Over time relationship between platelet reactivity, myocardial injury and mortality in patients with SARS-CoV-2-associated respiratory failure

Platelets. 2021 May 19;32(4):560-567. doi: 10.1080/09537104.2020.1852543. Epub 2020 Dec 3.


The aim of this study (NCT04343053) is to investigate the relationship between platelet activation, myocardial injury, and mortality in patients affected by Coronavirus disease 2019 (COVID-19). Fifty-four patients with respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were enrolled as cases. Eleven patients with the same clinical presentation, but negative for SARS-CoV-2 infection, were included as controls. Blood samples were collected at three different time points (inclusion [T1], after 7 ± 2 days [T2] and 14 ± 2 days [T3]). Platelet aggregation by light transmittance aggregometry and the circulating levels of soluble CD40 ligand (sCD40L) and P-selectin were measured. Platelet biomarkers did not differ between cases and controls, except for sCD40L which was higher in COVID-19 patients (p = .003). In COVID-19 patients, P-selectin and sCD40L levels decreased from T1 to T3 and were higher in cases requiring admission to intensive care unit (p = .004 and p = .008, respectively). Patients with myocardial injury (37%), as well as those who died (30%), had higher values of all biomarkers of platelet activation (p < .05 for all). Myocardial injury was an independent predictor of mortality. In COVID-19 patients admitted to hospital for respiratory failure, heightened platelet activation is associated with severity of illness, myocardial injury, and mortality.ClinicalTrials.gov number: NCT04343053.

Keywords: COVID-19; P-selectin; myocardial injury; platelet aggregation; soluble CD40 ligand.

Publication types

  • Clinical Trial
  • Video-Audio Media

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Platelets / metabolism*
  • CD40 Ligand / blood
  • COVID-19* / blood
  • COVID-19* / mortality
  • COVID-19* / pathology
  • Female
  • Heart Injuries* / blood
  • Heart Injuries* / mortality
  • Heart Injuries* / pathology
  • Heart Injuries* / virology
  • Humans
  • Male
  • Middle Aged
  • Myocardium* / metabolism
  • Myocardium* / pathology
  • P-Selectin / blood
  • Platelet Aggregation
  • Respiratory Insufficiency* / blood
  • Respiratory Insufficiency* / mortality
  • Respiratory Insufficiency* / pathology
  • Respiratory Insufficiency* / virology
  • SARS-CoV-2 / metabolism*


  • Biomarkers
  • P-Selectin
  • SELP protein, human
  • CD40 Ligand

Associated data

  • ClinicalTrials.gov/NCT04343053

Grant support

The study was an investigator-driven clinical trial conducted by the University of Ferrara.