Thrombosis and Hemostasis Department, Hematology Service, University General Hospital in Alicante, Alicante, Spain.
Biomedical Research Institute in Alicante, Alicante, Spain.
J Thromb Thrombolysis. 2021 Aug;52(2):497-503. doi: 10.1007/s11239-021-02457-9. Epub 2021 Apr 17.
The coronavirus disease 2019 (COVID-19) increases thrombotic risk. The mechanisms that lead to this prothrombotic state are not well established. The main aim was to evaluate the von Willebrand factor (VWF) antigen and plasma ADAMTS13 activity as endothelial injury markers in COVID-19. We present a prospective study in COVID-19 patients recruited in our institution. VWF antigen, ADAMTS13 activity, D-dimer, and fibrinogen were measured during the first week once COVID-19 was diagnosed. Fifty COVID-19 inpatients [44% in the intensive care unit (ICU)] and 102 COVID-19 outpatients were enrolled. Thirty age and gender matched non-COVID-19 ward inpatients and 30 non-COVID-19 healthy individuals were recruited. The COVID-19 inpatients had higher D-dimer, fibrinogen, and VWF antigen levels and a lower ADAMTS13 activity compared with the COVID-19 outpatients (p < 0.05). ICU patients had higher D-dimer and VWF antigen levels compared with the ward patients and the lowest ADAMTS13 activity (p < 0.05). An imbalance in VWF antigen/ADAMTS13 ratio was observed in COVID-19, reaching the highest in ICU patients. In contrast to other ward non-COVID-19 inpatients, a significative reduction in ADAMTS13 activity was observed in all COVID-19 patients. There is an increase in VWF antigen and an ADAMTS13 activity reduction in COVID-19 related to disease severity and could predict poor clinical outcomes. The ADAMTS13 activity reduction could be a marker associated with COVID-19 compared to other non-critical medical conditions.
新型冠状病毒病 2019（COVID-19）增加了血栓形成的风险。导致这种血栓前状态的机制尚未完全确定。主要目的是评估血管性血友病因子（VWF）抗原和血浆 ADAMTS13 活性作为 COVID-19 的内皮损伤标志物。我们在本机构招募了 COVID-19 患者进行了一项前瞻性研究。在 COVID-19 确诊后的第一周内测量了 VWF 抗原、ADAMTS13 活性、D-二聚体和纤维蛋白原。共纳入 50 名 COVID-19 住院患者[44%在重症监护病房（ICU）]和 102 名 COVID-19 门诊患者。招募了 30 名年龄和性别匹配的非 COVID-19 住院患者和 30 名非 COVID-19 健康个体作为对照组。与 COVID-19 门诊患者相比，COVID-19 住院患者的 D-二聚体、纤维蛋白原和 VWF 抗原水平更高，ADAMTS13 活性更低（p<0.05）。与病房患者相比，ICU 患者的 D-二聚体和 VWF 抗原水平更高，ADAMTS13 活性最低（p<0.05）。在 COVID-19 中观察到 VWF 抗原/ADAMTS13 比值失衡，在 ICU 患者中达到最高。与其他非 COVID-19 病房住院患者不同，所有 COVID-19 患者的 ADAMTS13 活性均显著降低。COVID-19 患者中 VWF 抗原增加，ADAMTS13 活性降低，与疾病严重程度相关，可预测不良临床结局。与其他非危急医疗状况相比，ADAMTS13 活性降低可能是 COVID-19 的一个标志物。
