Inflammation/coagulopathy/fibrinolysis: Dynamic indicators of COVID-19 progression in patients with moderate COVID-19 in Wenzhou, China

Clin Immunol. 2021 Nov;232:108852. doi: 10.1016/j.clim.2021.108852. Epub 2021 Sep 11.


Background: The majority of the coronavirus disease 2019 (COVID-19) non-survivors meet the criteria for disseminated intravascular coagulation (DIC). Although timely monitoring of clotting hemorrhagic development during the natural course of COVID-19 is critical for understanding pathogenesis, diagnosis, and treatment of the disease, however, limited data are available on the dynamic processes of inflammation/coagulopathy/fibrinolysis (ICF).

Methods: We monitored the dynamic progression of ICF in patients with moderate COVID-19. Out of 694 COVID-19 inpatients from 10 hospitals in Wenzhou, China, we selected 293 adult patients without comorbidities. These patients were divided into different daily cohorts according to the COVID-19 onset-time. Furthermore, data of 223 COVID-19 patients with comorbidities and 22 critical cases were analyzed. Retrospective data were extracted from electronic medical records.

Results: The virus-induced damages to pre-hospitalization patients triggered two ICF fluctuations during the 14-day course of the disease. C-reactive protein (CRP), fibrinogen, and D-dimer levels increased and peaked at day 5 (D) 5 and D9 during the 1st and 2nd fluctuations, respectively. The ICF activities were higher during the 2nd fluctuation. Although 12-day medication returned high CRP concentrations to normal and blocked fibrinogen increase, the D-dimer levels remained high on days 17 ± 2 and 23 ± 2 days of the COVID-19 course. Notably, although the oxygenation index, prothrombin time and activated partial thromboplastin time were within the normal range in critical COVID-19 patients at administration, 86% of these patients had a D-dimer level > 500 μg/L.

Conclusion: COVID-19 is linked with chronic DIC, which could be responsible for the progression of the disease. Understanding and monitoring ICF progression during COVID-19 can help clinicians in identifying the stage of the disease quickly and accurately and administering suitable treatment.

Keywords: C-reactive protein; Coagulopathy; Coronavirus disease 2019; D-dimer; Fibrinolysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anticoagulants / pharmacology
  • Blood Coagulation / drug effects
  • Blood Coagulation / physiology*
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Disorders / metabolism
  • Blood Coagulation Disorders / pathology
  • Blood Coagulation Disorders / virology
  • COVID-19 / complications*
  • COVID-19 / metabolism
  • COVID-19 / pathology
  • China
  • Disease Progression
  • Disseminated Intravascular Coagulation / etiology
  • Disseminated Intravascular Coagulation / metabolism
  • Disseminated Intravascular Coagulation / pathology
  • Disseminated Intravascular Coagulation / virology
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Fibrinogen / metabolism
  • Fibrinolysis / physiology*
  • Hemorrhage / etiology
  • Hemorrhage / pathology
  • Hemorrhage / virology
  • Humans
  • Inflammation / etiology*
  • Inflammation / pathology
  • Inflammation / virology*
  • Male
  • Middle Aged
  • Prothrombin Time
  • SARS-CoV-2 / pathogenicity


  • Anticoagulants
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Fibrinogen