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

Abstract The causes of coagulopathy associated with coronavirus disease 2019 (COVID-19) are poorly understood. We aimed to investigate the relationship between von Willebrand factor (VWF) biomarkers, intravascular hemolysis, coagulation, and organ damage in COVID-19 patients and study their associat...

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Bibliographic Details
Published in:TH open : companion journal to thrombosis and haemostasis 2021-01, Vol.5 (1), p.e89-e103
Main Authors: Sweeney, Joseph M., Barouqa, Mohammad, Krause, Gregory J., Gonzalez-Lugo, Jesus D., Rahman, Shafia, Gil, Morayma Reyes
Format: Article
Language:English
Subjects:
adamts13
coagulopathy
covid-19
Original
Original Article
schistocytes
von willebrand factor
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Summary:Abstract The causes of coagulopathy associated with coronavirus disease 2019 (COVID-19) are poorly understood. We aimed to investigate the relationship between von Willebrand factor (VWF) biomarkers, intravascular hemolysis, coagulation, and organ damage in COVID-19 patients and study their association with disease severity and mortality. We conducted a retrospective study of 181 hospitalized COVID-19 patients randomly selected with balanced distribution of survivors and nonsurvivors. Patients who died had significantly lower ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity, significantly elevated lactate dehydrogenase levels, significantly increased shistocyte/RBC fragment counts, and significantly elevated VWF antigen and activity levels compared with patients discharged alive. These biomarkers correlate with markedly elevated D-dimers. Additionally, 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. In conclusion, COVID-19 may present with low ADAMTS13 activity in a subset of hospitalized patients. Presence of schistocytes/RBC fragment and elevated D-dimer 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.
ISSN:2512-9465
2567-3459
2512-9465
DOI:10.1055/s-0041-1723784