Abstract
Background: Hypercoagulability is a risk factor of thromboembolic events in COVID-19. Anti-phospholipid (aPL) antibodies have been hypothesized to be involved. Typical COVID-19 dermatological manifestations of livedo reticularis and digital ischemia may resemble cutaneous manifestations of anti-phospholipid syndrome (APS).
Objectives: To investigate the association between aPL antibodies and thromboembolic events, COVID-19 severity, mortality, and cutaneous manifestations in patients with COVID-19.
Methods: aPL antibodies [anti-beta2-glycoprotein-1 (B2GP1) and anti-cardiolipin (aCL) antibodies] were titered in frozen serum samples from hospitalized COVID-19 patients and the patients’ clinical records were retrospectively analyzed.
Results: 173 patients were enrolled. aPL antibodies were detected in 34.7% of patients, anti-B2GP1 antibodies in 30.1%, and aCL antibodies in 10.4%. Double positivity was observed in 5.2% of patients. Thromboembolic events occurred in 9.8% of patients, including 11 pulmonary embolisms, 1 case of celiac tripod thrombosis, and six arterial ischemic events affecting the cerebral, celiac, splenic, or femoral-popliteal arteries or the aorta. aPL antibodies were found in 52.9% of patients with vascular events, but thromboembolic events were not correlated to aPL antibodies (adjusted OR = 1.69, p = 0.502). Ten patients (5.8%) had cutaneous signs of vasculopathy: nine livedo reticularis and one acrocyanosis. No significant association was observed between the presence of cutaneous vasculopathy and aPL antibodies ( p = 0.692).
Conclusions: Anti-phospholipid antibodies cannot be considered responsible for hypercoagulability and thrombotic events in COVID-19 patients. In COVID-19 patients, livedo reticularis and acrocyanosis do not appear to be cutaneous manifestations of APS.
Keywords: COVID-19; SARS-CoV-2; acrocyanosis; anti-phospholipid antibodies; anti-phospholipid syndrome; hypercoagulation; livedo reticularis; vasculopathy.
【저자키워드】 COVID-19, SARS-CoV-2, Anti-phospholipid antibodies, Hypercoagulation, Vasculopathy, acrocyanosis, anti-phospholipid syndrome, livedo reticularis, 【초록키워드】 Mortality, thrombosis, antibody, COVID-19 severity, risk factor, Patient, patients, hypercoagulability, COVID-19 patients, association, Ischemia, hospitalized COVID-19 patient, manifestation, cutaneous manifestation, Artery, pulmonary embolisms, Thromboembolic events, Vascular, syndrome, serum sample, Thromboembolic event, event, thrombotic event, enrolled, responsible, analyzed, occurred, involved, the patient, events, nine, adjusted, affecting, not correlated, patients with COVID-19, Typical, 【제목키워드】 antibodies, Prevalence, Retrospective study, hospitalized COVID-19 patient, thrombotic event,