Abstract
The ongoing COVID-19 pandemic has caused significant morbidity and mortality worldwide, as well as profound effects on society. COVID-19 patients have an increased risk of thromboembolic (TE) complications, which develop despite pharmacological thromboprophylaxis. The mechanism behind COVID-19-associated coagulopathy remains unclear. Mannose-binding lectin (MBL), a pattern recognition molecule that initiates the lectin pathway of complement activation, has been suggested as a potential amplifier of blood coagulation during thromboinflammation. Here we describe data from a cohort of critically ill COVID-19 patients ( n = 65) treated at a tertiary hospital center intensive care unit (ICU). A subset of patients had strongly elevated MBL plasma levels, and activity upon ICU admission, and patients who developed symptomatic TE (14%) had significantly higher MBL levels than patients without TE. MBL was strongly correlated to plasma D-dimer levels, a marker of COVID-19 coagulopathy, but showed no relationship to degree of inflammation or other organ dysfunction. In conclusion, we have identified complement activation through the MBL pathway as a novel amplification mechanism that contributes to pathological thrombosis in critically ill COVID-19 patients. Pharmacological targeting of the MBL pathway could be a novel treatment option for thrombosis in COVID-19. Laboratory testing of MBL levels could be of value for identifying COVID-19 patients at risk for TE events.
【초록키워드】 COVID-19, Treatment, Inflammation, thrombosis, intensive care, COVID-19 pandemic, hospital, risk, Blood coagulation, complement, ICU, Laboratory testing, Coagulation, Coagulopathy, Complement activation, Pattern recognition, amplification, Cohort, Critically ill, symptomatic, Patient, ICU admission, organ dysfunction, complications, plasma, morbidity and mortality, Thromboinflammation, mechanism, lectin pathway, COVID-19 patients, marker, Thromboprophylaxis, lectin, COVID-19 patient, critically ill COVID-19 patients, Society, thromboembolic, Activation, D-dimer levels, increased risk, mannose, pharmacological, Effect, MBL pathway, pathological thrombosis, develop, caused, elevated, events, treated, contribute, suggested, correlated, significantly higher, subset, initiate, 【제목키워드】 COVID-19, thrombosis, Ill,