Protein C and S activities in COVID-19: A systematic review and meta-analysis

• Published in: Journal of thrombosis and thrombolysis 2024-08, Vol.57 (6), p.1018-1030
• Main Authors: Khoshnegah, Zahra, Siyadat, Payam, Rostami, Mehrdad, Sheikhi, Maryam, Ghorbani, Mohammad, Mansouritorghabeh, Hassan
• Format: Article
• Language: English
• Subjects: Blood Coagulation; Cardiology; COVID-19; COVID-19 - blood; Hematology; Humans; Medicine; Medicine & Public Health; Meta-analysis; Protein C; Protein C - metabolism; Protein S - analysis; Protein S - metabolism; Proteins; SARS-CoV-2; Thrombosis; Thrombosis - blood; Thrombosis - etiology
• ISSN: 1573-742X; 0929-5305; 1573-742X
• DOI: 10.1007/s11239-024-02971-6

COVID-19 has been associated with alterations in coagulation. Recent reports have shown that protein C and S activities are altered in COVID-19. This may affect the complications and outcome of the disease. However, their exact role in COVID-19 remains uncertain. The aim of the current study was therefore to analyze all papers in the literature on protein C and S activities in COVID-19. We searched three medical electronic databases. Of the 2442 papers, 28 studies were selected for the present meta-analysis. For the meta-analysis, means ± standard deviations with 95% confidence intervals (CI) for protein C and S activities were extracted. Pooled p values were calculated using STATA software. Protein C and S activities were significantly lower in COVID-19 patients than in healthy controls (pooled p values: 0.04 and 0.02, respectively). Similarly, protein C activities were considerably lower in nonsurviving patients (pooled p value = 0.00). There was no association between proteins C or S and thrombosis risk or ICU admission in COVID-19 patients ( p value > 0.05). COVID-19 patients may exhibit lower activities of the C and S proteins, which might affect disease outcome; however, additional attention should be given when considering therapeutic strategies for these patients. Graphical Abstract