Abstract
Background: Severe coronavirus disease 2019 (COVID-19) is characterized by an increased risk of thromboembolic events, with evidence of microthrombosis in the lungs of deceased patients.
Objectives: To investigate the mechanism of microthrombosis in COVID-19 progression.
Patients/methods: We assessed von Willebrand factor (VWF) antigen (VWF:Ag), VWF ristocetin-cofactor (VWF:RCo), VWF multimers, VWF propeptide (VWFpp), and ADAMTS13 activity in a cross-sectional study of 50 patients stratified according to their admission to three different intensity of care units: low (requiring high-flow nasal cannula oxygenation, n = 14), intermediate (requiring continuous positive airway pressure devices, n = 17), and high (requiring mechanical ventilation, n = 19).
Results: Median VWF:Ag, VWF:RCo, and VWFpp levels were markedly elevated in COVID-19 patients and increased with intensity of care, with VWF:Ag being 268, 386, and 476 IU/dL; VWF:RCo 216, 334, and 388 IU/dL; and VWFpp 156, 172, and 192 IU/dL in patients at low, intermediate, and high intensity of care, respectively. Conversely, the high-to-low molecular-weight VWF multimers ratios progressively decreased with increasing intensity of care, as well as median ADAMTS13 activity levels, which ranged from 82 IU/dL for patients at low intensity of care to 62 and 55 IU/dL for those at intermediate and high intensity of care.
Conclusions: We found a significant alteration of the VWF-ADAMTS13 axis in COVID-19 patients, with an elevated VWF:Ag to ADAMTS13 activity ratio that was strongly associated with disease severity. Such an imbalance enhances the hypercoagulable state of COVID-19 patients and their risk of microthrombosis.
Keywords: ADAMTS13 Protein; COVID-19; Microvasculature; Severe acute respiratory syndrome coronavirus 2; Thrombosis; von Willebrand factor.
【저자키워드】 COVID-19, severe acute respiratory syndrome coronavirus 2, thrombosis, von Willebrand factor., microvasculature, ADAMTS13 Protein, 【초록키워드】 coronavirus disease, severe acute respiratory syndrome coronavirus 2, Coronavirus disease 2019, coronavirus, thrombosis, mechanical ventilation, cross-sectional, disease severity, lung, risk, nasal, severe acute respiratory syndrome Coronavirus, Antigen, cross-sectional study, ADAMTS13, Lungs, Patient, von Willebrand factor, respiratory, Admission, Care, patients, mechanism, COVID-19 patients, Hypercoagulable state, vWF, microvasculature, Microthrombosis, Evidence, Deceased, COVID-19 patient, Oxygenation, hypercoagulable, evidence of, nasal cannula, positive airway pressure, cofactor, with intensity, intensity, COVID-19 progression, Imbalance, thromboembolic, acute respiratory syndrome, Thromboembolic events, acute respiratory syndrome coronavirus, increased risk, severe coronavirus disease, ENhance, elevated, median, characterized, ranged, stratified, propeptide, 【제목키워드】 COVID-19 patient,