The purpose of the study was to determine the features of thrombosis (D-dimer) and inflammation (procalcitonin) in patients with COVID-19 with acute respiratory syndrome in combination with essential hypertension and to determine their role as markers of severity and prognosis of comorbid pathology. Materials and methods. A retrospective study of the medical records of 232 patients with confirmed COVID-19 disease with acute respiratory syndrome was performed. Patients were divided into two groups: with comorbid essential hypertension (main group) and without essential hypertension (comparison group), which amounted to 149 and 83 persons, respectively. The information obtained from the medical records included demographic data, symptoms and course of the disease, complications, instrumental and laboratory results (including peripheral blood platelet count, international normalized ratio, D-dimer and procalcitonin levels), and data of patients’ treatment. Results. According to the results of the study, the number of patients hospitalized in the intensive care unit with respiratory viral disease COVID-19 and comorbid hypertension, both in absolute and relative terms, was significantly higher (p = 0.005). The number of patients in this group who required non-invasive lung ventilation was also significantly higher (39% versus 17%), indicating a more severe and rapid course of the disease. In terms of hospitalization, both groups of patients had no significant differences, but the mortality rate in the group with comorbid essential hypertension was significantly higher (p = 0.005). In our study, level of D-dimer in patients of both study groups exceeded the reference values, but it was significantly higher in patients of the main group, compared with patients in the comparison group (p = 0.005). According to the platelet counts and international normalized ratio in patients of both groups no significant differences were found (p = 0.10 and p = 0.32, respectively), there was only a slight increase in peripheral blood leukocytes at the time of hospitalization in patients of the main group (p = 0.083). In addition, in patients with combined pathology, the mortality rate was higher and, at the same time, it was in these patients that direct correlations of strong density were found between D-dimer and procalcitonin with mortality (r = 0.77, and r = 0.72, respectively, p = 0.001 and p = 0.003). Conclusion. In patients with COVID-19 with acute respiratory syndrome, there is a significant increase in markers of thrombosis (D-dimer) and inflammatory activity (procalcitonin), while the severity of their changes is significantly greater in patients with comorbid essential hypertension. Patients with COVID-19 with acute respiratory syndrome in combination with essential hypertension have a more severe course of the disease and a significantly higher mortality rate, which is associated with a tendency to develop thrombocytopenia and is associated with changes in markers of thrombosis and inflammation. Determination of D-dimer and procalcitonin levels are reliable markers for both severity and prognosis in patients with COVID-19 with severe acute respiratory syndrome, and especially in conditions of comorbidity with essential hypertension, which may have a significant impact on strategy selection and tactics of treatment of such patients

Keywords: COVID-19, essential hypertension, coagulopathy, D-dimer, procalcitonin

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1. WHO. Coronavirus disease (COVID-19) pandemic. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
2. Wang H, Paulson KR, Pease SA, Watson S, Comfort H, Zheng P, et al. COVID-19 Excess Mortality Collaborators. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21. Lancet. 2022 Apr 16;399(10334):1513-1536. PMID: 35279232. PMCID: PMC8912932. https://doi.org/10.1016/S0140-6736(21)02796-3
3. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
4. Zhang JJ, Dong X, Liu GH, Gao YD. Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clin Rev Allergy Immunol. 2022 Jan 19;1-18. (2022). PMID: 35044620. PMCID: PMC8767775. https://doi.org/10.1007/s12016-022-08921-5
5. Ivanytska TA, Kazakov YuM, Fam TA, Petrov YeYe. Peculiarities of Changes in Some Indicators of Hospitalization, Hemostasis and Procalcitonin in Patients with COVID-19 in the Presence of Diabetes Mellitus. JMBS. 2022;7(1):98-103 https://doi.org/10.26693/jmbs07.01.098
6. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur Respir J. 2020 May 14;55(5):2000547. PMID: 32217650. PMCID: PMC7098485. https://doi.org/10.1183/13993003.00547-2020
7. Abayomi A, Osibogun A, Kanma-Okafor O, Idris J, Bowale A, Wright O, et al. Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study. Glob Health Res Policy. 2021 Jul 29;6(1):26. PMID: 34325747. PMCID: PMC8319704. https://doi.org/10.1186/s41256-021-00210-6
8. Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020 May;109(5):531-538. PMID: 32161990. PMCID: PMC7087935. https://doi.org/10.1007/s00392-020-01626-9
9. Xia F, Zhang M, Cui B, An W, Chen M, Yang P, et al. COVID-19 patients with hypertension are at potential risk of worsened organ injury. Sci Rep. 2021 Feb 12;11(1):3779. PMID: 33580165. PMCID: PMC7881102. https://doi.org/10.1038/s41598-021-83295-w
10. Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensive Care. 2020 Jul 10;8:49. PMID: 32665858. PMCID: PMC7348129. https://doi.org/10.1186/s40560-020-00466-z
11. Hashem MK, Khedr EM, Daef E, Mohamed-Hussein A, Mostafa EF, Hassany SM, et al. Prognostic biomarkers in COVID-19 infection: value of anemia, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and D-dimer. Egypt J Bronchol. 2021;15(1):29. PMCID: PMC8139548. https://doi.org/10.1186/s43168-021-00075-w
12. Delshad M, Safaroghli-Azar A, Pourbagheri-Sigaroodi A, Poopak B, Shokouhi S, Bashash D, et al. Platelets in the perspective of COVID-19; pathophysiology of thrombocytopenia and its implication as prognostic and therapeutic opportunity. Int Immunopharmacol. 2021 Oct;99:107995. PMID: 34304001. PMCID: PMC8295197. https://doi.org/10.1016/j.intimp.2021.107995
13. Comer SP, Cullivan S, Szklanna PB, Weiss L, Cullen S, Kelliher S, et al. COVID-19 induces a hyperactive phenotype in circulating platelets. PLoS Biol. 2021;19(2):e3001109. PMID: 33596198. PMCID: PMC7920383. https://doi.org/10.1371/journal.pbio.3001109
14. Wool GD, Miller JL. The Impact of COVID-19 Disease on Platelets and Coagulation. Pathobiology. 2021;88(1):15-27. PMID: 33049751. PMCID: PMC7649697. https://doi.org/10.1159/000512007
15. Ming DK, Myall AC, Hernandez B, Weiße AY, Peach RL, Barahona M, et al. Informing antimicrobial management in the context of COVID-19: understanding the longitudinal dynamics of C-reactive protein and procalcitonin. BMC Infect Dis. 2021 Sep 08;21(1):932. PMID: 34496795. PMCID: PMC8424157. https://doi.org/10.1186/s12879-021-06621-7
16. Shibata S, Arima H, Asayama K, Hoshide S, Ichihara A, Ishimitsu T, et al. Hypertension and related diseases in the era of COVID-19: a report from the Japanese Society of Hypertension Task Force on COVID-19. Hypertens Res. 2020 Oct;43(10):1028-1046. PMID: 32737423. PMCID: PMC7393334. https://doi.org/10.1038/s41440-020-0515-0
17. Nakaz MOZ Ukrainy № 358 vid 22.02.2021. Pro vnesennya zmin do protokolu «Nadannya medychnoi dopomohy dlya likuvannya koronavirusnoi khvoroby (COVID-19)» [On Amendments to the Protocol "Provision of Medical Care for the Treatment of Coronavirus Disease (COVID-19)"]. [Ukrainian]. Available from: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-22022022--358-pro-vnesennja-zmin-do-protokolu--nadannja-medichnoi-dopomogi-dlja-likuvannja--koronavirusnoi-hvorobi-covid-19
18. Nakaz MOZ Ukrainy № 1979 vid 20.09.2021. Pro vnesennya zmin do protokolu «Nadannya medychnoi dopomohy dlya likuvannya koronavirusnoi khvoroby (COVID-19)» [On Amendments to the Protocol "Provision of Medical Care for the Treatment of Coronavirus Disease (COVID-19)"]. [Ukrainian]. Available from: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-20092021--1979-pro-vnesennja-zmin-do-protokolu--nadannja-medichnoi-dopomogi-dlja-likuvannja--koronavirusnoi-hvorobi-covid-19
19. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020 Jun;75(6):1334-1357. PMID: 32370572. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
20. McGonagle D, O'Donnell JS, Sharif K, Emery P, Bridgewood C. Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia. Lancet Rheumatol. 2020 Jul;2(7):e437-45. https://doi.org/10.1016/S2665-9913(20)30121-1
21. Mitchell WB. Thromboinflammation in COVID-19 acute lung injury. Paediatr Respir Rev. 2020;35:20-4. PMID: 32653469. PMCID: PMC7289106. https://doi.org/10.1016/j.prrv.2020.06.004
22. Andina T, Tampubolon D. Comparation of d-dimer levels in hypertensive and non-hypertensive adult covid-19 patients. J Hypertension. 2021 May;39:e14 https://doi.org/10.1097/01.hjh.0000752564.68879.af
23. Escher R, Breakey N, Lammle B. Severe COVID-19 infection associated with endothelial activation. Thromb Res. 2020;190:62. PMID: 32305740. PMCID: PMC7156948. https://doi.org/10.1016/j.thromres.2020.04.014
24. Burmak YuG, Petrov YeYe, Kazakov YuM. The peculiarities of the changes of some cardiohemodynamic and microcirculatory indices in conditions of the comorbid course of essential hypertension. New Armenian Med J. 2020;14(2):20-28.
25. Trybrat TA, Kazakov YuM, Honcharova OO, Shut SV, Sakevych VD. Perebih hostroi respiratornoi khvoroby COVID-19 uskladnenoi nehospitalnoyu pnevmoniyeyu na tli patolohiyi sertsevo-sudynnoyu systemy [The course of acute respiratory disease COVID-19 complicated by community-acquired pneumonia on the background of pathology of the cardiovascular system]. Problemy ekolohiyi i medytsyny . 2021;25(3-4):14-17. [Ukrainian]. https://doi.org/10.31718/mep.2021.25.3-4.03