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COVID-19-Induced Thrombosis in Patients without Gastrointestinal Symptoms and Elevated Fecal Calprotectin: Hypothesis Regarding Mechanism of Intestinal Damage Associated with COVID-19

Sciprofile linkMauro Giuffrè, Sciprofile linkStefano Di Bella, Sciprofile linkGianluca Sambataro, Sciprofile linkVerena Zerbato, Sciprofile linkMarco Cavallaro, Sciprofile linkAlessandro Occhipinti, Sciprofile linkAndrea Palermo, Sciprofile linkAnna Crescenti, Sciprofile linkFabio Monica, Sciprofile linkRoberto Luzzati, Sciprofile linkLory Crocè
Published: 16 September 2020
 by  MDPI
Tropical Medicine and Infectious Disease , Volume 5; doi:10.3390/tropicalmed5030147

Abstract: Background: Patients with coronavirus infectious disease 2019 (COVID-19) and gastrointestinal symptoms showed increased values of fecal calprotectin (FC). Additionally, bowel abnormalities were a common finding during abdominal imaging of individuals with COVID-19 despite being asymptomatic. The current pilot study aims at evaluating FC concentrations in patients without gastrointestinal symptoms. Methods: we enrolled 25 consecutive inpatients with COVID-19 pneumonia, who were admitted without gastrointestinal symptoms and a previous history of inflammatory bowel disease. Results: At admission, 21 patients showed increased FC with median values of 116 (87.5; 243.5) mg/kg despite absent gastrointestinal symptoms. We found a strong positive correlation between FC and D-Dimer (r = 0.745, p < 0.0001). Two patients developed bowel perforation. Conclusion: our findings may change the current understanding of COVID-19 intestinal-related disease pathogenesis, shedding new light on the potential role of thrombosis and the consequent hypoxic intestinal damage.
Keywords: ischemia / thrombosis / D-dimer / Fecal Calprotectin / Bowel Perforation / COVID-19 / SARS-CoV-2

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