Hamostaseologie 2021; 41(S 01): S24-S25
DOI: 10.1055/s-0041-1728127
Oral Communication
COVID-19

Prothrombotic alterations of von Willebrand factor level and ADAMTS13 activity in hospitalized COVID-19 patients

G Sinkovits
1   Department of Internal Medicine and Hematology, Semmelweis University, Budapest
,
B Mező
1   Department of Internal Medicine and Hematology, Semmelweis University, Budapest
2   Office for Supported Research Groups, Research Group for Immunology and Hematology, Semmelweis University - Eötvös Loránd Research Network, Budapest
,
M Réti
3   Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest - Institute of Hematology and Infectious Diseases, Budapest
,
V Müller
4   Department of Pulmonology, Semmelweis University, Budapest
,
Z Iványi
5   Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest
,
J Gál
5   Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest
,
L Gopcsa
3   Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest - Institute of Hematology and Infectious Diseases, Budapest
,
P Reményi
3   Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest - Institute of Hematology and Infectious Diseases, Budapest
,
B Szathmáry
6   Department of Infectology, Central Hospital of Southern Pest - Institute of Hematology and Infectious Diseases, Budapest
,
B Lakatos
6   Department of Infectology, Central Hospital of Southern Pest - Institute of Hematology and Infectious Diseases, Budapest
,
J Szlávik
6   Department of Infectology, Central Hospital of Southern Pest - Institute of Hematology and Infectious Diseases, Budapest
,
I Bobek
7   Department of Anaesthesiology and Intensive Therapy, Central Hospital of Southern Pest - Institute of Hematology and Infectious Diseases, Budapest
,
ZZ Prohászka
1   Department of Internal Medicine and Hematology, Semmelweis University, Budapest
,
Z Förhécz
1   Department of Internal Medicine and Hematology, Semmelweis University, Budapest
,
D Csuka
1   Department of Internal Medicine and Hematology, Semmelweis University, Budapest
,
L Hurler
1   Department of Internal Medicine and Hematology, Semmelweis University, Budapest
,
E Kajdácsi
1   Department of Internal Medicine and Hematology, Semmelweis University, Budapest
,
L Cervenak
1   Department of Internal Medicine and Hematology, Semmelweis University, Budapest
,
P Kiszel
2   Office for Supported Research Groups, Research Group for Immunology and Hematology, Semmelweis University - Eötvös Loránd Research Network, Budapest
,
T Masszi
1   Department of Internal Medicine and Hematology, Semmelweis University, Budapest
,
I Vályi-Nagy
3   Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest - Institute of Hematology and Infectious Diseases, Budapest
› Author Affiliations
› Further Information
Also available at
 

Objective Based on our current knowledge, the severity of the COVID-19 disease is associated with the dysregulation of inflammation and haemostasis. Endothelial cells play a central role in regulating both processes.

Our aim was to determine the VWF antigen (Ag) level, the ADAMTS13 activity (Ac) and their ratio in samples of COVID-19 patients, and to analyze their associations with disease severity, thromboembolic complications and laboratory parameters associated with COVID-19 severity.

Material and Methods Between 20th of April and 2nd of June 2020, 128 PCR-positive COVID-19 patients were included in our observational clinical study. Patients were stratified according to the severity at the time of sampling. The following groups were defined: (1) outpatient (n = 26), (2) hospitalized, not requiring oxygen support (n = 31), (3) hospitalized, receiving oxygen therapy (n = 36), (4) critical, requiring intensive care (n = 35). VWF:Ag level was determined by ELISA; ADAMTS13:Ac was determined by a FRET assay. Non-parametric statistical tests were used for statistical analysis.

Results VWF:Ag levels were significantly elevated in all groups of hospitalized patients (median values: 196 %, 270 % and 383 % in groups 2, 3 and 4, respectively). ADAMTS13:Ac was decreased in patients requiring oxygen support or intensive therapy (median 75 % and 50 % in groups 3 and 4, respectively). Consequently, the VWF:Ag/ADAMTS13:Ac ratio was increased in all hospitalized patients, the rate of increase correlated with disease severity (median 1.97, 3.71 and 10.73 in groups 2, 3 and 4, respectively). The VWF:Ag level and VWF:Ag/ADAMTS13:Ac ratio were higher in patients with thromboembolic complications (median 390 % vs. 213 % and 6.0 vs. 2.3, respectively). We found a number of significant correlations between the above parameters and those related to the pathophysiology or severity of the COVID-19 disease: CRP, PCT, IL-6, neutrophil/lymphocyte ratio, RDW, D-dimer and markers of complement activation.

Conclusion Our results show that VWF:Ag, ADAMTS13:Ac and their ratio correlate strongly with disease severity and are associated with an increased risk of thromboembolic complications. Moreover, they are associated with several markers of inflammation, coagulation and complement activation, which may indicate a potential key role of endothelial cells in the pathogenesis of immunothrombosis in COVID-19.



Publication History

Article published online:
18 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany