Effects of COVID-19 disease on PAI-1 antigen and haematological parameters during disease management: A prospective cross-sectional study in a regional Hospital in Ghana
Authors: Nkansah Charles , Owusu Michael , Appiah Samuel Kwasi , Mensah Kofi , Bani Simon Bannison , Osei-Boakye Felix , Agyemang Lawrence Duah , Ackah Ezekiel Bonwin , Abbam Gabriel , Daud Samira , Quansah Yeduah , Derigubah Charles Angnataa , Apodola Francis Atoroba , Ayangba Valentine , Afrifa David Amoah , Eshun Caleb Paul , Iddrisu Abdul-Waliu , Mintaah Selina , Twum Benjamin , Mohammed Abidatu , Agyare Eugene Mensah , Gyasi Wendy Akomeah , Agbadza Peace Esenam , Wilson Candy Adwoa Ewusiwaa , Anane Seth , Antwi Prince , Antwi Reginald Akwasi Yeboah 
Published: June 2023

Background
Individuals with COVID-19 experience thrombotic events probably due to the associated hypofibrinolysis resulting from the upregulation of plasminogen activator inhibitor-1 (PAI-1) antigen. This study evaluated plasma PAI-1 antigen levels and haematological parameters before treatment and after recovery from severe COVID-19 in Ghana.

Materials and methods
This cross-sectional study was conducted at Sunyani Regional Hospital, and recruited 51 patients who had RT-PCR-confirmed SARS-CoV-2. Participants’ sociodemographic data and clinical characteristics were taken from the hospital records. Venous blood was taken before COVID-19 treatment commenced for FBC, PAI-1 and ferritin assays. FBC was assessed using an automated haematology analyzer, whilst plasma PAI-1 Ag and serum ferritin levels were assessed with sandwich ELISA. All the tests were repeated immediately after participants recovered from COVID-19.

Results
Of the 51 participants recruited into the study, 78.4% (40) had non-severe COVID-19 whiles 21.6% (11) experienced a severe form of the disease. Severe COVID-19 participants had significantly lower haemoglobin (g/dL): 8.1 (7.3–8.4) vs 11.8 (11.0–12.5), p<0.001; RBC x 1012/L: 2.9 (2.6–3.1) vs 3.4 (3.1–4.3), p = 0.001; HCT%: 24.8 ± 2.6 vs 35.3 ± 6.7, p<0.001 and platelet x 109/L: 86.4 (62.2–91.8) vs 165.5 (115.1–210.3), p<0.001, compared with the non-severe COVID-19 group. But WBC x 109/L: 11.6 (9.9–14.2) vs 5.4 (3.7–6.6), p<0.001 and ferritin (ng/mL): 473.1 (428.3–496.0) vs 336.2 (249.9–386.5), p<0.001, were relatively higher in the participants with severe COVID-19 than the non-severe COVID-19 counterparts. Also, the severely ill SARS-CoV-2-infected participants had relatively higher plasma PAI-1 Ag levels (ng/mL): 131.1 (128.7–131.9) vs 101.3 (92.0–116.8), p<0.001, than those with the non-severe form of the disease. Participants had lower haemoglobin (g/dL): 11.4 (8.8–12.3 vs 12.4 (11.5–13.6), p<0.001; RBC x 1012/L: 3.3 (2.9–4.0) vs 4.3 (3.4–4.6), p = 0.001; absolute granulocyte count x 109/L: 2.3 ± 1.0 vs 4.6 ± 1.8, p<0.001, and platelet x 109/L: 135.0 (107.0–193.0) vs 229.0 (166.0–270.0), p<0.001 values at admission before treatment commenced, compared to when they recovered from the disease. Additionally, the median PAI-1 Ag (ng/mL): 89.6 (74.9–100.8) vs 103.1 (93.2–128.7), p<0.001 and ferritin (ng/mL): 242.2 (197.1–302.1) vs 362.3 (273.1–399.9), p<0.001 levels were reduced after a successful recovery from COVID-19 compared to the values at admission.

Conclusion
Plasma PAI-1 Ag level was higher among severe COVID-19 participants. The COVID-19-associated inflammation could affect red blood cell parameters and platelets. Successful recovery from COVID-19, with reduced inflammatory response as observed in the decline of serum ferritin levels restores the haematological parameters. Plasma levels of PAI-1 should be assessed during the management of severe COVID-19 in Ghana. This will enhance the early detection of probable thrombotic events and prompts Physicians to provide interventions to prevent thrombotic complications associated with COVID-19.