Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 Patients

Autor: Mohammad Barouqa, Jesus D. Gonzalez-Lugo, Joseph M. Sweeney, Morayma Reyes Gil, Gregory J. Krause, Shafia Rahman
Rok vydání: 2021
Předmět:
ACLPS Abstracts
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_specialty
2019-20 coronavirus outbreak
Coronavirus disease 2019 (COVID-19)
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
030204 cardiovascular system & hematology
Gastroenterology
Adamts13 activity
coagulopathy
schistocytes
03 medical and health sciences
0302 clinical medicine
Antigen
Von Willebrand factor
hemic and lymphatic diseases
Internal medicine
Severity of illness
Coagulopathy
adamts13
medicine
030212 general & internal medicine
biology
business.industry
Microangiopathy
Retrospective cohort study
General Medicine
medicine.disease
ADAMTS13
Schistocyte
von willebrand factor
Coagulation
covid-19
lcsh:RC666-701
Reference values
Adamts13 gene
biology.protein
2021 ACLPS Annual Meeting Abstracts
Original Article
business
AcademicSubjects/MED00690
Zdroj: TH Open, Vol 05, Iss 01, Pp e89-e103 (2021)
TH Open: Companion Journal to Thrombosis and Haemostasis
American Journal of Clinical Pathology
ISSN: 1943-7722
0002-9173
DOI: 10.1093/ajcp/aqab189.011
Popis: Systemic inflammation and coagulopathy are characteristic hallmarks of COVID19. “COVID coagulopathy” manifests mainly as a prothrombotic state affecting both large and small blood vessels, and presenting as arterial, venous, and microangiopathic thrombotic events with von Willebrand factor (VWF) and soluble thrombomodulin increased in hospitalized patients. The causes of coagulopathy are poorly understood. Aim: To investigate the relationship between von Willebrand factor (VWF) biomarkers, intravascular hemolysis, coagulation, and organ damage in COVID19 patients and to study their association with disease severity and mortality. Methods: 181 hospitalized adult COVID19 patients were randomly selected with a balanced distribution of survivors and non-survivors during the period of March 26th 2020 to May 5th 2020. The medical records and laboratory values were reviewed. Statistical analysis was performed using R studio V.3.6.2. Results: Patients who died (n=90) had significantly lower ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity, elevated lactate dehydrogenase levels, increased schistocyte/RBC fragment counts, and elevated VWF antigen and activity levels compared to patients discharged alive (n=91). In 31 patients, we measured several of these biomarkers on two or more occasions. The trending of ADAMTS13 activity illustrated that it is not steady throughout the hospitalization course. ADAMTS13 activity levels tended to improve and/or reach normal levels in patients that survived, yet ADAMTS13 activity levels worsened in most patients that died. Likewise, the VWF antigen and activity levels tended to decrease in patients that survived whereas tended to increase well above the normal range (2-3 folds) in patients that died. D-Dimer levels trended downwards in survivors, sometimes to levels less than 1 µg/ml, yet tended to increase in patients who died. Given the relationship between ADAMTS13 activity and mortality, we wanted to determine a cut-point of initial ADAMTS13 activity (within 72 hours from admission) to predict mortality. 102 patients in our cohort had an ADAMTS13 activity measurement within this timeframe. We determined that this optimal cut-point of initial ADAMTS13 activity was 43% using Youden’s J statistic. Only 30% of patients who had an ADAMTS13 activity level of less than 43% on admission survived, yet 60% of patients survived who had an ADAMTS13 activity level of greater than 43% on admission. Conclusions: COVID-19 may present with low ADAMTS13 activity in a subset of hospitalized patients. Presence of schistocytes/RBC fragment and elevated D-dimer levels on admission may warrant a work-up for ADAMTS13 activity and VWF antigen and activity levels. These findings indicate the need for future investigation to study the relationship between endothelial and coagulation activation and the efficacy of treatments aimed at prevention and/or amelioration of microangiopathy in COVID-19.
Databáze: OpenAIRE
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