Optimal diagnostic points for predicting vessel Endothelial dysfunction by protease active receptors signal among post cases of COVID-19: A Review Article

Abstract

Background: Endothelial dysfunction is emerging as one of the main contributors to the pathogenesis of thromboembolic events in COVID-19. Although the leading cause of mortality in patients with COVID-19 is hypoxic respiratory failure due to viral pneumonia and acute respiratory distress syndrome, accumulating evidence has shown that the risk of thromboembolism is substantially high in patients with severe COVID-19 and that a thromboembolic event is another major complication contributing to the high morbidity and mortality in patients with post COVID-19. Since, Protease-activated receptor type 1 (PAR1) is the main thrombin receptor and may represent an essential link between coagulation and inflammation in the pathophysiology of COVID-19, therefore, the level of Protease-activated receptors would be correlated with the standard coagulation and inflammation markers of COVID-19. Methodology: A cross-sectional study for a total of (93) patient samples, including critical, severe and post-COVID19 patient.  Samples were collected from Al-Shehid Hassan Al-Hatmy Hospital in Al-Najaf Governorate, Iraq. Serum biomarkers level were measured for the following parameter: PAR-1, thrombin and prothrombin levels were measured using ELISA technique.; D-Dimer assay was performed by sandwich chemiluminescence immunoassay; The association between biochemical markers and disease severity was evaluated. The efficiency of the predicting value was assessed using receiver operating characteristic (ROC) curve. Results: Levels of hematological parameters were varied based on severity of disease. serum PAR-1 level was quietly increased in post COVID-19 and critical cases. The serum level of thrombin was shown a massive significant increase in severe and critical cases (p <0.05) Serum PAR-1 levels was positively significant correlated to d-dimer. In critical cases, a weakly correlation was confirmed between D-dimer and PAR-1. Results of the receiver operating curve (ROC) curve and AUC analysis for the PAR-1 and Thrombin levels as possible diagnostic parameters.   Both markers were shown a good diagnostic performance for prediction critical cases of covid-19 Patients compared to severe and post cases group. PAR-1 levels: (sensitivity = 96%, specificity = 92%) at a level = 596, while thrombin levels: (sensitivity = 0.96%, specificity = 0.76%) at a level = 39.5. Conclusion: Levels of PAR-1 was statistically significant among groups of COVID-19 patients. Among the three groups of COVID-19 patients (severe, critical and post cases), D-dimer and PAR-1 levels were demonstrated a high prognosis value through the confirming results that obtained by the ROC curves for prediction of coagulopathy in post cases of Covid-19.