ArticleJournal of thrombosis and haemostasis : JTH2021
Platelets contribute to disease severity in COVID-19.
Article in Journal of thrombosis and haemostasis : JTH, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 137 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
137 citing papers in PubMed, 2 syntheses or guidelines pooled it, 196 citations in OpenAlex.
- A composite ranking of risk factors for COVID-19 time-to-event data from a Turkish cohort.Computational biology and chemistry · 2022Pooled it
- Are platelet volume indices of clinical use in COVID-19? A systematic review.Frontiers in cardiovascular medicine · 2022Pooled it
- Effect of P2Y12 Inhibitors on Organ Support-Free Survival in Critically Ill Patients Hospitalized for COVID-19: A Randomized Clinical Trial.JAMA network open · 2023Trial
- Trial
- Viral subversion of megakaryopoiesis: reshaping the landscapes of immune regulation.Infection · 2026Review
- Platelet-to-Lymphocyte Ratio-A Real or Fake Bridge Between Inflammation and Coagulation in COVID-19 Patients: A Scoping Review.Diagnostics (Basel, Switzerland) · 2026Review
- Sexually distinct multi-omic responses to progressive endurance exercise training in the rat lung.American journal of respiratory cell and molecular biology · 2026Article
- SARS-CoV-2 Omicron variant spike protein maintains the ability to bind and activate human platelets: Comparison with the wild-type.Scientific reports · 2026Article
- Platelet Count and Platelet Indices as Predictive Markers of COVID-19 Mortality.Physiological research · 2026Article
- Microbiome-Metabolome Crosstalk as a Driver of COVID-19 Severity.Medical sciences (Basel, Switzerland) · 2026Article
- Association of human leukocyte antigen B genotypes with COVID-19 severity in Egyptian patients.Scientific reports · 2026Article
- Review
- CXCL4 and CXCL4L1 activate human macrophage via TLR4 signaling to modulate inflammatory responses.Cell insight · 2026Article
- Hematological and biochemical markers for predicting severity in COVID-19 patients.BMC infectious diseases · 2026Observational
- Host Responses to SARS-CoV-2 with an Emphasis on Cytokines.International journal of molecular sciences · 2026Review
- Platelet-derived mediators in hospitalized COVID-19 patients and associations to respiratory failure, ICU admittance and 60-day mortality.Frontiers in cardiovascular medicine · 2026Article
- Full blood count dynamics in immunologically naïve individuals with mild COVID-19: A prospective community cohort study.PloS one · 2026Article
- Article
- P-Selectin and Platelet-Monocyte Interaction in Inflammation: Mechanisms, Hypothesis, and Open Questions.Journal of inflammation research · 2026Review
- A platelet transcriptomic signature of thromboinflammation predicts cardiovascular risk.JCI insight · 2025Article
77 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
22 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveHeightened inflammation, dysregulated immunity, and thrombotic events are characteristic of hospitalized COVID-19 patients. Given that platelets are key regulators of thrombosis, inflammation, and immunity they represent prime candidates as mediators of COVID-19-associated pathogenesis. The objective of this study was to understand the contribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the platelet phenotype via phenotypic (activation, aggregation) and transcriptomic characterization. APPROACH AND
resultsIn a cohort of 3915 hospitalized COVID-19 patients, we analyzed blood platelet indices collected at hospital admission. Following adjustment for demographics, clinical risk factors, medication, and biomarkers of inflammation and thrombosis, we find platelet count, size, and immaturity are associated with increased critical illness and all-cause mortality. Bone marrow, lung tissue, and blood from COVID-19 patients revealed the presence of SARS-CoV-2 virions in megakaryocytes and platelets. Characterization of COVID-19 platelets found them to be hyperreactive (increased aggregation, and expression of P-selectin and CD40) and to have a distinct transcriptomic profile characteristic of prothrombotic large and immature platelets. In vitro mechanistic studies highlight that the interaction of SARS-CoV-2 with megakaryocytes alters the platelet transcriptome, and its effects are distinct from the coronavirus responsible for the common cold (CoV-OC43).
conclusionsPlatelet count, size, and maturity associate with increased critical illness and all-cause mortality among hospitalized COVID-19 patients. Profiling tissues and blood from COVID-19 patients revealed that SARS-CoV-2 virions enter megakaryocytes and platelets and associate with alterations to the platelet transcriptome and activation profile.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.