnal Lantai 2, Gedung Cipto Mangunkusumo, Fakultas Kedokteran, UPN Veteran Jakarta, Indonesia.
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