Emergency Unit and Endocrinology Unit, Istituto Clinico "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy; Centre for Applied Clinical Research (Ce.R.C.A.), Istituto Clinico "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy.
Intensive Care Unit, Istituto Clinico "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy.
Nutr Metab Cardiovasc Dis. 2020 Oct 30;30(11):1914-1919. doi: 10.1016/j.numecd.2020.07.040. Epub 2020 Jul 28.
Despite anticoagulation, usually with heparin, mortality for thromboembolic events in COVID-19 remains high. Clinical efficacy of heparin is due to its interaction with antithrombin (AT) that may be decreased in COVID-19. Therefore, we correlated AT levels with outcomes of COVID-19.
We recruited 49 consecutive patients hospitalized for COVID-19. AT levels were significantly lower in 16 non-survivors than in 33 survivors (72.2 ± 23.4 versus 94.6 ± 19.5%; p = 0.0010). A multivariate Cox regression analysis showed that low AT (levels below 80%) was a predictor of mortality (HR:3.97; 95%CI:1.38 to 11.43; p = 0.0103). BMI was the only variable that showed a significant difference between patients with low and those with normal AT levels (32.9 ± 7.9 versus 27.5 ± 5.9%; p = 0.0104). AT levels were significantly lower in obese patients than in subjects with normal weight or overweight (77.9 ± 26.9 versus 91.4 ± 26.9 versus 91.4 ± 17.1%; p = 0.025). An inverse correlation between AT levels and BMI was documented (r:-0.33; p = 0.0179).
Our data first suggest that AT is strongly associated with mortality in COVID-19. In addition, AT may be the link between obesity and a poorer prognosis in patients with COVID-19. Other studies should confirm whether AT may become a prognostic marker and a therapeutic target in COVID-19.
尽管进行了抗凝治疗（通常使用肝素），COVID-19 患者的血栓栓塞事件死亡率仍然很高。肝素的临床疗效归因于其与抗凝血酶 (AT) 的相互作用，而 COVID-19 患者的 AT 可能会降低。因此，我们将 AT 水平与 COVID-19 的结果相关联。
我们招募了 49 例连续住院的 COVID-19 患者。16 例非幸存者的 AT 水平明显低于 33 例幸存者（72.2±23.4 与 94.6±19.5%；p=0.0010）。多变量 Cox 回归分析表明，低 AT（水平低于 80%）是死亡的预测因素（HR：3.97；95%CI：1.38 至 11.43；p=0.0103）。BMI 是唯一在低 AT 组和正常 AT 水平组之间显示出显著差异的变量（32.9±7.9 与 27.5±5.9%；p=0.0104）。肥胖患者的 AT 水平明显低于体重正常或超重的患者（77.9±26.9 与 91.4±26.9 与 91.4±17.1%；p=0.025）。记录到 AT 水平与 BMI 之间存在负相关（r=-0.33；p=0.0179）。
我们的数据首次表明，AT 与 COVID-19 患者的死亡率密切相关。此外，AT 可能是肥胖与 COVID-19 患者预后较差之间的联系。其他研究应证实 AT 是否可能成为 COVID-19 的预后标志物和治疗靶点。
