Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 Patients
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...
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| Format: | Article |
| Language: | English |
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Georg Thieme Verlag KG
2021-01-01
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| Series: | TH Open |
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| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1723784 |
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| author | Joseph M. Sweeney Mohammad Barouqa Gregory J. Krause Jesus D. Gonzalez-Lugo Shafia Rahman Morayma Reyes Gil |
| author_facet | Joseph M. Sweeney Mohammad Barouqa Gregory J. Krause Jesus D. Gonzalez-Lugo Shafia Rahman Morayma Reyes Gil |
| author_sort | Joseph M. Sweeney |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T17:41:16Z |
| format | Article |
| id | doaj.art-feaf5bece3944db8864d637c9451297b |
| institution | Directory Open Access Journal |
| issn | 2512-9465 |
| language | English |
| last_indexed | 2024-12-13T17:41:16Z |
| publishDate | 2021-01-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | TH Open |
| spelling | doaj.art-feaf5bece3944db8864d637c9451297b2022-12-21T23:36:45ZengGeorg Thieme Verlag KGTH Open2512-94652021-01-010501e89e10310.1055/s-0041-1723784Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 PatientsJoseph M. Sweeney0Mohammad Barouqa1Gregory J. Krause2Jesus D. Gonzalez-Lugo3Shafia Rahman4Morayma Reyes Gil5Department Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, United StatesDepartment of Pathology Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United StatesDepartment of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, United StatesDivision of Hematology, Department of Medical Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United StatesDivision of Hematology, Department of Medical Oncology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United StatesDepartment of Pathology Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United StatesThe 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1723784von willebrand factoradamts13covid-19schistocytescoagulopathy |
| spellingShingle | Joseph M. Sweeney Mohammad Barouqa Gregory J. Krause Jesus D. Gonzalez-Lugo Shafia Rahman Morayma Reyes Gil Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 Patients TH Open von willebrand factor adamts13 covid-19 schistocytes coagulopathy |
| title | Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 Patients |
| title_full | Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 Patients |
| title_fullStr | Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 Patients |
| title_full_unstemmed | Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 Patients |
| title_short | Low ADAMTS13 Activity Correlates with Increased Mortality in COVID-19 Patients |
| title_sort | low adamts13 activity correlates with increased mortality in covid 19 patients |
| topic | von willebrand factor adamts13 covid-19 schistocytes coagulopathy |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1723784 |
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